Published on: September 13, 2013
by Dr. Sanjay Gupta for Everyday Health:
Research may help diagnose Alzheimer’s and other mental illnesses before patients develop symptoms.
By the year 2050, the number of Americans over the age of 65 is projected to hit 88.5 million – more than double the number of senior citizens in 2010. As the population continues to grow older, the number of people diagnosed with Alzheimer’s and other dementias will likely skyrocket. The Alzheimer’s Association expects the number of people with the disease to nearly triple over the next four decades, from 5 million now to a projected 13.8 million.
“The aging of the population is a huge issue,” said Jason Hassenstab, MD, an assistant professor of neurology and psychology at Washington University in St. Louis. “There’s a major push to diagnose well before people have symptoms. Once people start showing symptoms, trying to treat the disease at that point may be too late.”
Some progress is being made in improved screening and early detection. Swedish researchers recently identified common risk factors in young people with early-onset dementia, including alcohol and drug use, depression, and high blood pressure.
The study, published in JAMA Internal Medicine, looked at nearly a half a million soldiers in Sweden, where all men must enlist in the army when they’re 18 years old. Researchers cross-referenced enlistment records, which included physical and cognitive exams, with hospital databases for later health and dementia diagnoses.
“Early detection of dementia in adults in their 40s and 50s continues to be plagued by a medical field that doesn’t look for dementia as the initial or secondary diagnosis in middle-aged individuals, given the stereotype that the disease is an older adult problem,” said Mario Dulay, Jr., PhD, a neuropsychologist at the Houston Methodist Neurological Institute.
Murray Grossman, MD, director of the Penn Frontotemporal Degeneration Center at the University of Pennsylvania, agrees that “there is no system available for wide-based screening of 40- to 65-year-olds who are at risk for developing dementia, and there is not enough funding being devoted to the development of screening instruments.”
In another study, from Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center, researchers showed photos of famous figures such as John F. Kennedy and Princess Diana to people with an average age of 62. Half of the participants had early-onset dementia, while the other half had normal cognitive function.
Those with dementia could name the faces 49 percent of the time, while the healthy group could name the famous faces 93 percent of the time. If they couldn’t think of the famous person’s name, participants were asked to give describing characteristics.
“The goal was to look at signs and symptoms that commonly occur in dementia and to disentangle them,” said Emily Rogalski, PhD, an assistant professor and one of the study’s authors. “When you can see where in the brain there is damage, and what symptom it’s associated with such as name recognition, it’s helpful when we think about cures and treatment. That way we know what to target.”
Today, patients typically undergo a variety of psychological tests to diagnose dementia, from having to recall the names of objects to doing basic math and copying drawings. These tests may help spot a patient’s dementia but don’t identify what kind they have. Hassenstab points out that they also often miss subtle signs of mental impairment.
“Current screening measures are notoriously non-specific in differentiating types of dementias,” said Dulay.
Research is also being done in biomarker testing, where biological indicators could potentially highlight early signs of Alzheimer’s, just as high blood sugar levels may point to diabetes. But “the results are not absolutely confirmatory or exclusionary of actually developing a neurodegenerative disease,” said Dr. Grossman.
While there’s no cure for Alzheimer’s and medications can only slow progression of the disease, early detection can help patients and loved ones prepare for the challenges ahead. “Specialists can help parents find ways to explain to kids what it means if a parent has dementia,” said Dulay. “They can also help explain what to expect regarding the course of the disease.”
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