Alzheimer’s Disease – The Importance of Early Detection

Alzheimer’s Disease – The Importance of Early Detection

Passmore Peter, Todd Stephen
Published: European Neurology - Volume 3 Issue 2
download article

| More
dots

Alzheimer’s disease (AD), with its insidious impairment of those most human of faculties – memory, reasoning, judgement and abstraction – exacts a great burden on each individual patient.1 A significant toll is also placed on care-givers – typically the spouse or daughter – as their relative becomes less communicative and more behaviourally disturbed.2,3 This toll is financial, with both direct and indirect costs4,5 as well as psychological6,7 physical,8 and emotional pressures.9 Dementia, of which AD is the most frequent cause, is also responsible for significant usage of and expenditure on health and social care throughout Europe. It is estimated to be responsible for 11.2% of years lived with disability in people over 60 years of age, compared with 9.5% for stroke, 5.0% for cardiovascular disease and 2.4% for cancer.10 In Europe, the prevalence of AD increases exponentially with age.11,12 The incidence also increases with age,13,14 although perhaps with a plateau in extreme old age.15 There were an estimated 4.916 to 7.6 million17 western Europeans with dementia in 2001, and this could increase to 9.9 million by 204016 or even 16.2 million by 2050,17 driven by the ageing population.

In the UK alone, the total cost of care for late-onset dementia in 2005–2006 is estimated at £17.03 billion (€21.88 billion; US$29.89 billion), to which supported accommodation and informal care costs are the leading contributors.5 One estimate suggests that this cost will treble in the next 25 years.18 Across Europe, the total costs of care per person with dementia, adjusted to 2004 € level,19 range from approximately €6,000 in France20 to €19,500 in Finland.21 One report observes that the annual total costs of care per person with dementia are significantly greater for those in institutional care (€27,620 in 2002) compared with those cared for at home (€5,346 in 2002).22 In Scandinavia, the total annual costs in 2003 US$ were estimated to range from approximately US$7,500 in mild dementia to US$46,350 in severe dementia.21 Informal care costs account for roughly one-third of total costs, and increase markedly with advancing disease severity.21 Therefore, interventions that retard the progressive cognitive impairment of AD and maintain subjects at a higher functional level would be of great economic benefit to health and social care systems, as well as to patients and their care-givers. Thus, there is a growing consensus both nationally23,24 and across Europe25 that early diagnosis and treatment of dementia, including AD, would be beneficial for patients, care-givers and health and social care systems and should become the standard of care. This article reviews the evidence in favour of and against such a consensus.

1234next ›last »
References:
  1. Corey-Bloom J, Fleischer AS, The natural history of Alzheimer’s disease. In: Burns A, O’Brien J, Ames D (eds), Dementia. 3rd ed., London: Hodder Arnold, 2005:376–86.
  2. Lyketsos CG, Lopez O, Jones B, et al., Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the Cardiovascular Health Study, JAMA, 2002;288:1475–83.
  3. Schneider J, Murray J, Banerjee S, Mann A, EUROCARE: A crossnational study of co-resident spouse carers for people with Alzheimer’s disease: I—factors associated with carer burden, Int J Geriatr Psychiatry, 1999;14:651–61.
  4. National Audit Office, Improving services and support for people with dementia, London: The Stationary Office, 2007.
  5. Dementia UK, A report into the prevalence and cost of dementia prepared by the personal social services research unit (PSSRU) at the london school of economics and the institute of psychiatry at king’s college london, for the Alzheimer’s Society, London: Alzheimer’s Society, 2007:1–189.
  6. Baumgarten M, Battista RN, Infante-Rivard C, et al., The psychological and physical health of family members caring for an elderly person with dementia, J Clin Epidemiol, 1992;45:61–70.
  7. Rosenthal CJ, Sulman J, Marshall VW, Depressive symptoms in family caregivers of long-stay patients, Gerontologist, 1993;33: 249–57.
  8. Schulz R, Visintainer P, Williamson GM, Psychiatric and physical morbidity effects of caregiving, J Gerontol, 1990;45:P181–91.
  9. Brodaty H, Hadzi-Pavlovic D, Psychosocial effects on carers of living with persons with dementia, Aust N Z J Psychiatry, 1990;24:351–61.
  10. World Health Organization, World health report 2003 – shaping the future, Geneva: WHO, 2003.
  11. Lobo A, Launer LJ, Fratiglioni L, et al., Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group, Neurology, 2000;54:S4–9.
  12. Rocca WA, Hofman A, Brayne C, et al., Frequency and distribution of Alzheimer’s disease in Europe: A collaborative study of 1980–1990 prevalence findings. The EURODEMPrevalence Research Group, Ann Neurol, 1991;30:381–90.
