Reasons for the Early Identification of AD and MCIThe earlier the treatment, the longer the delay of symptom progression from MCI and the less overall financial cost. (RS Doody et al Archives of Neurology, 58: 427-433, 2001) Earlier* References:
Many studies have focused upon treatment of those cognitive ability changes known as Mild Cognitive Impairment (MCI), which are most predictive of Alzheimer's. The CANS-MCI detects those changes in primary care facilities so that patients have a better chance of being responsive to early MCI treatment. Impairments that are milder than AD are predictive of AD years before a diagnosis. This became evident to many scientists around 1998: Mild and even moderate AD is underdiagnosed in primary
care.
This became evident to many scientists around 1997: Early*
References: Early Alzheimer's diagnosis
can delay disease progression and hepl reduce costs, complications. Healthc
Demand Dis Manag. 3:71-75, 1997. DR Gifford & JL Cummings Neurology,
52: 224-227, 1999. MCI
Family members often have inhibitions that keep them
from bringing loved ones with dementia to a primary care physician. Sometimes
people with dementia or MCI resist any effort to have their mental abilities
evaluated. The result is that Mild Cognitive Impairment (MCI) and even
AD is sometimes not diagnosed until long after the initial onset. Even
physician recognition of early dementia symptoms in primary care is sometimes
poor because they do not use validated methods for testing mental status.
The distinction between Mild Cognitive Impairment (MCI or even early AD)
and normal cognitive changes associated with aging can be difficult for
primary care physicians to make unless they are trained to use psychometrics.
Although there are not good data concerning avoidance by primary care
physicians, we have heard a number of people say that their spouses were
not examined for the possibility of AD and, instead, were told, "Oh,
you're doing okay". In the absence of treatments that would reverse
the dementia, many primary care physicians might not feel comfortable
dealing with the issue. People with very high intelligence may also be
able to compensate for (or just mask) the symptoms when examined by their
primary care doctors. On the other hand, there are good
data to indicate that spouses are excellent judges of the changes
associated with Mild Cognitive Impairment (MCI) and the first signs of
AD.
Early* References: Not only does the delay in diagnosis miss an opportunity
for treatment, but, because the disorder involves memory loss, the delay
increases the chances of other problems, multiplying the demands placed
upon caretakers. For example, people with cognitive impairments have trouble
following prescribed treatment for their hypertension, infections, psychiatric
problems, or diabetes unless helped.
Early* Reference: If a way could be found to delay the onset of Alzheimer's
disease for an average of just two years, between now and 2050, the number
of affected individual would decline by 1.9 million. Researchers
at Johns Hopkins used U.S. Census and mortality data to project the prevalence
of Alzheimer's off into the future. In 1997, an estimated 2.3 million
Americans had the disease, with about 360,000 new cases diagnosed each
year. By 2050, the rate of Alzheimer's is expected to almost quadruple,
with the disease afflicting some 8.6 million Americans, one person in
45, with 1.1 million diagnoses each year. But if the disease could be
delayed even as briefly as for two years, through such interventions as
statins, anti-inflammatory drugs, Aricept, Excelon, or other drugs, 1.9
million cases could be prevented by 2050, saving the country more than
$10 billion in cost of care. The authors conclude that even without a
major treatment breakthrough, small, incremental progress could make a
real difference.
Reference: *Following the more recent work of early reference authors
is often a useful way to stay abreast of the most up to date material
on a specific topic. |
| Screening in primary care for MCI |