Arthur, are you saying that since Alzheimer's progression cannot be halted that waiting until clinical symptoms appear would spare families and the patient from years of psychosocial problems? Early screening could prevent automobile accidents as well as at home accidents. I believe support groups are essential for early diagnosis, for both the family and the patient. If screening is negative it should be a relief; however, preventive strategies should be followed that can delay the onset of cognitive decline. I know of a geriatric who was diagnosed with Alzheimer's and needed an Aide. She was proactive and decided to join her community's exercise classes. The symptoms lessened and she no longer requires an Aide. Exercise and diet may help at the early stages to lessen the progression and possibly reverse symptoms.

Thank you Joan for your answer .but things are not always so simple.

"If screeening is negative - it should be a relief " ??  But what happens when it is inconclusive ? Or wrong ? Early diagnosis is not based on firm clinical criteria...

Since we do not know what causes Alzheimer's Disease prevention strategies

are not possible.

Generally speaking - pro arguments could exist . But in a thorough research published recently by the Cochrain Convention : They concluded that there is no 

evidence of benefit from early detection in Alzheimer's . Dis . I also ask  peple not to 

refer to Dementia  ( which is a syndrom ) but to concentrate on Alzheimer's Dis ,

I would like to hear about cases in which early detection or prsumed early detection 

had negative cosequences. 

I have just found this paper, which could be interesting -

Hung SC, Liao KF, Muo CH, Lai SW, Chang CW, Hung HC: Hearing Loss is Associated With Risk of Alzheimer's Disease: A Case-Control Study in Older People. J Epidemiol; 2015 Aug 5;25(8):517-21

[Fulltext service] Download fulltext PDF of this article and others, as many as you want.[Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.

[Title] Hearing Loss is Associated With Risk of Alzheimer's Disease: A Case-Control Study in Older People.

BACKGROUND: It remains unknown whether hearing loss increases the risk of Alzheimer's disease.

This study aimed to examine the association between hearing loss and risk of Alzheimer's disease in older people in Taiwan.

METHODS: Analyzing the database from Taiwan's National Health Insurance Program, this case-control study enrolled 488 subjects ≥65 years old with newly diagnosed Alzheimer's disease as a case group and 1952 subjects without Alzheimer's disease as a control group from 1998-2011.

Patients with Alzheimer's disease and other comorbidities were identified by analyzing ICD-9 coding in claims data.

The association of hearing loss, other comorbidities, and risk of Alzheimer's disease were compared between groups.

RESULTS: After controlling for confounders, multivariable logistic regression showed an adjusted odds ratio of Alzheimer's disease of 1.39 in people with hearing loss (95% CI, 1.05-1.84) versus those without.

Parkinson's disease (OR 4.44; 95% CI, 2.54-7.78), head injury (OR 2.31; 95% CI, 1.46-3.66), depression (OR 1.68; 95% CI, 1.19-2.39), hypertension (OR 1.40; 95% CI, 1.10-1.79), and age (each year, OR 1.03; 95% CI, 1.01-1.05) also showed strong links with Alzheimer's.

CONCLUSIONS: Hearing loss is associated with increased risk of Alzheimer's disease in older people in Taiwan.

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(PMID = 25986155.001).

[ISSN] 1349-9092

[Journal-full-title] Journal of epidemiology / Japan Epidemiological Association

[ISO-abbreviation] J Epidemiol

[Language] eng

[Publication-type] Journal Article

[Publication-country] Japan

[Other-IDs] NLM/ PMC4517989

The latest information on the topic

Resveratrol Stabilizes Amyloid in Alzheimer's

Pauline Anderson

| September 17, 2015  

9 comments

Alzheimer Disease and APOE-4

High doses of purified resveratrol, a polyphenol found in some foods, appear to stabilize levels of amyloid beta (Aβ) in cerebrovascular fluid (CSF) and in plasma in patients with mild to moderate Alzheimer disease (AD) and are safe and well tolerated, a new phase 2 study has shown.

Although it is too soon to start recommending resveratrol supplements to patients, the research indicates that this compound is safe and is promising, lead author R. Scott Turner, MD, PhD, professor, Neurology, and director of the Memory Disorders Program, Georgetown University Medical Center, Washington, DC, one of 21 medical centers across the United States participating in the study.

"It seems to have some interesting effects, enough to justify further research into this strategy," he told Medscape Medical News.

The study was published online September 11 as an Open Access article in Neurology.

I believe in individual self-determination.  If a person has a family history of Alzheimer's disease and wants to be tested, that is his or her decision to make.  Our obligation is to present them with the pluses and minuses of the consequences of getting the results from the test so they make an informed choice.  There are no current medications to cure or stop the progress of Alzheimer's but there are drugs that can lessen the symptoms.  Tomorrow or the next day or the next year, there will be better drugs. 

Madalaine, that is a socially positive idea. Perhaps the case I presented was not diagnoses properly and had cognitive decline and not Alzheimer's. Still it was remarkable to witness her improvement.

I have multiple examples of wrong diagnoses due to hearing loss and to visual impairment. There is no point in assessing persons who will answer what they think they hear or giving pen and pencil tests to those with cataracts, macular degeneration or glaucoma.  The most important thing that is missed before assessment iasa full and complete physical examination and, if there is any degree of haring loss, the use of a voice amplifier. I am completing a small study of the MMSE (although I never use it for assessment purposes) in men with significant noise induced hearing loss, with and without voice amplification. Guess what the results are showing?