  13. Fratiglioni L, Launer LJ, Andersen K, et al., Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group, Neurology, 2000;54:S10–15.
  14. Matthews F, Brayne C, Medical Research Council Cognitive Function and Ageing Study Investigators, The incidence of dementia in England and Wales: Findings from the five identical sites of the MRC CFA study, PLoS Med, 2005;2:e193.
  15. Gao S, Hendrie HC, Hall KS, Hui S, The relationships between age, sex, and the incidence of dementia and Alzheimer disease: A meta-analysis, Arch Gen Psychiatry, 1998;55:809–15.
  16. Ferri CP, Prince M, Brayne C, et al.; Alzheimer’s Disease International, Global prevalence of dementia: A Delphi Consensus Study, Lancet, 2005;366:2112–17.
  17. Wancata J, Musalek M, Alexandrowicz R, Krautgartner M, Number of dementia sufferers in Europe between the years 2000 and 2050, Eur Psychiatry, 2003;18:306–13.
  18. Comas-Herrera A, Wittenberg R, Pickard L, Knapp M. Cognitive impairment in older people: Future demand for long-term care services and the associated costs, Int J Geriatr Psychiatry, 2007;22:1037–45.
  19. Jonsson L, Berr C, Cost of dementia in Europe, Eur J Neurol, 2005;12(Suppl. 1):50–53.
  20. Souetre EJ, Qing W, Vigoureux I, et al., Economic analysis of Alzheimer’s disease in outpatients: Impact of symptom severity, Int Psychogeriatr, 1995;7:115–22.
  21. Jonsson L, Eriksdotter Jonhagen M, Kilander L, et al., Determinants of costs of care for patients with Alzheimer’s disease, Int J Geriatr Psychiatry, 2006;21:449-459.
  22. Scuvee-Moreau J, Kurz X, Dresse A; National Dementia Economic Study Group, The economic impact of dementia in Belgium: Results of the National Dementia Economic Study (NADES), Acta Neurol Belg, 2002;102:104–13.
  23. National Collaborating Centre for Mental Health, Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care, London: Royal Psychological Society, 2007.
  24. Department of Health, Transforming the quality of dementia care: Consultation on a national dementia strategy, London: Department of Health, 2008.
  25. Waldemar G, Phung KT, Burns A, et al., Access to diagnostic evaluation and treatment for dementia in Europe, Int J Geriatr Psychiatry, 2007;22:47–54.
  26. O’Connor DW, Pollitt PA, Hyde JB, et al., Do general practitioners miss dementia in elderly patients?, BMJ, 1988;297:1107–10.
  27. Olafsdottir M, Skoog I, Marcusson J, Detection of dementia in primary care: The linkoping study, Dement Geriatr Cogn Disord, 2000;11:223–9.
  28. Maeck L, Haak S, Knoblauch A, Stoppe G, Early diagnosis of dementia in primary care: A representative eight-year follow-up study in lower Saxony, Germany, Int J Geriatr Psychiatry, 2007;22:23–31.
  29. Stoppe G, Sandholzer H, Staedt J, et al., Diagnosis of dementia in primary care: Results of a representative survey in lower Saxony, Germany, Eur Arch Psychiatry Clin Neurosci, 1994;244:278–83.
  30. Vernooij-Dassen MJ, Moniz-Cook ED, Woods RT, et al., Factors affecting timely recognition and diagnosis of dementia across Europe: From awareness to stigma, Int J Geriatr Psychiatry, 2005;20:377–86.
  31. Iliffe S, Booroff A, Gallivan S, et al., Screening for cognitive impairment in the elderly using the mini-mental state examination, Br J Gen Pract, 1990;40:277–9.
  32. Boise L, Camicioli R, Morgan DL, et al., Diagnosing dementia: Perspectives of primary care physicians, Gerontologist, 1999;39: 457–64.
  33. Facing Dementia. Available at: www.alz.co.uk/media/ dementiasurvey.html (accessed 13 October 2008).
  34. Bryans M, Keady J, Turner S, et al., An exploratory survey into primary care nurses and dementia care, Br J Nurs, 2003;12: 1029–37.
  35. Manthorpe J, Iliffe S, Eden A, Early recognition of dementia by nurses, J Adv Nurs, 2003;44:183–91.
  36. Wilkinson D, Stave C, Keohane D, Vincenzino O, The role of general practitioners in the diagnosis and treatment of Alzheimer’s disease: A multinational survey, J Int Med Res, 2004;32:149–59.
