Mayo Clinic study identifies earliest stages of Alzheimer’s disease
Addressing the earliest stages of Alzheimer’s disease, before a patient shows outward signs of cognitive problems, has sometimes been a challenge for physicians and researchers, in part because they have not been using common and specific terms to describe the disease’s initial phases. A Mayo Clinic study recommends adding categories to more effectively identify and treat people and give researchers standard definitions to work with. The study is published in this month’s issue of the Annals of Neurology.
The researchers assessed new guidelines for preclinical Alzheimer’s disease (AD) that were recently published by a working group formed by the National Institute on Aging and the Alzheimer’s Association (NIA-AA). The group’s work marked the first attempt to define criteria for Alzheimer’s preclinical phase, which is increasingly recognized as a long latent stage of the disease in which Alzheimer’s pathology and biomarkers of that pathology become abnormal, while subjects remain clinically asymptomatic. The guidelines represented a significant step forward because evidence increasingly suggests this early phase is the best time to treat the disease.
The Mayo researchers concluded, however, that the three stages defined by the workgroup are not sufficient to describe all cognitively normal elderly patients. They recommend adding two more groups.
“The important guidelines developed by the NIA-AA workgroup were a vital step in clarifying the progression of this devastating disease and aiding in earlier diagnosis,” says lead author Clifford R. Jack, Jr., M.D., a Mayo Clinic neurologist and the Alexander Family Professor of Alzheimer’s Disease Research. “Our study builds on that work by recommending two additional sub-groups that merit attention.”
In addition to stages 1, 2 and 3 identified by the NIA-AA workgroup, the authors suggest two additional categories
* Stage 0- Patients with normal biomarkers and no evidence of cognitive impairment. An estimated 43 percent of all cognitively normal elderly people would be classified as Stage 0.
* SNAP patients- Those with “suspected non-AD pathophysiology.” Such patients have normal brain amyloid imaging studies, but abnormal neurodegeneration biomarkers. An estimated 23 percent of cognitively normal elderly patients would fall into the SNAP category.
What Are the Signs of Alzheimer’s Disease?
The classic sign of early Alzheimer’s disease is gradual loss of short-term memory. Other signs include-
* Problems finding or speaking the right word.
* Inability to recognize objects.
* Forgetting how to use simple, ordinary things, such as a pencil.
* Forgetting to turn off the stove, close windows, or lock doors.
Mood and personality changes also may occur. Agitation, problems with memory, and poor judgment may cause unusual behavior. These symptoms vary from one person to the next.
Symptoms appear gradually in persons with Alzheimer’s disease but may progress more slowly in some persons than in others. In other forms of dementia, symptoms may appear suddenly or may come and go.
If you have some of these signs, this does not mean you have Alzheimer’s disease. Anyone can have a lapse of memory or show poor judgment now and then. When such lapses become frequent or dangerous, however, you should tell your doctor about them immediately.
“Without the additional categories we recommend, more than half of all preclinical AD patients would be ‘forced’ into a category that was not descriptive of their current state,” says co-author Ronald C. Petersen, M.D., Ph.D., a neurologist and the Cora Kanow Professor of Alzheimer’s Disease Research at Mayo Clinic. “By more clearly defining the stages of preclinical Alzheimer’s disease and categories of elderly subjects who should not be classified as preclinical AD, we can improve its diagnosis and help in the management of this devastating disease.”
Overview of Early Stage Alzheimer’s Disease
A diagnosis of Alzheimer’s disease for yourself or a loved one can be difficult to accept. As you read through this fact sheet, we encourage you to keep an open mind and remember that you are not alone. Organizations that provide assistance and support to people with AD and their families are located in communities all across the nation. You’ll find contact information for service organizations at the end this Fact Sheet under Community Resources.
Facts
Alzheimer’s disease (AD) is a slowly progressing disease that results in the loss of nerve cells in the brain, eventually leading to impairment in memory, judgment and decision-making, orientation to physical surroundings, concentration and language. Though the loss of nerve cells is irreversible, medications are available that may slow the disease’s progress.
AD can affect your ability to perform day-to-day tasks and can lead to changes in behavior and mood. While symptoms often interfere with social, family and work activities, many AD patients and caregivers have learned a variety of strategies that have helped them maintain an active and productive life. This Fact Sheet offers information about this medical condition as well as practical tips for coping with its effects.
Stages
AD affects people in different ways. The progress of the disease and its symptoms may differ from person to person. However, the general course of the disease is often divided into stages (early, middle and late) based upon memory, thinking, and your ability to care for yourself. Long-term memory (e.g., events from childhood and early adulthood) is not affected in the early stages of AD.
Early Diagnosis and Intervention
Although scientists have not found a cure for AD, certain important actions and resources can be helpful to you and your family. The first step is to get a full medical examination to rule out potentially reversible causes of memory loss (e.g., depression, reaction to medication, etc.). In addition, early diagnosis and intervention allow you to-
* Improve your understanding - and the understanding of those around you—about the changes that are taking place.
* Increase your knowledge of AD.
* Access community resources that help AD patients and caregivers.
* Take advantage of medications. Several prescription drugs may delay, for a time, the worsening of symptoms in people with AD.
* Make plans for the future (e.g., financial and health care planning).
* Increase your awareness of local and national research projects and clinical trials of new medications.
* Increase your awareness of safety issues and health.
According to the Alzheimer’s Association, more than 5.4 million Americans have the disease, and its incidence is on the rise; one American develops the disease every 69 seconds. Alzheimer’s destroys brain cells, causing memory, thinking and behavioral problems severe enough to affect work, family and social relationships. Eventually, it affects the most basic activities of daily living, is incurable and, ultimately, is fatal. Alzheimer’s is the sixth-leading cause of death in the United States, and the fifth-leading cause for people 65 and older, association statistics show.
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Mayo Clinic