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Screening for Alzheimer’s Disease General Principles

Screening for Alzheimer’s Disease General Principles. J.W. Ashford, University of Kentucky Veterans Affairs Medical Center Lexington AAGP – 3/3/03. Early Recognition of AD: Consensus Statement (AAGP, AGS, Alzheimer’s Association). AD continues to be missed as diagnosis

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Screening for Alzheimer’s Disease General Principles

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  1. Screening for Alzheimer’s DiseaseGeneral Principles J.W. Ashford, University of Kentucky Veterans Affairs Medical Center Lexington AAGP – 3/3/03

  2. Early Recognition of AD: Consensus Statement(AAGP, AGS, Alzheimer’s Association) • AD continues to be missed as diagnosis • AD is unrecognized and under-reported • patients do not realized • families tend to compensate • Effective treatment and management techniques are available Small et al., JAMA, 1997

  3. Why Diagnose AD Early? • Safety (driving, compliance, cooking, etc.) • Family stress and misunderstanding (blame, denial) • Early education of caregivers of how to handle patient (choices, getting started) • Advance planning while patient is competent (will, proxy, power of attorney, advance directives) • Patient’s and Family’s right to know • Specific treatments now available • May slow underlying disease process • May delay nursing home placement longer if started earlier

  4. Importance of screening for Alzheimer’s disease • Early treatments may: • Slow the course of the disease • Delay nursing home placement • Decrease the cost of the disease • Very early treatments may prevent dementia • What is the cost of testing versus the cost of not testing? • At what age is testing cost-effective?

  5. Total = 281,421,906 >60 = 45,809,291 >65 = 35,003,844 >85 = 4,251,678 >100= 62,545

  6. Factors Influencing Variation in Age of Onset • Genetics (especially APOE), family history • Neurological factors • Stroke • Brain injury • Medical factors • Vascular disease • Medications: NSAIDS, statins, female HRT • Education • Gender • Ageism (more concern for younger individuals)

  7. Age-Associated Memory Impairment(loss of memory without loss of social function)vsMild Cognitive Impairment / Early Alzheimer • Memory declines with age • At what point is memory abnormal? • Heisenbergian uncertainty – • the earlier problem is, the less clearly defined it is. • How does age affect consideration of abnormality? • Memory problems are more tolerated in older individuals • Older individuals remember more complex items and relationships • Older individuals are slower to respond

  8. ALZHEIMER’S DISEASE AAMI / MCI DEMENTIA Ashford et al., 1995

  9. Yesavage et al., 2002

  10. BLT/Ashford Memory Test(to detect AD onset) • New test to screen patients for Alzheimer’s disease using the World-Wide Web – based testing • Test only takes 1-minute • Test can be repeated often (quarterly) • Any change over time can be detected • Test is at: www.ibaglobal.com/BLT • For info, see: www.medafile.com

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