  37. Birks J, Harvey RJ, Donepezil for dementia due to Alzheimer’s disease, Cochrane Database Syst Rev, 2006;(1):CD001190.
  38. Loy C, Schneider L, Galantamine for Alzheimer’s disease and mild cognitive impairment, Cochrane Database Syst Rev, 2006;(1): CD001747.
  39. Birks J, Grimley Evans J, Iakovidou V, Tsolaki M, Rivastigmine for Alzheimer’s disease, Cochrane Database Syst Rev, 2000;(4):CD001191.
  40. Birks J, Cholinesterase inhibitors for Alzheimer’s disease, Cochrane Database Syst Rev, 2006;(1):CD005593.
  41. Ritchie CW, Ames D, Clayton T, Lai R, Metaanalysis of randomized trials of the efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer disease, Am J Geriatr Psychiatry, 2004;12:358–69.
  42. Seltzer B, Zolnouni P, Nunez M, et al.; Donepezil “402” Study Group. Efficacy of donepezil in early-stage Alzheimer disease: A randomized placebo-controlled trial, Arch Neurol, 2004;61:1852–6.
  43. Seltzer B, Cholinesterase inhibitors in the clinical management of Alzheimer’s disease: Importance of early and persistent treatment, J Int Med Res, 2006;34:339–47.
  44. Raskind MA, Peskind ER, Wessel T, Yuan W, Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension. the galantamine USA-1 study group, Neurology, 2000;54:2261–8.
  45. Farlow M, Anand R, Messina J Jr, et al., A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer’s disease, Eur Neurol, 2000;44:236–41.
  46. Doody RS, Geldmacher DS, Gordon B, et al.; Donepezil Study Group. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease, Arch Neurol, 2001;58:427–33.
  47. Geldmacher DS, Provenzano G, McRae T, et al., Donepezil is associated with delayed nursing home placement in patients with Alzheimer’s disease, J Am Geriatr Soc, 2003;51:937–44.
  48. Cummings JL, Schneider L, Tariot PN, et al., Reduction of behavioral disturbances and caregiver distress by galantamine in patients with Alzheimer’s disease, Am J Psychiatry, 2004;161:532–8.
  49. Feldman H, Gauthier S, Hecker J, et al.; Donepezil MSAD Study Investigators Group. Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer’s disease and the effect on caregiver burden, J Am Geriatr Soc, 2003;51:737–44.
  50. Sano M, Wilcock GK, van Baelen B, Kavanagh S, The effects of galantamine treatment on caregiver time in Alzheimer’s disease, Int J Geriatr Psychiatry, 2003;18:942–50.
  51. Wimo A, Winblad B, Shah SN, et al., Impact of donepezil treatment for Alzheimer’s disease on caregiver time, Curr Med Res Opin, 2004;20:1221–5.
  52. Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H, Cholinesterase inhibitors for patients with Alzheimer’s disease: Systematic review of randomised clinical trials, BMJ, 2005;331:321–7.
  53. Loveman E, Green C, Kirby J, et al., The clinical and costeffectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease, Health Technol Assess, 2006;10:iii–iv, ix–xi, 1–160.
  54. Woods RT, Moniz-Cook E, Iliffe S, et al.; INTERDEM (Early Detection and Intervention in Dementia) Group, Dementia: Issues in early recognition and intervention in primary care, J R Soc Med, 2003;96:320–24.
  55. Lingler JH, Hirschman KB, Garand L, et al., Frequency and correlates of advance planning among cognitively impaired older adults, Am J Geriatr Psychiatry, 2008;16:643–9.
  56. Banerjee S, Willis R, Matthews D, et al., Improving the quality of care for mild to moderate dementia: An evaluation of the Croydon memory service model, Int J Geriatr Psychiatry, 2007;22: 782–8.
  57. Mittelman MS, Roth DL, Clay OJ, Haley WE, Preserving health of Alzheimer caregivers: Impact of a spouse caregiver intervention, Am J Geriatr Psychiatry, 2007;15:780–89.
  58. Mittelman MS, Roth DL, Coon DW, Haley WE, Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disease, Am J Psychiatry, 2004;161: 850–56.
  59. Mittelman MS, Haley WE, Clay OJ, Roth DL, Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease, Neurology, 2006;67:1592–9.
  60. Brodaty H, Green A, Koschera A, Meta-analysis of psychosocial interventions for caregivers of people with dementia, J Am Geriatr Soc, 2003;51:657–64.
  61. Brodaty H, McGilchrist C, Harris L, Peters KE, Time until institutionalization and death in patients with dementia. role of caregiver training and risk factors, Arch Neurol, 1993;50:643–50.
