Recognising Early Symptoms of Alzheimer’s Disease in Routine Clinical Practice
Recognising Early Symptoms of Alzheimer’s Disease in Routine Clinical Practice
European Neurological Review, 2009;4(2):14-6
Abstract
The prevalence of Alzheimer’s disease is expected to significantly increase over the next few decades. Recognising symptoms in the routine clinical setting can be challenging, particularly in the early stages. Memory loss that causes disruption to everyday life may be the first presenting complaint; however, more subtle changes may occur much earlier. These may include difficulty in performing complex activities of daily living, decline in objective neuropsychological testing and apathy, which may be present for a decade before a diagnosis is made. In the non-specialist setting, the Mini Mental State Examination and the clock-drawing test still predominate and there is limited scope for applying tests such as magnetic resonance imaging (MRI) scanning or plasma markers. At present we remain poor at diagnosing Alzheimer’s dementia, particularly in the early stages; therefore, improved awareness of early symptoms as well as a belief in the value of early diagnosis may lead to more effective management of patients.
Keywords
Alzheimer’s disease, dementia, recognising early symptoms, routine clinical practice, function, apathy, diagnosis
Disclosure: This article was initiated and funded by Eisai Europe Limited. Sean Knox is a full-time employee of Eisai Europe Limited. Craig W Ritchie has received honoraria and assistance from the following pharmaceutical and biotechnology companies that market or develop drugs for Alzheimer’s disease: GlaxoSmithKline, Novartis, Eisai, Shire, Abbott, Pfizer, Epix Pharmaceuticals and Prana Biotechnology (in which he has a financial interest).
Received: 7 December 2009 Accepted: 21 January 2010
Correspondence: Sean Knox, European Medical Advisor, Eisai Europe Limited, Mosquito Way, Hatfield, Herts, AL10 9SN, UK. E: sean_knox@eisai.net
In the EU, more than seven million people are estimated to have dementia.1 An ageing population will lead to an increase in dementia cases,1 with prevalence rates in both western and eastern Europe expected to at least double by 2040.2 Worldwide, it is forecast that one in 85 people will be living with Alzheimer’s disease (AD) by 2050.3 In Europe, AD is the most common form of dementia, accounting for approximately two-thirds of cases.4 It is suggested that about half of dementia cases remain undiagnosed;2,5 however, rates of missed diagnosis or under-recognition vary, and a large proportion (up to 90%) of patients with mild disease remain undiagnosed.6,7 Several reasons have been cited for this lack of recognition, including a lack of awareness among care-givers of the symptoms of Alzheimer’s dementia, a lack of recognition of Alzheimer’s dementia by physicians and late referral of patients to a specialist.8 As primary care physicians play a crucial role in the identification, diagnosis and overall management of patients with dementia, their interface with secondary care is of great significance.
Alzheimer’s dementia is the consequence of a degenerative disorder and has an insidious onset. In both sporadic and familial AD, genetic mutations and genetic risk factors will be present at birth. However, multiple environmental factors interact with the ageing process and genetic vulnerability to determine the age at onset of disease and, thereafter, dementia. At the time of the diagnosis of dementia (usuallyin individuals over 60 years of age), pathological changes and cell death have already occurred. As there are currently no validated diagnostic biomarkers available, a definitive diagnosis can only be made at autopsy.9 Clinical diagnosis may be made by using a combination of neuropsychological testing, neuroimaging and plasma, urinary and cerebrospinal fluid markers, but the diagnosis of AD is never 100% accurate until post mortem. In the absence of definitive, widely available and accurate diagnostic tests for AD before the development of dementia, definition of the early stages of cognitive impairment thought to presage Alzheimer’s dementia or represent its earliest manifestations are very much reliant on specific changes in cognition and function, often observed by the patient’s care-givers and family.
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