Alzheimer's group urges more focus on early detection

Improved treatments make it possible to slow the disease's progression.

By Victoria Stagg Elliott — Posted Aug. 15, 2005

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The emergence of a handful of drugs that can slow but not undo the mental deterioration that characterizes Alzheimer's has increased the need to diagnose it at an early stage. The result: More people are being diagnosed at a point in which these drugs can be most effective.

At the same time, experts are struggling to meet the needs of those who are diagnosed when they still have significant functioning, said several presenters at the Alzheimer's Assn. annual dementia care conference held in Chicago last month. For example, for the first time, the meeting featured a track on early-stage issues.

"There's no doubt that there's more recognition by physicians, but the programs and services are not there," said association Senior Vice President Kathleen O'Brien.

Experts said Alzheimer's interventions need to be individualized to suit the patient's disease stage and empower him or her to take a more active role in coping with the condition and preventing its progression.

Treatment strategies also should take into account the fact that those in the early stages could be far more active in their own care. Many widely used interventions are more geared to patients at later stages and speak more to the caregiver than the patient.

"We really need to be thinking how we can tailor our education and support to the early-stage patients who may still have a lot of skills. They need to be enticed to be involved in coping with this disease," said J. Scott Roberts, PhD, who spoke on the research and practice issues associated with early-stage patients. He is a clinical psychologist at the Boston University School of Medicine's Alzheimer's Disease Center.

But while Alzheimer experts are paying increasing attention to the needs of patients diagnosed at an early stage, they also say significant work is needed to increase the rate of early detection, particularly in primary care. The majority of patients are still diagnosed when they are at moderate or late stages of the disease.

"The earlier we can intervene, the better, and the longer time they may have to be well," said Gary Epstein-Lubow, MD, who presented on stress reduction for caregivers and is a staff psychiatrist at Butler Hospital in Providence, R.I. "Primary care is where people will present with the first symptoms long before they're in a memory program."

This need is also increasing because of the nation's growing elderly population. Alzheimer's was the 8th leading cause of death in 2003, with a nearly 6% increase over the previous year, according to "Deaths: Preliminary Data for 2003," issued by the National Center for Health Statistics in February.

"We have got to look at what's happening," said Neelum Aggarwal, MD, a conference keynote speaker and assistant professor of neurology at Rush University Medical Center in Chicago. "We are going to have an increasing number of cases, and this disease is going to basically change the demographics of the United States."

Experts expect that early-stage issues will become more significant as more effective treatment modalities are developed. Most clinicians appreciate that there is something they can do to treat cognitive decline but recognize that the efficacy of most of these medications is modest. Most hope that a vaccine currently in phase 2 trials could turn out to reverse the disease.

"None of these medications have helped in ways that are truly satisfactory," Dr. Aggarwal said. "We need disease-modifying treatments."

Meanwhile, recognizing the need for increasing physician involvement in the care of Alzheimer's patients as well as the ever shrinking office visit, the association has launched the "Partnering with your Doctor" campaign. This aims to educate patients and caregivers on strategies to get the most out of a doctor appointment.

"Alzheimer's is not a death sentence. We can now live with this disease, and we need to work together with physicians," O'Brien said.

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Health literacy experts consider new strategies for the elderly

Those older than 65 are more likely to have impairments that interfere with their ability to understand health-related information and are more likely to be on complicated medication regimens.

This combination is leading to medical errors and worse outcomes for this patient group, according to several presentations at last month's Mini-Conference on Health Literacy and Health Disparities, co-sponsored by the American Medical Association and BlueCross BlueShield Assn.

"As physicians and health care professionals, we need to design better health care systems that will improve health literacy and meet the needs of aging patients," said Joanne Schwartzberg, MD, AMA director of aging and community health.

The mini-conference was part of a series of gatherings across the country that will develop recommendations on a range of subjects for the White House Conference on Aging, scheduled for this December. The conference is held every 10 years to develop policy for consideration by the government and the private sector in order to deal with an increasingly elderly population.

Speakers said action on health literacy, which long has been looked at as a means to decrease health disparities among racial and ethnic groups, is crucial for the aged, too. Most elderly patients experience declines in cognition as well as reductions in the ability to hear and see, which means that health literacy usually declines as well.

"Clearly, there is a huge gap in what people are able to do and what the health care system expects of them," said David W. Baker, MD, MPH, one of the speakers and chief of general internal medicine at the Feinberg School of Medicine at Northwestern University in Chicago.

Doctors said this factor not only interfered with taking medications appropriately but was also a barrier to understanding public health prevention messages or even something as critical as applying for Medicare benefits.

"Patients always complain about understanding the Medicare and private insurance forms," said Joseph L. Murphy, MD, a Chicago internist. "That should be on the agenda, too."

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External links

"Alzheimer Disease, Report of the American Medical Association's Council on Scientific Affairs," abstract, Archives of Family Medicine, July 1999 (link)

13th annual Alzheimer's Assn. Dementia Care Conference (link)

White House Conference on Aging (link)

White House Conference on Aging Mini-Conference on Health Literacy and Health Disparities, sponsored by the American Medical Association and the BlueCross BlueShield Assn. (link)

AMA Foundation on health literacy (link)

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