New Alzheimer's criteria would change diagnosis for millions

By Rachael Rettner
MyHealthNewsDaily

Almost everyone currently diagnosed with a mild form of Alzheimer's disease would be downgraded to not having the condition, if new proposed criteria for the diagnosis of cognitive problems were applied, a new study shows.

Instead, people diagnosed as having "very mild" and " mild" Alzheimer's disease would be reclassified as having mild cognitive impairment (MCI), which is currently recognized as an intermittent stage between the normal loss of mental function that comes with age and the development of dementia.

The new criteria broaden the definition of mild cognitive impairment, and this will cause confusion when doctors try to diagnose MCI and Alzheimer's, said study researcher Dr. John Morris, a professor of neurology at Washington University School of Medicine in St. Louis.

Moreover, the new criteria highlight the fallacy of thinking about MCI and Alzheimer's as different entities, Morris said.

"[The] idea that there is an MCI stage, distinct from very early Alzheimer's disease, is artificial," Morris said. "It really is the same disease process."

Instead of widening the criteria so more people are diagnosed with MCI, researchers should do the opposite — try to figure how to winnow down the group of patients with MCI to find those who will go on to develop Alzheimer's disease, Morris said. In fact, if a patient's memory and thinking troubles are due to early Alzheimer's, and not due to depression or medication use, "We can just call it very early Alzheimer's disease. There's no need to have this distinction," Morris said.

The report is published online today in the Archives of Neurology.

Previously, mild cognitive impairment was defined as a decline in cognitive function — which could include memory and language problems — that do not interfere with everyday activities.

But the new criteria, proposed by the National Institute on Aging and the Alzheimer's Association, state that people with MCI have "independence in functional activities."

This could mean that, as long as a person can do everyday activities by themselves, they would be classified as having MCI, even if they had mild problems with activities such as shopping, paying bills and cooking, Morris said. (In fact, having mild problems with such activities is a criterion for dementia, Morris said.)

To assess what the impact of the new criteria would be on patients diagnosed with Alzheimer's disease, Morris analyzed information from 17,535 people who had been classified as having normal cognition, MCI or Alzheimer's disease. Participants were classified based on how well they could function performing a variety of activities, including preparing meals and taking mediation.

The results showed 99.8 percent of patients currently diagnosed with very mild Alzheimer's disease, and 92.7 percent of those diagnosed with mild Alzheimer's disease, would be reclassified as having MCI based on the revised criteria.

Considering about 2.5 million people have very mild Alzheimer's disease, the findings suggest that, very roughly, about 2.2 million people could be reclassified as having MCI (although this calculation is speculative), Morris said.

William Thies, chief medical and scientific officer at the Alzheimer's Association, said the proposed criteria for MCI are less than a year old, and experts will likely continue to discuss and tweak them in the years to come.

"We are really now working on trying to identify exactly where people will fit in the continuum of Alzheimer's disease," Thies said.

Thies agreed the disease is a continuous process, and said you could likely not tell the difference between someone with the most severe case of MCI and someone with the mildest case of Alzheimer's disease.

But Thies said he does not think the new criteria will create much confusion. They are intended to be used by experts in the field, some of whom have already been thinking of MCI in the manner described by the new criteria. And others who are very conservative when it comes to diagnosing people with Alzheimer's disease likely won't change their ways, he said.

Thies also said the field should move toward identifying which patients with MCI are actually in the early stages of Alzheimer's disease. This could be done once there are well defined biomarkers for the condition, Thies said.

While the field is moving toward this goal, it will likely be a while before biomarkers are routinely used by doctors to diagnose patients, he said.

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Discuss this post

i wonder how this will affect insurance? will they not have to pay any longer for alzheimers? just a thought but things like this have to do with money in the end.

  • 3 votes
Reply#2 - Mon Feb 6, 2012 5:49 PM EST

Good question - it's always about the money. I know that currently Medicare will pay for a PET scan if a patient is diagnosed with Alzheimer's, although it's not a definitive diagnosis until a brain autopsy is performed. Not sure if an MCI diagnosis will get a PET Scan paid for under Medicare.

