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Published on: July 25, 2016
by Pam Belluck for The New York Times:
“Has the person become agitated, aggressive, irritable, or temperamental?” the questionnaire asks. “Does she/he have unrealistic beliefs about her/his power, wealth or skills?”
Or maybe another kind of personality change has happened “Does she/he no longer care about anything?”
If the answer is yes to one of these questions — or others on a new checklist — and the personality or behavior change has lasted for months, it could indicate a very early stage of dementia, according to a group of neuropsychiatrists and Alzheimer’s experts.
They are proposing the creation of a new diagnosis: mild behavioral impairment. The idea is to recognize and measure something that some experts say is often overlooked: Sharp changes in mood and behavior may precede the memory and thinking problems of dementia.
The group made the proposal on Sunday at the Alzheimer’s Association International Conference in Toronto, and presented a 34-question checklist that may one day be used to identify people at greater risk for Alzheimer’s.
Take the test here.
“I think we do need something like this,” said Nina Silverberg, the director of the Alzheimer’s Disease Centers program at the National Institute on Aging, who was not involved in creating the checklist or the proposed new diagnosis.
“Most people think of Alzheimer’s as primarily a memory disorder, but we do know from years of research that it also can start as a behavioral issue.”
Under the proposal, mild behavioral impairment (M.B.I.) would be a clinical designation preceding mild cognitive impairment (M.C.I.), a diagnosis created more than a decade ago to describe people experiencing some cognitive problems but who can still perform most daily functions.
Dr. Zahinoor Ismail, a neuropsychiatrist at the University of Calgary and member of the group proposing the new diagnosis, said studies and anecdotes suggested that emotional and behavioral changes were “a stealth symptom,” part of the dementia disease process, not separate from it.
Whatever is eroding memory and thinking skills in the dementia process may also affect the brain’s systems of emotional regulation and self-control, he said.
If two people have mild cognitive impairment, the one with mood or behavior changes develops full-blown dementia faster, he said.
Alzheimer’s patients with those symptoms “do much worse over time;” after death, autopsies have shown they had more brain damage.
Of course, not everyone experiencing mood swings with age is suffering warning signs of dementia. Dr. Ismail emphasized that, to be considered M.B.I., a symptom should have lasted for at least six months and be “not just a blip in behavior, but a fundamental change.” Still, some experts worry that naming and screening for such an early-stage syndrome might end up categorizing large numbers of people, making some concerned they will develop Alzheimer’s when there are not yet effective treatments for the disease.
“There’s the potential benefit of early diagnosis, identifying people more likely to decline,” said Dr. Kenneth Langa, a professor of internal medicine at the University of Michigan. But “the flip side is overdiagnosis, labeling someone and getting people in the clinical cascade, where you start doing the test and people start doing more brain imaging and being at the doctor’s more and getting more concerned.”
“If it becomes a routine practice, that’s a huge amount of dollars,” he added.
Dr. Langa, who has written about M.C.I., cited the experience with that designation. Many people given an M.C.I. diagnosis do not develop full-blown dementia even a decade later, and as many as 20 percent have later been deemed cognitively normal, he said. That could be because on the day they were screened, their cognitive function was lower than usual, possibly a result of stress or medications taken for other conditions.
“That’s one of the things that makes me think twice” about creating M.B.I., said Dr. Langa, who recommended the checklist be tested by researchers before doctors began using it.
Others are more enthusiastic.
“We have to improve our ability to identify people at risk,” said Arthur Toga, a neuroscientist at University of Southern California. Eventually “there will be an effective treatment,” he said, “and there’s too much unknown about this disease anyway.”
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