The guidelines, the by the National Institute on aging and the Alzheimer's Association, Tuesday issued are the disease in three phases to divide: a phase in dementia has developed, a middle phase in the mild problems arise can still perform daily functions, and most recently discovered phase, in which no symptoms are clear, but changes are brewing in the brain.
"We are redefining of Alzheimer's and look at this differently at all had happened," Creighton Phelps, founded Director of the National Institute on aging said Alzheimer's disease centers. "I think we're going to start to identify it earlier and earlier."
To diagnose before it deep into the drive of Alzheimer's dementia developed diagnosis codes for Alzheimer's also reflected in a Bill in Congress this month, the certain Medicare costs including the steps that would create discussions between the patient, doctor and tutor introduced, a recognition that can keep well informed members of the family to better planning and maintenance.
"Early diagnosis is really the key to this," said Representative Edward j. Markey, Democrat of Massachusetts, and sponsor of the Bill. "Often family members notice the symptoms in their love, but it is only years later, that they get diagnosed or understand what resources are available."
The most striking in addition to the guidelines concerns methods that assess brain changes in Alzheimer's disease, including brain scans and tests of the cerebral spinal fluid. Such methods measure what is after all, just as biomarker, physiological indicators that someone probably develop dementia such as cholesterol and blood biomarkers of upcoming heart disease are called.
For now, the guidelines specify the Alzheimer's biomarkers - including abnormal proteins amyloid and Tau and shrinkage of certain areas of the brain - should still not in widespread use in fact, but used only for patients in clinical trials.
This is because scientists standardize nor the results of the tests, or know, "what is really unusual and what action is not", said Marilyn Albert, Director of the Johns Hopkins Alzheimer's disease research center, and one of the leaders of a working group, which developed the new guidelines.
More than a third of all patients with amyloid plaques in their brains, for example, developed not Alzheimer's symptoms at the the time they die. The guidelines urge also caution, because there are known to stop currently no drug or to onset of symptoms significantly delay, so that people are told they likely that Alzheimer's have to take any effective medication.
"We have not enough information about what people say," said Dr. Steven DeKosky, Dean of the University of Virginia medical school, who were involved in one of the working groups. "To you, a clinician can say, ' If you this test you have X amount of reliability and to make a difference in the lives of your patients ' - until then, it remains in the laboratory."
However, the guidelines reflect a feeling in the medical community, which is not so far away at the moment when science will have more specific knowledge of biomarkers. You will can to promote more research so that drugs can be developed, attack to early brain changes and to identify people who benefit from one such drugs as they become available.
The goal, said William Thies, medical and scientific head of Office for the Alzheimer's Association, is "extension of our ability to investigate this disease and finally find the treatment as necessary to avoid the epidemic of Alzheimer's disease, that we see will be facing us in the next 40 years."
In the short term she will be largest effects to be seen, that with people in the middle phase, the with mild cognitive impairment associated with Alzheimer's disease. Experts say there are at least as many people experience this phase than the 5.4 million estimated have Alzheimer's dementia. And they expect that other their doctors now questions whether they mild impairment, for including experience some difficulties or signs are inefficiency with memory, attention, or other intellectual abilities, work while still independently of each other.
Dr. Albert said, if patients with symptoms of mild cognitive impairment "to increase the certainty" to the diagnosis of a brain scan or spinal fluid test, they should get such tests in a research study, so they have a better chance on accurate results.
The guidelines clarify also diagnostic criteria for people with dementia, Alzheimer's disease from other dementias, including vascular, Fronto-temporal and Lewy body indistinguishable. And they note that the earliest symptom of Alzheimer's dementia is not always memory loss, but may have mood swings or problems with language, spatial perception, or reasoning.
Dr. Pierre Tariot, Director of the Institute of the banner Alzheimer's in Phoenix, who was not in the preparation of the guidelines, called it "a step in the right direction", would not be "emission determined" as a sign that he hoped, that are on the biomarker tests, further, as they are. He added: "the idea that the that the Alzheimer's disease a continuum that has a comprehensive time phase is a very important message out."
Dr. Phelps said it would hardly be the last word by the medical community on Alzheimer's disease.
"We have to draw a line and say that's it," said Dr. Phelps. "What we say is this is the best know and not us 27 years wait them back again."
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