  • 2 votes
#2.1 - Mon Feb 6, 2012 8:22 PM EST

1 deleted, more2bits-4021678 with a terrible start, a derail about the POTUS. Post on-topic. You're suspended for a day for violating #4 of the Code of Honor.

  • 1 vote
#2.2 - Wed Feb 8, 2012 7:32 PM EST
Reply

I agree Mr. Blinn the almighty dollar is lurking around this new "classification". My mom had a case of MCI and now they don't even label what is going on anymore- but who knows when she crossed over -the fact is she's declining and whatever it is - it is clearly the memory part of the brain being effected. Does it really matter what it is called? It is a drain on families physically, financially, emotionally... and it will only get worse as more baby boomers enter the medicare system. So clearly I think there may be some posturing taking place here.

  • 4 votes
Reply#3 - Mon Feb 6, 2012 7:05 PM EST

I am surprised although maybe I'm just a bit ahead of myself. Usually something like this happens after a new drug or vaccine is developed. Then they can take the statistics a year or two later and trumpet how the incidence of the disease plummeted after the new drug came on the market.

  • 3 votes
Reply#4 - Mon Feb 6, 2012 7:48 PM EST

So, I have to assume this impacts healthcare coverage as well. Someone diagnosed with this made-up condition is not going to receive the same amount of care and coverage as someone who is diagnosed with Alzheimer's. What a joke. Alzheimer's is Alzheimer's whether in the early stages or the advanced stages.

  • 4 votes
Reply#5 - Mon Feb 6, 2012 8:38 PM EST

Alzheimer's starts like 7 to 10 years before it's actually diagnosed. This MCI sounds like someone trying to get 15 minutes of fame - get written up in some publication and then 5 years late written up again reversing any findings.

This MCI is BS but Pharma will be pushing some drug, feeding BS to the public. The drugs they have for Alzheimer's that Pharma is making massive amounts of profits on -- are no better than giving the person M&M's -- as neither do anything.

  • 2 votes
#5.1 - Tue Feb 7, 2012 4:27 PM EST
Reply

Don't any of you people think this Alzheimers crap is becoming a epidemic just like cancer.It really makes you wonder what the Hell is Really Going On.

Doesn't it Occur to any of you people?

I find it just a tad strange!

  • 2 votes
Reply#6 - Mon Feb 6, 2012 8:53 PM EST

Strange that they would change this and the diagnosis criteria for Autism as well. A lot of backscratching going on.

  • 2 votes
Reply#7 - Tue Feb 7, 2012 2:15 AM EST

First Autism and now this. I guess if we close our eyes and say we don't see anything the disease will just go away. Reclassifying something doesn't solve the problem. It is so sad that our health care system is so messed up that we have now resorted to changing the diagnosis in order to control costs and insurance claims.

  • 3 votes
Reply#8 - Tue Feb 7, 2012 4:32 AM EST

Ever wonder why neurological disorders are becoming more and more prevalent. Look to the skies. Day in and day out we are being bombarded from the air with various elements being dumped from aircraft and other delivery methods. Much of it is oxidized Au. Why? It's called geo-engineering. Google it. Ask why the lines from planes turn into clouds that criss cross the skies sometimes in circled or curved patterns. Look up the American Meteorological Society and the IPCC. Your health is being sacrificed for global warming and you have no say in it.

    Reply#9 - Tue Feb 7, 2012 7:03 AM EST

    i find it rather interesting that so many diseases such as alzheimers and autism are suddenly being redefined along with the sudden change in how often women should have mammograms and men should have prostrate screening. seems more and more will not be covered under our new wonderful all people will be insured health care system

    • 2 votes
    Reply#10 - Tue Feb 7, 2012 8:26 AM EST

    Gotta do everything possible to keep those insurance company's profits hitting records every year....

