Early diagnosis of Alzheimer's disease is important now that drugs can slow mental decline. But clinicians shouldn't rely solely on cognitive tests, says a leading expert in the field, because loved ones know a patient best. Alzheimer's disease, which affects more than 4 million Americans, creates problems with memory, speech and perception. Among adult Americans, it is the fourth leading cause of death.
John C. Morris, M.D., recently presented a paper on the early diagnosis of Alzheimer's disease during a satellite symposium at the Congress of the International Psychogeriatric Association in Vancouver, Canada. He is the Harvey A. and Dorismae Hacker Friedman Professor of Neurology at Washington University School of Medicine in St. Louis. He also co-directs the school's Alzheimer's Disease Research Center.
Research at the center and other institutions suggests that information from a person close to a patient is even more valuable than cognitive tests in the very early stages of Alzheimer's disease. Cognitive tests, such as reading a paragraph and recalling what you have read, assess current mental performance. "But they don't tell us how that performance relates to what that person once did," Morris says. "So someone who is well educated and bright could lose a substantial amount of intellectual ability and still do well on a screening test."
Morris cites the example of President Ronald Reagan, whose Alzheimer's disease perhaps began in the White House. "But his native abilities and extensive support system allowed him to continue to perform in a very demanding position," Morris says.
When Morris assesses a patient, he conducts a structured interview with a spouse, adult child, close friend or colleague. "That helps us determine not only how an individual has changed relative to his or her own past performance but also whether that change is interfering with everyday activities," Morris says.