Dementia Of The Alzheimer Type

New Alzheimer Drugs Will Mean Huge Patient Demand


By Janet Morgan
The Medical Post, December 17, 1996

GENEVA - GPs are currently unprepared for the rush of patients that will follow the launch of the new generation of "memory-enhancing" drugs soon to be marketed.

Experts at the Alzheimer's Disease Applied Diagnosis and Assessment Conference here agreed that family doctors needed, but did not have, quick and easy diagnostic tests to determine who would benefit from the new cholinesterase inhibitors.

"People who are 55 and older are going to be after these drugs, claiming their memory is going. There is going to be an assault on family doctors," predicted Dr. William Molloy, a consultant geriatrician at Henderson Hospital in Hamilton.

Fast-track approval

The new drugs -- the first of which has been granted fast-track approval by the U.S. Food and Drugs Administration recently -- are recommended for early treatment of Alzheimer's disease. Study results suggest that they can delay the deterioration of cognitive function by as much as two years. But Dr. Molloy suggested that most elderly patients, whether they had Alzheimer's or not, would be asking their GP for a prescription.

The difficulty at present, the conference agreed, was that there are no simple and fast tests that GPs could use to determine if memory loss was simply due to old age, depression or true dementia.

Ten years ago the need to make a definite diagnosis of Alzheimer's was not that important as little could be done for the patient. But that has now changed. "We need to give the doctors simple questions about what to ask these patients when they come in complaining that they are getting a little forgetful," said Dr. Molloy.

If the memory loss was severe and progressive, then the GP should carry out standard lab tests such as Vitamin B12, glucose, TSH, a CT scan and APOE4 to determine if there was a reversible cause for the dementia such as diabetes.

In the absence of a diagnostic algorithm, Dr. Molloy suggested two short tests could reliably identify those patients with cognitive impairments caused by dementia. A simple delayed recall test and asking about orientation were recommended.

With delayed recall, a patient was asked to remember three simple words -- such as bell, toy, dog -- and then repeat them to the interviewer after a delay of two minutes or so. Answers from the patient about what day, month, year it was and where they were could also give an indication about the patient's cognitive function.

Responses to the clock test -- asking the patient to draw a clock -- were also reliable. The key points to look for on the drawing were the presence of the 12, two hands and if the patient could read the time they had drawn on the
clock.


Head turn test may help Dx of Alzheimer's

GENEVA - A simple test measuring head movement may be effective at detecting early signs of Alzheimer's disease.

The test, which uses a computer to measure motor skills as subjects follow a moving object by moving their head, has so far been able to discriminate between patients with mild cognitive impairment and those with early Alzheimer's. Tests measuring motor co-ordination would have the advantage of not being affected by a subject's IQ, unlike many of the traditional cognitive tests.

Mild cognitive impairment

Alan Kluger, from the Aging and Dementia Research Centre in New York, measured the outcome in 91 subjects given the motor test -41 normal elderly, 25 with mild cognitive impairment and 25 with early Alzheimer's. The results showed significant differences in performance, he told the recent Alzheimer's Disease Applied Diagnosis and Assessment Conference here.

The accuracy of the test was 79% for discriminating the normal group from the mildly impaired and 92% for the normal from the Alzheimer's cases. These levels were similar to those achieved on the cognitive tests.

"The results indicate that motor impairment is an important aspect of cognitive decline in older adults. The test may improve identification of at-risk non-demented elderly, especially among diversely educated individuals," said Dr. Kluger.


Copyright 1996 Maclean Hunter Publishing Limited
Reprinted with permission.

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