    • 1 vote
    #10.1 - Tue Feb 7, 2012 4:11 PM EST

    IMHO one reason they are trying to use MCI instead of mild Alzheimers is that Alzheimers, in the early stages, looks just like every other dementia out there. There are many kinds of dementia, and they have different treatments now. someone with Alzheimers, they can use Exelon patches, aricept and a few others. Those drugs will not help someone with Pick's disease or Lewy body dementia. PIck's disease starts the same as Alzheimers but there is no cure for Pick's disease. There are meds that might help alzheimers. But may make Pick's disease worse. so it is probably better to wait to delineate the difference.

      #10.2 - Thu Feb 9, 2012 7:58 PM EST
      Reply

      I guess I fit into this category. The wife accuses me of "selective memory" and especially when she tells me something and an hour later I ask her a question that is exactly what she says she was talking about! Won't even address the sex topic.... may have been a week ago but I insist it's been a month.

        Reply#11 - Tue Feb 7, 2012 8:38 AM EST

        Must be a 'male' thing because my husband has the exact same problem. I fully empathize with your wife.

        • 1 vote
        #11.1 - Tue Feb 7, 2012 8:59 AM EST

        dsb....lol. But I do tell her.."would you rather me NOT desire you dear?"

          #11.2 - Tue Feb 7, 2012 9:08 AM EST
          Reply

          And this is just the start of a whole new criteria for every illness and disease, thanks to ObamaCare. Now the government, instead of doctors and the medical community, get to decide what criteria to use when diagnosing you. When you liberals are sitting in your rocking chairs with drool sliding down your mouth and can't get medical attention becuase your president says you're healthy, remember, you got what you asked for.

          • 2 votes
          Reply#12 - Tue Feb 7, 2012 8:56 AM EST
          Reply

          Jim....agreed sir. Heck, the end result of Obama Care may very well be the recreation of final scene in Solient Green when Charlton Heston yells our..."The wafers ARE people!"

          It is sad that government looks at it's seniors as a bottom-line commodity. Doesn't matter if you work your ass off for 40-50 years paying into the system...god help you when you hang it up and retire. No longer considered a cash cow, a "contributor"....you've out-lived your purpose.

          • 1 vote
          Reply#13 - Tue Feb 7, 2012 9:01 AM EST

          Where is Obama Care...I'd like to sign up? I pay $430 a month for singular me to have a decent Health insurance. My daughter has NO insurance and no reasonable options since she makes minumum wage. Her decision is Healthcare or food! The only thing I see is a fine that she will pay because she doesn't have Healthcare! I have an idea...tell the IRS to take our monthly Healthcare costs right off the top of our income (no taxes on our premiums) and then maybe it will be worth the expense for "good" plans to our citizens!! That sure should cut some red tape and not have to finance committees that spend billions to wonder how we can have Healthcare...that is...if the gov even really cares beyond collecting the fines and the income it generates.

          • 1 vote
          Reply#14 - Tue Feb 7, 2012 9:30 AM EST

          people get old and their brains begin to not function so well. neither do their bones, muscles, eyes or ears. it is a normal, natural part of aging and dying. we used to say they were getting senile. they said my 81 year old father had alzheimers. bull- he was old and his brain was dying along with the rest of him. alzheimers is over-diagnosed, kind of like ADD.

          i have known 2 women in my life, one a dear friend, who have been stricken with "younger onset" alzhiemers. for those of you on here who have never seen this terrifying disease in a younger person, let me explain what happens. "C" was diagnosed on her 49th birthday. 3 years later she died in a nursing home. she was curled up in a fetal position. she recognized no one. she did not know how to chew or swallow. she forgot how to breathe. my dear friend "E" had been behaving oddly. at first we thought maybe she was depressed- her mom had died recently. "e" was an intelligent, active, very organized and involved person. she stopped going out of the house, she stayed in her nightgown all day, she was losing weight rapidly, her immaculent house was starting to look disorganized and messy. depression, right? then she couldn't figure out how to button her clothes or work the dishwasher. at 63 she was diagnosed with alzhiemers. she is 65 now and in a nursing home. it won't be long before she forgets how to breathe. THAT is alzhiemers.

