Developments in diagnosis and management of Alzheimer's

With our ageing population, and growing focus on caring for that population, managing dementia is an increasingly challenging topic. As with other disabilities, there is a whole segment of the population that acts as unpaid caregivers providing vital support for aged persons with various cognitive impairments. Improvements in diagnosis, treatment and appropriate palliative care are all in great demand as the stresses placed on health services and social support systems reaches saturation. Two new articles in BMC Medicine examine the latest research in Alzheimer’s Disease (AD) from opposite ends of the spectrum.

Wagner Gattaz and colleagues provide an update for researchers interested in the early diagnosis of AD. It is extremely difficult to diagnose AD early because no significant cognitive impairment is obvious using standard clinical measures at the very earliest stages of pathogenesis. New developments in characterizing AD-related biomarkers in cerebrospinal fluid may aid efforts to diagnose AD in its initial stages. With the caveat that translation to clinical practice may be some way off, the hope is that early diagnosis will allow pharmacological interventions to have an effect before dementia takes hold.

There has so far been little research into understanding the burden of mental health problems on family caregivers for AD patients once their relative is taken into clinical care. Research from a consortium of geriatricians in the United States, led by Joseph Gaugler, set out to identify key predictors of clinically persistent depression in caregivers in the first year after institutionalization of the AD patient. Understanding the prevalence of depression in caregivers should allow appropriate development of screening processes to identify families who are at risk following institutionalization.

Early tackling of AD at the same time as improving care in the community is a key to combating this debilitating disease and is the underlying principle of a recent update from NICE to allow the treatment of mild cases of AD with medication on the NHS in the UK.



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