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Press Release Date: September 25, 1996
Significant mental impairment is not a part of normal aging and should be a signal for action on the part of clinicians, patients and family members, according to a new clinical practice guideline released today by HHS' Agency for Health Care Policy and Research. Despite their prevalence, Alzheimer's disease and related dementias often go unrecognized or misdiagnosed in their early stages. In approximately 20 percent of cases, signs of decline are due to other conditions that are very treatable, such as depression or taking multiple medications.
"Many health care professionals, as well as patients, their families and friends, mistakenly view the early symptoms of Alzheimer's disease as inevitable consequences of aging," said HHS Secretary Donna E. Shalala. "I urge all physicians to become familiar with the guideline's findings and recommendations so patients will receive the best care possible.
"I also urge everyone, especially people with aging family members and friends, to become acquainted with the symptoms that may indicate Alzheimer's disease. If you or someone you know has any of these symptoms, you should talk about them with a doctor as soon as possible," Shalala said.
"Early recognition of Alzheimer's disease, or identification of other types of dementias, can prevent costly and inappropriate treatment, and give patients and family members time to address the complex financial, legal and medical issues these conditions present," said Paul T. Costa, Jr., Ph.D., of the Gerontology Research Center at the National Institute on Aging, and co-chair of the panel of public- and private-sector experts responsible for the guideline. "This guideline provides the tools needed to conduct an initial assessment when symptoms are present," Dr. Costa said.
Symptoms like increased difficulty with learning and retaining new information, handling complex tasks, reasoning, and spatial ability and orientation should trigger a clinical assessment. A family history of dementia and/or Down syndrome are possible risk factors that merit special attention.
"Patients who are depressed, taking multiple medications, or abusing alcohol are frequently misdiagnosed or not treated because their symptoms are confused with Alzheimer's disease or other dementias," according to T. Franklin Williams, M.D., FACP, Professor of Medicine Emeritus, University of Rochester Medical Center, Distinguished Physician, Department of Veterans Affairs Medical Center, and guideline panel co-chair. "Depression is the most common psychiatric illness in older persons, and can be difficult to distinguish from dementia."
An initial clinical assessment should combine information on the symptoms' onset, progression, and duration; results of a physical examination; an evaluation of mental and functional status; and reports from family members and/or friends.
Clinicians should consider factors such as physical disability, and they should also rule out delirium and depression.
When findings of an initial evaluation do point to Alzheimer's disease or other dementias, the AHCPR-sponsored guideline recommends further clinical evaluation, and stresses the importance of follow-up and continuity of care. Only when the initial assessment is complete is it appropriate to conduct laboratory tests. Follow-up, with assessment of declining mental function, may be the most useful diagnostic procedure for differentiating Alzheimer's disease from normal aging.
AHCPR's Clinical Practice Guideline on Alzheimer's disease is the agency's last guideline and marks a transition in the guideline program. AHCPR's guideline program has been restructured in response to requests from public- and private-sector guideline users seeking the scientific foundation to produce their own high-quality, evidence-based guidelines.
In the future, AHCPR will respond to these requests by providing evidence reports that will include literature reviews, evidence tables, decision analyses, meta-analyses, and other products. As a result, the agency will be able to produce a broader base of scientific information and foster a wider range of tools for the enhancement of clinical practice.
The Overview and Consumer Version will be available Friday, September 27, 1996, on the Internet through AHCPR's Home Page. To access and/or download the guideline products, use a Web browser, specifying URL http://www.guideline.gov/, and click on "Clinical Practice Guidelines Online."
Editor's Note: To arrange a telephone interview on Thursday, September 26, 1996, with Paul T.
Costa, Jr., Ph.D., and/or T. Franklin Williams, MD, FACP, co-chairs of the guideline panel, contact Howard Holland, (301) 427-1857. Brief bios for Dr. Costa and Dr. Williams are given below.
The guideline documents, Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias, Clinical Guideline No. 19, Early Identification of Alzheimer's Disease and Related Dementias: Quick Reference for Clinicians, Early Alzheimer's Disease: Patient and Family Guide, are in production and will be available later this year (Winter 1996). These publications will be available free of charge from the AHCPR Publications Clearinghouse. To receive these publications, call toll-free 800-358-9295; or write to Alzheimer's Guideline, AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD, 20907-8547.
The Alzheimer's Association has issued a statement welcoming the new clinical practice guideline. To receive a copy of the Alzheimer's Association statement, call Howard Holland, (301) 427-1857, or Judith Riggs, at the Alzheimer's Association's Washington, DC, office, (202) 393-7737.
Biographies of Panel Co-chairs
Paul T. Costa, Jr., Ph.D.
Chief, Laboratory of Personality and Cognition
Gerontology Research Center
National Institute on Aging
National Institutes of Health
Specialty: Psychological Assessment
Dr. Costa's research interests include the structure and stability of personality, age-related changes in cognitive performance, and early markers of Alzheimer's disease. He is coauthor of the Revised NEO Personality Inventory and has published more than 200 articles and book chapters. In 1993, Dr. Costa received the Distinguished Contribution Award from the American Psychological Association's Adult Development and Aging Division.
T. Franklin Williams, M.D., FACP
Professor of Medicine Emeritus
University of Rochester Medical Center
Department of Veterans Affairs Medical Center
Specialty: Geriatric Medicine and Aging Research
Dr. Williams served as Director of the National Institute on Aging, National Institutes of Health, from 1983 to 1991. His research and more than 90 publications focus on metabolic diseases, including hereditary rickets and diabetes mellitus, and varied aspects of care of chronically ill and aging persons. Dr. Williams is coeditor of the Oxford Textbook of Geriatric Medicine and is a member of numerous local and national boards related to aging and long-term care.
For additional information, contact AHCPR Public Affairs: Howard Holland, (301) 427-1857, or Karen Migdail, (301) 427-1855 .