## New guidelines offer tips on Alzheimer's disease diagnosis, management

Physicians can accurately diagnose 95 percent of patients with Alzheimer's disease and need to do so early. That's a key message from the American Academy of Neurology, which issued updated evidence-based clinical guidelines this spring on the detection, diagnosis and treatment of dementia in the elderly, with an emphasis on Alzheimer's disease.

"We're talking about a disease for which there is no cure at the present time," says FP Tom Norris, M.D., associate dean of the University of Washington School of Medicine in Seattle. "It's not a situation where catching it early allows one to get started with definitive therapy that's going to slow the progress of the disease or cure the disease. The huge advantage -- if we can catch this disease early -- is that so much of it is an educational process, helping the family understand what's going on and what they can do."

Physicians can also begin offering medications, behavioral suggestions and other support to help "avoid some of the problems that occur when the disease gets to fairly advanced stages without being recognized," says Norris, who has worked extensively with patients with the disease. For example, cholinesterase inhibitors have been shown to alleviate symptoms in some patients with mild to moderate Alzheimer's disease.

The AAN guidelines reflect the efforts of 21 experts who examined more than 6,000 abstracts. Although they don't include any major revelations, Norris says, they do feature useful information detailing the level of support for each recommendation.

Alzheimer's disease is fairly common in the elderly. According to the AAN, 10 percent of people older than 65 and 50 percent of those older than 85 suffer from the disease. Physicians should identify and monitor mild cognitive impairment (memory impairment without dementia) because from 6 percent to 25 percent of patients with MCI progress to dementia or Alzheimer's disease, the AAN says.

Norris encourages FPs to check out the new guidelines, which were published in the May 8 issue of Neurology. To access them online, go to http://www.aan.com and click on "Dementia Resources." He also encourages physicians to distribute a list of 10 warning signs (see box above) to patients or families asking about Alzheimer's disease.