Evidence-Based Reviews

New Alzheimer’s disease guidelines: Implications for clinicians

Current Psychiatry. 2012 March;11(3):15-22

References

1. Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):257-262.

2. Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):280-292.

3. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):270-279.

4. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):263-269.

5. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939-944.

6. Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington DC: American Psychiatric Association; 2000.

7. Ihl R, Frölich L, Winblad B, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of Alzheimer’s disease and other dementias. World J Biol Psychiatry. 2011;12(1):2-32.

8. Chertkow H, Massoud F, Nasreddine Z, et al. Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ. 2008;178(10):1273-1285.

9. McKhann GM. Changing concepts of Alzheimer disease. JAMA. 2011;305(23):2458-2459.

10. Galasko D. Biomarkers in non-Alzheimer’s dementias. Clinical Neuroscience Research. 2004;3(6):375-381.

11. Desai AK, Grossberg GT, Chibnall JT. Healthy brain aging: a road map. Clin Geriatr Med. 2010;26(1):1-16.

12. Wilson RS, Hoganson GM, Rajan KB, et al. Temporal course of depressive symptoms during the development of Alzheimer disease. Neurology. 2010;75(1):21-26.

13. Bremner JD, Narayan M, Anderson ER, et al. Hippocampal volume reduction in major depression. Am J Psychiatry. 2000;157(1):115-118.

14. Yaffe K, Fox P, Newcomer R, et al. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA. 2002;287(16):2090-2097.

15. Mittelman MS, Haley WE, Clay OJ, et al. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006;67(9):1592-1599.

Depression and AD. Having depression nearly doubles one’s risk of developing AD later in life, and depression may exacerbate AD.¹² Although the precise mechanism linking depression to AD is unclear, depression seems to exert a toxic effect on the hippocampus.¹³ Treating depression may prevent or mitigate the rate of memory impairment and overall AD severity and improve a patient’s quality of life, overall health, and ability to function.

Clinical Point

In the MCI and dementia phases, biomarkers can help determine the level of certainty that AD is responsible for the patient’s symptoms

Almost one-third of family caregivers become depressed while helping a family member with DAT.¹⁴ Directing caregivers to peer support groups and providing them with tips on how to take care of themselves physically, emotionally, and psychologically can be extremely beneficial. Data suggest that improving the psychological and emotional well-being of caretakers may delay nursing home placement of patients with DAT.¹⁵ Delaying nursing home placement can substantially improve quality of life and reduce the financial strain on patients and caregivers.

Patients and families often turn to clinicians for advice on what problems they or their loved ones may encounter if they suffer from cognitive impairment. One benefit of the new guidelines is that they can help us become educated about the early phases of AD as well as the long and often difficult course of the disease. In turn, we can better educate our patients and their families about the disease.

Clinical Point

Clinicians can use the new guidelines to better educate patients and families about AD

As early screening of AD improves, patients in the early phases will have an opportunity to take part in clinical trials for potential pharmacologic treatments of the disease. Our role as clinicians will be to guide patients and their families to such trials and give them the opportunity to help change our understanding of and approach to treating AD. It is important to keep in mind that the new guidelines should not be considered final, but rather as a work in progress that periodically will be revised as AD research progresses.³

Table 3

Promoting healthy brain aging

Healthy diet (eg, Mediterranean diet)
Adequate sleep
Daily exercise
Smoking cessation
Active, socially integrated lifestyle
Leisure activities
Cognitive stimulation
Optimize treatment of depression and other mental illnesses
Meditation and other mindfulness strategies (eg, yoga)
Spiritual activities
Controlling vascular risk factors (hypertension, diabetes, dyslipidemia, and obesity)
Source: References 8,11

Related Resources

Alzheimer’s Association. www.alz.org.
National Institute on Aging. Alzheimer’s disease education and referral center. www.nia.nih.gov/alzheimers.

Disclosures

Drs. Kimchi and Desai report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Dr. Grossberg is a consultant to Baxter, Forest Laboratories, Merck, Otsuka, and Novartis.