          • 3 votes
          Reply#15 - Tue Feb 7, 2012 9:35 AM EST

          Allison...you are right...it used to be senility...We used to say thngs like "old man Wiggins is just senile, don't pay him no mind...he won't hurt you"...etc. I don't know about you, but senility was always something that just happened to some people as they aged. I don't think we really feared it so much.

          Now, we have this condition/disease called Alzhiemers...AND...it scares the b-jesus out of us. We have become so afraid of the aging/dying process that some can't enjoy their senior years. The best we can hope for is a reasonable amount of health as we go through life. There is a book called "Aging as a Spiritual Practice" authored by Lewis Richmond. It's purpose is to offer a contemplative guide to growing older.

          I am sorry for the loss of your two friends...I have a friend of mine whose entire female line on her mother's side has had Alzhiemers (and her father passed two years ago from it)..she is just waiting her turn...so sad.

          • 3 votes
          #15.1 - Tue Feb 7, 2012 9:55 AM EST

          Allison, there are different dementias that to us would look the same. Dementia is dementia, right? Wrong. There is Pick's disease, Lewy body dementia, atheroschlerosis, strokes, blood clots, etc. I took care of several people once that had Pick's disease. He had been a bush pilot in Alaska, he came home to visit, and every time he'd see something touching on TV, he would burst into tears and cry. then he started having crashes on landings. Finally they took his license away. Then he was tested and he tested with Pick's disease, which is a frontal lobe dementia without the plaques of Alzheimers. He was 52 when he died. Another was 63 when she died. A neighbor died of Lewy Body Dementia when he was about 55. None of these people had Alzheimers plaques. Sad to say, there's other bad things out there too.

          • 1 vote
          #15.2 - Thu Feb 9, 2012 8:03 PM EST
          Reply

          ISIS, thank you for the book referral, i will read it. i could not agree with you more concerning death. we have been taught to fear it, yet it is as normal and natural as being born.

            Reply#16 - Tue Feb 7, 2012 10:14 AM EST

            I have been a nursing home/ hospice nurse for over 20 years. I've seen lots of people die, with cancers, neurological diseases, strokes, etc. And there are some things worse than death. Almost all of them end up iin a nursing home. We love and care for them, even tho they never say a word to us. A good friend of mine was a newlywed at 60. Her husband was diagnosed with ALS about a year after they married. he was starting to do more falling down. One morning, he got up, started breakfast, and fell over dead of a massive coronary. she called to tell me, heartbroken I know. And it was all I could do to contain my relief. because dying of a massive coronary is a whole lot better than dying of ALS. He was lucky. Everybody dies. We try to forget that, but working hospice, i know that everybody dies. I told my daughter, "whatever you do, don't let anybody see me dead." I couldn't stand the thought of people standing around looking at me laying there dead. Other than that, I'm fine with it. Its funny, the things we think up.

              #16.1 - Thu Feb 9, 2012 8:08 PM EST
              Reply

              Given the fact the over 50% of physicians in the workforce today are incompetent and are more interested in the "ch-ching," perhaps it really doesn't really matter what they call the condition. In fact, labeling someone as having "Alzheimer's" is just one of the many ways that physician's mask their own inability to get at the true cause of a person's condition. Typically a spouse or family member (the first to notice changes) is ignored by the physician at the early stage of cognitive impairment and the usual comment from the frontline Doc is that it's all about stress or depression. (Forget that the patient has been constipated for a year prior to onset, and thus is in the middle of a fully reversible metabolic disaster.) So the emphasis is to ignore the family members, get the patient in and out the door with script in hand for stress and schedule a follow-up in a month or so. (Ch-ching times two). When the patient returns, up the dose of whatever was given to offset symptoms, schedule a follow-up and perhaps a referral of some kind (to mainly distance the initial Dr. from responsibility.) This allows the first practitioner to essentially "pass the buck," and off the patient goes into the medical establishment's rat maze, emerging 3 years later in a now serious, irreversible neurodegenerative state, his or her fate sealed. And of course, now the real billing begins, and this is where the medical establishment really cleans up. Alzheimer's is a multi-billion dollar bonanza, there is no doubt.