  62. Banerjee S, Murray J, Foley B, et al., Predictors of institutionalisation in people with dementia, J Neurol Neurosurg Psychiatry, 2003;74:1315–16.
  63. Gaugler JE, Kane RL, Kane RA, Newcomer R, Early communitybased service utilization and its effects on institutionalization in dementia caregiving, Gerontologist, 2005;45:177–85.
  64. Brodaty H, Thomson C, Thompson C, Fine M, Why caregivers of people with dementia and memory loss don’t use services, Int J Geriatr Psychiatry, 2005;20:537–46.
  65. Ball K, Berch DB, Helmers KF, et al.; Advanced Cognitive Training for Independent and Vital Elderly Study Group. Effects of cognitive training interventions with older adults: A randomized controlled trial, JAMA, 2002;288:2271–81.
  66. Willis SL, Tennstedt SL, Marsiske M, et al.; ACTIVE Study Group. Long-term effects of cognitive training on everyday functional outcomes in older adults, JAMA, 2006;296:2805–14.
  67. Clare L, Woods RT, Moniz Cook ED, et al., Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia, Cochrane Database Syst Rev, 2003;(4):CD003260.
  68. Rozzini L, Costardi D, Chilovi BV, et al., Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors, Int J Geriatr Psychiatry, 2007;22: 356–60.
  69. Olazaran J, Muniz R, Reisberg B, et al., Benefits of cognitivemotor intervention in MCI and mild to moderate Alzheimer disease, Neurology, 2004;63:2348–53.
  70. Loewenstein DA, Acevedo A, Czaja SJ, Duara R, Cognitive rehabilitation of mildly impaired Alzheimer disease patients on cholinesterase inhibitors, Am J Geriatr Psychiatry, 2004;12:395–402.
  71. Wenisch E, Cantegreil-Kallen I, De Rotrou J, et al., Cognitive stimulation intervention for elders with mild cognitive impairment compared with normal aged subjects: Preliminary results, Aging Clin Exp Res, 2007;19:316–22.
  72. Galante E, Venturini G, Fiaccadori C, Computer-based cognitive intervention for dementia: Preliminary results of a randomized clinical trial, G Ital Med Lav Ergon, 2007;29:B26–32.
  73. Graff MJ, Vernooij-Dassen MJ, Thijssen M,et al., Community based occupational therapy for patients with dementia and their care givers: Randomised controlled trial, BMJ, 2006;333:1196.
  74. Graff MJ, Vernooij-Dassen MJ, Thijssen M, et al., Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: A randomized controlled trial, J Gerontol A Biol Sci Med Sci, 2007;62:1002–9.
  75. Graff MJ, Adang EM, Vernooij-Dassen MJ, et al., Community occupational therapy for older patients with dementia and their care givers: Cost effectiveness study, BMJ, 2008;336:134–8.
  76. Broe GA, Henderson AS, Creasey H, et al., A case-control study of Alzheimer’s disease in Australia, Neurology, 1990;40: 1698–1707.
  77. Laurin D, Verreault R, Lindsay J, et al., Physical activity and risk of cognitive impairment and dementia in elderly persons, Arch Neurol, 2001;58:498–504.
  78. Verghese J, Lipton RB, Katz MJ, et al., Leisure activities and the risk of dementia in the elderly, N Engl J Med, 2003;348:2508–16.
  79. Buchner DM, Larson EB, Falls and fractures in patients with Alzheimer-type dementia, JAMA, 1987;257:1492–5.
  80. Morris JC, Rubin EH, Morris EJ, Mandel SA, Senile dementia of the Alzheimer’s type: An important risk factor for serious falls, J Gerontol, 1987;42:412–17.
  81. Tinetti ME, Doucette J, Claus E, Marottoli R, Risk factors for serious injury during falls by older persons in the community, J Am Geriatr Soc, 1995;43:1214–21.
  82. Krenz C, Larson EB, Buchner DM, Canfield CG, Characterizing patient dysfunction in Alzheimer’s-type dementia, Med Care, 1988;26:453–61.
  83. Magaziner J, Simonsick EM, Kashner TM, et al., Predictors of functional recovery one year following hospital discharge for hip fracture: A prospective study, J Gerontol, 1990;45:M101–7.
  84. Wolf-Klein GP, Silverstone FA. Weight loss in Alzheimer’s disease: An international review of the literature, Int Psychogeriatr, 1994;6:135–42.
  85. Heyn P, Abreu BC, Ottenbacher KJ, The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis, Arch Phys Med Rehabil, 2004;85: 1694–1704.
