Alzeihmer’s Disease will be encountered more frequently in future thanks to the increasing life expectancy .In India  majority of the rural  settings have no access to specialized medical treatment. Where there is no access to Imaging & other neurological settings won’t clinical diagnosis  and  early intervention help the primary care takers & clinicians  to monitor these Senior citizens?

       Team@CMHF

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

The guidelines published today were “extensively revised” from those presented last summer, Creighton H. Phelps, director of the Alzheimer’s Disease Centers Program at NIA, told reporters during a press teleconference

“Special attention” is paid in the new document to how biomarkers may be used to add levels of confidence to clinical findings in MCI and AD, primarily in the research setting,

In fact, the take on biomarkers appears to be one of the biggest changes from last summer’s presentation. The working groups had developed these documents in isolation from each other and had come to somewhat divergent positions on the use of biomarkers, such as advanced imaging and cerebrospinal fluid (CSF) markers of disease. The working group on MCI had urged their inclusion at least in the research setting, for example, whereas the AD working group had not addressed the use of biomarkers at all.

“Another thing that we tried to do in revision of these documents after last summer was to make it a little clearer what was there for clinical use now vs what is a research agenda for the future,” Dr. Phelps told Medscape Medical News. “I think that’s come out in discussion fairly well today, but that was a little murky last summer

Study Highlights

• In dementia due to AD, cognitive and behavioral symptoms hinder the patient’s ability to function in daily life.
• The diagnosis of AD is still primarily a clinical diagnosis, with the physician determining whether or not dementia has occurred or is occurring, based on information from the family and even the patient.
• As in the original AD criteria, it is essential to exclude other causes of dementia and to document progressive deterioration with time.
• Memory impairment may not always be the most prominent or presenting feature of AD. Impairments in word-finding, vision/spatial issues, reasoning, judgment, and/or problem solving may be the initial or most troublesome symptoms.
• The diagnostic criteria are intended to be useful to general healthcare providers without access to imaging, CSF measures, or neuropsychological testing, as well as to specialized investigators in clinical trial settings.
• Diagnostic criteria for probable and possible AD include biomarker evidence, at least for research settings.
• The diagnostic criteria for MCI are not much changed for the purposes of clinical practice and are meant to be used by physicians in any setting.
• In MCI due to AD, there are mild, but noticeable and quantifiable, changes in memory and cognitive function. However, these are insufficient to cause impairments in activities of daily living.
• Recognition of the mild impairment in MCI due to AD is gradually increasing and improving in medical and specialty practice.
• A substantial percentage of, but not all, patients with MCI due to AD ultimately go on to have dementia due to AD.
• Additional research is needed to help identify those individuals with MCI who will deteriorate to the category of dementia due to AD.
• Biomarkers may be useful in this regard, but they are currently included only in the research setting.
• The MCI working group developed 2 sets of criteria: “core clinical criteria,” intended for clinicians without availability of advanced imaging or CSF analysis; and research criteria, including biomarkers intended for use in clinical trials and other research settings.
• 4 clinical criteria for MCI due to AD include the following:
1. Concern regarding a change in cognition: The earlier criteria required that the patient had to report this concern and that an informant had to corroborate it, whereas the new criteria require that the concern can be expressed by the patient, an informant, or a skilled clinician.
2. Impairment in 1 or more cognitive domains, with test scores lower than expected for the patient’s age and education, and with worsening on subsequent testing, if available: Episodic memory impairment is most common in patients with MCI who progress to AD, but initial impairments in MCI may involve executive function, language, attention, or visuospatial skills.
3. Maintained independence in functional abilities: Patients with MCI should retain functional independence with minimal assistance, although they may take longer, be less efficient, and make more errors in tasks such as paying bills and cooking.
4. Not demented: In MCI, cognitive changes should be mild enough that there is no evidence of social or occupational impairment.

Clinical Implications

• In dementia due to AD, cognitive and behavioral symptoms hinder the patient’s ability to function in daily life. The diagnosis of AD is still primarily a clinical diagnosis, made after other causes of dementia have been excluded and deterioration over time has been documented.
• The diagnostic criteria for MCI are not much changed for the purposes of clinical practice and are meant to be used by physicians in any setting. In MCI due to AD, there are mild, but noticeable and quantifiable, changes in memory and cognitive function that are insufficient to cause impairments in activities of daily living.

Ref:  http://www.medscape.org/viewarticle/741690?src=cmemp