              Until Doctors deploy definitive diagnostics, they have no business dismissing a patient's condition as early stage Alzheimer's or anything for that matter. They should just say, "I dunno." By the way, real Alzheimer's may not be so much about the tau tangles themselves, but rather also very much about the destructive force of what is left behind at the cellular level, the cellular debris. A recent article from Melbourne, Australia points to iron which precipitates out and collects in the dying nerve/brain cells as something of notice and concern. Iron is essential to cellular respiration, and under normal conditions, comes and goes, but is otherwise very destructive.... you don't want it just hanging around. The Australian scientists found accumulated iron in cells along the path of destruction within the brain. Hardly anyone is currently studying iron's role in neurodegenerative conditions of all kinds. In the meantime, the system is rigged for the Ch-ching. Call it what you like, but to me it's a nightmare.

              • 4 votes
              Reply#17 - Tue Feb 7, 2012 10:24 AM EST

              interesting post randolino. we have wells in this area and a very high level of iron in our water.

                #17.1 - Tue Feb 7, 2012 11:16 AM EST

                Hi Allison,

                Although I am not pointing the finger at our intake of excess levels of iron, and I had not considered high levels of iron in drinking water as an issue, it certainly would be an interesting study. As for our intake of iron, it can't hurt to use filtered water for the heck of it.

                The discussion from the Australian scientists refers more to cellular accumulation of iron rather than high levels of circulating iron. It is possible that the patients examined had normal blood lab tests while they were living. Here is the article:

                http://www.rsc.org/chemistryworld/News/2012/January/alzheimers-parkinsons-neurodegeneration-linked-iron.asp

                For two years, I've been obsessed with the role of excess iron relative to a spontaneous breach in the Blood Brain Barrier, and, although I've wanted to focus on cellular chemistry and electromagnetics, I don't want to overlook things like diet and physical injury.

                • 1 vote
                #17.2 - Tue Feb 7, 2012 12:44 PM EST

                A good friend of mine has hemochromatosis. Too much iron in her body. She was allright when she was younger, due to menstruation. However, after menopause, she has to have blood drawn twice a month, to keep her iron level lower. Hemochromatosis does not have as a symptom, any form of dementia or mind problem. Its all heart, liver and lungs. Dementia is not one of the normal problems of aging with hemochromatosis.

                  #17.3 - Thu Feb 9, 2012 8:11 PM EST
                  Reply

                  To insist that all MCI is Alzheimers is non-sense. However, iIt would be interesting to know how this new classification scheme will effect billing procedures, and if there will be a difference in what is allowable under one classification versus the other. I AM curious just to get some insight at to how the insurance companies are maneuvering. Perhaps it is meant to allow the Ins. Co's to more easily sideline these ("MCI") patients where there are less allowable tests or procedures and thus less cost.

                  If that is the case, then I would be an advocate for labeling all MCI as "Alzheimers" by default, until proven otherwise. Big Ins. is sand bagging enough as it is.

                  • 3 votes
                  Reply#18 - Tue Feb 7, 2012 11:09 AM EST

                  If one has Alzheimer's, exelon patches and aricept would work. It does not work on Pick's disease or Lewy body dementia or hardening of the arteries in the brain. As a nursing home/hospice nurse, spending my two last years of work in a special care unit for dementia patients, I think out of 10 in the unit, maybe 3 acted as if they truly had Alzheimer's. Of course, I'm not a doctor, but I have taken care of these people from beginning to end.