  86. Teri L, Gibbons LE, McCurry SM,et al., Exercise plus behavioral management in patients with Alzheimer disease: A randomized controlled trial, JAMA, 2003;290:2015–22.
  87. Holmes C, Boche D, Wilkinson D, et al., Long-term effects of Abeta42 immunisation in Alzheimer’s disease: Follow-up of a randomised, placebo-controlled phase I trial, Lancet, 2008;372: 216–23.
  88. Wilcock GK, Black SE, Hendrix SB, et al.; Tarenflurbil Phase II Study investigators. Efficacy and safety of tarenflurbil in mild to moderate Alzheimer’s disease: A randomised phase II trial, Lancet Neurol, 2008;7:483–93.
  89. Aisen PS, Gauthier S, Vellas B, et al., Alzhemed: A potential treatment for Alzheimer’s disease, Curr Alzheimer Res, 2007;4:473–8.
  90. Doody RS, Gavrilova SI, Sano M, et al.; Dimebon Investigators, Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer’s disease: A randomised, double-blind, placebocontrolled study, Lancet, 2008;372:207–15.
  91. Study Group, Safety, efficacy, and biomarker findings of PBT2 in targeting abeta as a modifying therapy for Alzheimer’s disease: A phase IIa, double-blind, randomised, placebo-controlled trial, Lancet Neurol, 2008;7:779–86.
  92. Qiu C, Winblad B, Fratiglioni L, The age-dependent relation of blood pressure to cognitive function and dementia, Lancet Neurol, 2005;4:487–99.
  93. Ott A, Andersen K, Dewey ME, et al.; EURODEM Incidence Research Group, Effect of smoking on global cognitive function in nondemented elderly, Neurology, 2004;62:920–24.
  94. Reitz C, den Heijer T, van Duijn C, et al., Relation between smoking and risk of dementia and Alzheimer disease: The Rotterdam Study, Neurology, 2007;69:998–1005.
  95. Biessels GJ, Staekenborg S, Brunner E, et al., Risk of dementia in diabetes mellitus: A systematic review, Lancet Neurol, 2006;5: 64–74.
  96. McGuinness B, Todd S, Passmore P, Bullock R, The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease, Cochrane Database Syst Rev, 2006;(2):CD004034.
  97. NICE public health guidance 16, Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care, London: National Institute for Health and Clinical Excellence, 2008.
  98. Lliffe S, Manthorpe J, The hazards of early recognition of dementia: A risk assessment, Aging Ment Health, 2004;8:99–105.
  99. Gove D, Ethical and legal aspects of dementia in the European Union. In: Warner M, Furnish S, Longley M, Lawlor B (eds), Alzheimer’s Disease: Policy and Practice Across Europe, Oxford: Radcliffe, 2002:27–60.
  100. Pratt R, Wilkinson H, Tell Me the Truth, London: Mental Health Foundation, 2001.
  101. Fearnley K, McLennan J, Weeks D, The right to know? Sharing the diagnosis of dementia, Edinburgh: Alzheimer Scotland Action on Dementia, 1997.
  102. Audit Commission, Forget me not 2002: Developing mental health services for older people in England, London: Audit Commission, 2002.
  103. Tuokko H, Tallman K, Beattie BL, et al., An examination of driving records in a dementia clinic, J Gerontol B Psychol Sci Soc Sci, 1995;50:S173–81.
  104. Rossor MN, Dementia and driving: European national guidelines. EFNS Scientist Panel on Dementia, Eur J Neurol, 2000;7:745.
  105. Ott BR, Anthony D, Papandonatos GD, et al., Clinician assessment of the driving competence of patients with dementia, J Am Geriatr Soc, 2005;53:829–33.
  106. Molnar FJ, Patel A, Marshall SC, et al., Clinical utility of officebased cognitive predictors of fitness to drive in persons with dementia: A systematic review, J Am Geriatr Soc, 2006;54: 1809–24.
  107. Breen DA, Breen DP, Moore JW, et al., Driving and dementia, BMJ, 2007;334:1365–9.
  108. Freeman EE, Gange SJ, Munoz B, West SK, Driving status and risk of entry into long-term care in older adults, Am J Public Health, 2006;96:1254–9.
  109. Iliffe S, Wilcock J, Haworth D, Obstacles to shared care for patients with dementia: A qualitative study, Fam Pract, 2006;23:353–62.
  110. Renshaw J, Scurfield P, Cloke L, Orrell M, General practitioners’ views on the early diagnosis of dementia, Br J Gen Pract, 2001;51:37–8.

Copyright® 2012 Touch Group PLC. All rights reserved.
Touch Neurology is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations.