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Alzheimer’s debate: Test if you can’t treat it?
“I don’t remember if I had a bath,” said Lesher, who lives north of Harrisburg, Pa. “It took me two hours to follow a recipe. I drove to my childhood homestead the other week instead of my own home. It’s really scary.”
Doctors are arguing about whether to test patients for signs of the incurable disease and tell them the results.
The debate raged this past week at the Alzheimer's Association International Conference in France, where research on new methods _ easier brain scans, an eye test, a blood test _ made it clear there soon may be more such tools available.
Here’s why it’s an issue: Many people have brain plaques, suggesting they might be developing Alzheimer’s even if they don’t have any symptoms. This plaque can be seen decades beforehand and does not ensure someone will get the disease. Many also won’t live long enough to develop symptoms.
For those who do have Alzheimer’s, there are no good treatments. Current drugs ease symptoms _ they work for half who try them and for less than a year on average. Most experts think treatment starts too late, but there’s no evidence that starting sooner or learning you have brain plaque will help. Experts are divided.
But Dr. Kenneth Rockwood of Dalhousie University in Halifax, Nova Scotia, Canada, says there is no data “to show that knowing makes any difference in outcomes. Until we do, this is going to be a tough sell.”
More than 35 million people worldwide have Alzheimer’s, the most common form of dementia. In the U.S., more than 5 million do _ 13 percent of those 65 and over, and 43 percent of those 85 and up, a rapidly growing group.
Still, half of people who meet medical criteria for dementia have not been diagnosed with it, the Alzheimer's Association estimates. And many who are told they have Alzheimer’s or are assumed to have it really don’t.
Even when researchers use the best cognitive tests to enroll people in clinical trials, about 10 percent ultimately are discovered not to have the disease, said William Thies, the Alzheimer's Association’s scientific director.
“The Alzheimer’s drugs don’t work in these folks, so there’s no reason to expose them to those risks,” said Thies, long an advocate of early diagnosis.
Misdiagnosis is a lost opportunity to help. A new medication or combination of medications may suddenly make someone appear demented. Brain fog can occur after surgery and abate over time. Sleep problems are common in older people and can cause profound confusion that can be misinterpreted as dementia, according to research presented at the conference by Dr. Kristine Yaffe of the University of California, San Francisco.
“Some of these are treatable” by avoiding naps during the day or treating sleep apnea, in which brief interruptions of breathing cause people to wake during the night, Yaffe said. Snoring is a big sign. Older people with sleep problems are more likely to be put in nursing homes, she said.
Dr. R. Scott Turner, director of the memory disorders program at Georgetown University Medical Center, has seen that all too often.
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