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Alzheimer's Cases Could Double With New Guidelines: Expert
Date:4/19/2011

By Amanda Gardner
HealthDay Reporter

TUESDAY, April 19 (HealthDay News) -- The first new guidelines in 27 years for the diagnosis of Alzheimer's disease could double the number of Americans defined as having the brain-robbing illness.

The guidelines, issued Tuesday by the Alzheimer's Association and the U.S. National Institute of Aging, differ in two important ways from the last recommendations, which have been in use since 1984.

First, Alzheimer's is now being recognized as a continuum of stages: Alzheimer's itself with clear symptoms; mild cognitive impairment (MCI) with mild symptoms; and also the "preclinical" stage, when there are no symptoms but when recognizable brain changes may already be occurring.

Second, the new guidelines incorporate the use of so-called "biomarkers" -- such as the levels of certain proteins in blood or spinal fluid -- to diagnose the disease and assess its progress, but almost exclusively for research purposes only.

Still, the authors of the guidelines emphasized that these revisions are unlikely to change what happens in doctors' offices when diagnosing Alzheimer's or its precursors.

"It will not change practice," said Dr. Guy M. McKhann, one of the guideline authors, at a Monday press conference.

MCI will, however, become a new diagnosis. And that could mean that the number of people considered to be on the new Alzheimer's continuum could double, said Marilyn Albert, another author, director of the division of cognitive neuroscience at Johns Hopkins. But how MCI is determined won't change.

The new U.S. National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease now recognize three clear stages of Alzheimer's disease.

The first and most severe is Alzheimer's dementia, when patients are clearly cognitively and functionally impaired. This is to be characterized now not just by memory loss but also visual,
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