                  • 1 vote
                  #18.1 - Thu Feb 9, 2012 8:14 PM EST
                  Reply

                  The redefinitions of things like autism and dementia are not some kind of plot, and have nothing to do with money. The DSM diagnostic manual has been undergoing a process of updating for the past two or three years. Experts across fields have been meeting in committees, reviewing the scientific literature, and using that information to try to better conceptualize and diagnose mental and emotional conditions. This is the first update in about 20 years, and long overdue. Imagine if medical science had not incorporated any new findings into their diagnostics in twenty years! The new manual will be published in the spring of next year, so committees are coming down to their final recommendations regarding diagnostic criteria, and this is why the information is starting to trickle out into the public realm. Those of us in the fields of psychiatry, psychology, and other mental health professions have known about these proposed changes for about two years and have had the opportunity to offer feedback as part of the process. The insurance companies have nothing to do with this process.

                    Reply#19 - Tue Feb 7, 2012 11:17 AM EST

                    Hi Molly,

                    I believe that is incorrect regarding insurance companies, and in fact Big Pharma is involved as well. There are known conflicts of interest amongst some of those involved in the DSM process.

                    "Each category of disorder has a numeric code taken from the ICD coding system, used for health service (including insurance) administrative purposes."

                    • 2 votes
                    #19.1 - Tue Feb 7, 2012 1:59 PM EST

                    And we have to also consider that the DSM is a document where opinion is used to decide what will be a mental disorder. I was very concerned that suddenly ordinary bereavement is being considered a mental illess. This introduces a host of unnecessary potential government rights-grabs. It reminds me of when the all-male panel considered normal changes in women to be mental disorders. It's a group of people who eventually vote on what should be included, so it is full of human bias--much more art than science. Although it may be useful to categorize mental situations, we have to remember that the ignorant, including in congress and state and local legislatures and councils, will try to use it to push through partisan preferences. The DSM can make or break lives on a shared bias, if improperly used, and those developing it need to realize that a disclaimer isn't going to stop the ignorant or those with an agenda from misusing it.

                      #19.2 - Thu Mar 8, 2012 6:28 PM EST
                      Reply

                      I'm pleased with this change. There are so many people whose family could have them institutionalized or who could lose their rights, just because they've been diagnosed with "Alzheimer's disease." This limits such situations to only those who potentially could be a real danger to themselves or others. My family tends to live into their 90s and 100s, and most of them are clearer-headed at that age than many younger people who are just stressed by overwork. And most prefer to live alone and still do their own laundry, cook for themselves, and get plenty of exercise. They need transportation to shopping, church, and doctors, but not much else. Bravo for this more reasonable way of categorizing people.

                      • 1 vote
                      Reply#20 - Thu Mar 8, 2012 6:20 PM EST

                      If you look hard you will see the following text at the bottom of this article:

                      "A new study is underway involving drugs that may prevent Alzheimer's. NBC's Robert Bazell reports."

                      Don't be too worried about your failing memory. Some will develop Alzheimers, but others will not. This is the same old game being played by the drug industry. Put the fear into the American public then come out with a drug to correct the problem--or as we have seen in recent times, not correct anything and bringing along a mountain of bad side effects.

                      There are many reasons for memory problems: thyroid function, sleep apnea, disturbed sleep, underlying health problem, medications, and the list goes on. For me it was finding out that I had a problem with gluten, something that the CDC thinks effects 1 in three Americans. We are not eating the same wheat as our grandparents ate. It was modified by breeding back in the 60's and people have been getting fatter and fogger since then. So if you feel foggy, have memory problems, find thinking and concentration hard work, you have a lot of gas and have lost ambition, give going gluten free for a month a try.

                        Reply#21 - Fri May 10, 2013 12:00 PM EDT

                        Randolino, I would believe anything asbout health insurance. Do you know that they purchase information from those supermarket rewards cards to see what kinds of food you buy and if they contribute or have the likelyhood of generating health problems they can (and have) refuse and cover approve drugs or medical procedure as it was your own fault you were sick. They will use any reason they not to pay up. If you look like you have a degree and the ability to sue you get better coverage that some Jo Smo with a high school education.

                          Reply#22 - Fri May 10, 2013 12:07 PM EDT
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