It was demonstrated that cognitive deficits are under-diagnosed in the elderly attending primary care services (Mitchell, Meader, & Pentzek, 2011) and only 24.4% of general practitioner reported screening their patients aged 75 years and older each year (Gaboreau et al., 2014). Cognitive screening can lead to false-positive, but we can think that this likelihood his lessened when using normative data instead of cut-off as in the MMSE or the MoCA. Moreover, pharmacological interventions are not the only possible avenues of support. At the stage of MCI, neuropsychologists can teach seniors with cognitive remediation strategies, including memory (Belleville et al., 2011) and executive functions (Levine et al., 2007), to offset deficits. Giving recommendations to prevent a possible cognitive decline could also be appropriate (e.g..: promotion of physical activity, cognitively stimulating activities (Stern & Munn, 2010), promotion of healthy lifestyles for reducing vascular risk factors (Kaduszkiewicz et al., 2010), as well as referrals to support services for patients and their families (Elliott et al. 2008)).

Dear Irene  - welcome to this discussion and please share with us the results of your study as well as your vast experience in this field.

Arthur

Interesting question Arthur -- but it seems as though your question shifted a great deal from its initial form to its current state. Most "screening" has little risk, but for a while it seemed like brain biopsy might become part of the protocol which does have inherent medical risks but also a risk of a "false negative." Brain biopsy is not only very costly but less useful compared to more standard screening steps of physical/neuro exam, psych eval, cognitive testing, or even brain imaging -- these can all assist in differential diagnosis with little negative consequence to the patient.

I think what you really wanted to know was  -- are there negative EMOTIONAL effects of getting the diagnosis of DAT? (dementia of the Alzheimer's type) -- I'd add related questions such as 1) negative outcomes of withholding the diagnosis of DAT if made, 2) the negative consequences of NOT getting "screened"/assessed, and 3) the negative consequences of MIS-diagnosis of DAT. As some have mentioned, individuals have indivudual emotional responses to the diagnosis, and as the disease progresses, the response shifts as they lose awareness of their symptoms. At even the best specialty clinics, accuracy of DAT diagnosis during life is around 90%, so some models we have of DAT are incorrectly labeled if not confirmed with autopsy (see my attached now somewhat old, or maybe "classic" publication atached below) .

I'd say at this point, this topic might be effectively explored qualitatively using content analysis of the growing body of first person narratives from person's with dementia (PWDs). Person's with dementia today are more public, have stonger advocates and have a growing "voice" or body of work to study directly. What do the people with the diagnosis of dementia say?

In short, from both a public health and personal perspective, I believe the real negative outcomes are in NOT getting any kind of screening or assessment IF an older adult experiences cognitive decline. As Irene's comment and endless research supports, we must thoroughly and carefully and continuously asess elders with cogntive decline to find the TREATABLE conditions. Early and accurate diagnosis of DAT is important because likely, the most effective near term treatments will need to be applied early in the disease course before too much neurodegeneration happens.

Best regards, Xeno

Article Accuracy of Clinical Diagnosis of Alzheimer Disease and Clin...

You are spot on by stating early detection is not all that. However, in some cases it can allow some people to be involved like the amazing Helga Rohra who has lived with dementia with Lewy bodies for several years now and presents at Alzheimer;'s conferences around the world. She tells early depression at diagnosis and that she had been an interpreter with several languages at her disposal. but by being involved with the working group at Alzheimer Europe has helped her retain identity though she is now limited to two languages, English and German. She spoke at the opening ceremony of Alzheimer Europe in Ljubljana recently. Some of the downsides however of early diagnosis are that others can take over your life, the initiation of choice and action that separates us from circuit boards may abandon us due tot he actions of others. The constant (at the start) barrage of visits to doctors who label us as sufferers and implement the DNAR (do not rescus) The Mental Capacity Act (2007) that was meant to help us retain identity is often done in the community, sometimes by well meaning people sometimes by labellers who don't understand it and do it in five minutes using derogatory language picked up from text books i.e. confabulates and so on.  The use of the mini mental statements to constantly determine what we have lost (see Helga Rohra speak about how the focus should be on what we retain). Scientist look through their microscopes to explore the pathology of dementia with Lewy bodies (even start PhD studentships to examine it)  in those with  to look at cellular level reasons for depression, fine, but perhaps they often don't look at the person, the individual, in front of them to see how to alleviate the depression from the external environment alongside the internal changes.  My own current work focuses upon the identity of the person but from their perspective.

Since the introduction of new criteria for DAT some years ago, it has become possible.to diagnose "biological Alzheimer's" in non-demented patients. (Bruno Dubois elaborated this nicely at the World Congress of Neurology 2013 in Vienna.) So there is a difference of biological Alzheimer's with no symptoms at all, MCI, mostly of the amnestic type, and early DAT. In my opinion, MCI and early DAT require diagnostic effort and follow-up, if it was only for organization of care when disease advances.

Biological Alzheimer's raises some ethical issues as it is unknown when disease manifests, as the conversion from biological to mildly symptomatic Alzheimer's may take even decades. (imagine offspring of some 70 year-old patient recently diagnosed with DAT) As these patients are asymptomatic, do not "benefit" from anosognosia, and no studies are available on the progression, it may lead to at best unhappy patients. It may be interesting whether the pharmacological interventions tested in manifest DAT may be of use in biological Alzheimer's, which might change my reluctance to adhere to the new criteria actually. Hope I was of use.

Screening testes have been used for years but recently it has always been argued that massive screening  is not recommended because of high false positive rate, just like what you said--people who are not dementia patients have a positive screening score indicating that they have the condition. Recently a new approach called "case finding" is of more applicability because it take into account risk factors for dementia. Hence instead of applying screening to everybody, we identify people with risk factor and perform test on them only. By this approach false positive rate is reduced and we get higher positive predictive value. Hope you find the below publication useful.

Article Clinical Utility of the Informant AD8 as a Dementia Case Fin...