Alzheimer's Starts Sooner Than Thought

(HealthScout) -- Even minor mental losses may signal the start of Alzheimer's disease, new research shows.

Until now, scientists thought memory lapses and other mild cognitive losses were a natural part of aging. But a study in the current issue of the Archives of Neurology says they usually progress to Alzheimer's disease. And autopsies of those with mild impairment showed nearly all had early Alzheimer's.

"The notion of an inevitable decline in mental faculties with age appears not to be the case. More likely, what previously was believed to be age-associated cognitive decline may have represented what we now recognize as very early AD," says Dr. John C. Morris at Washington University School of Medicine and lead author of the study., "Most individuals who qualify for the diagnosis of a condition termed mild cognitive impairment (MCI) in fact have early-stage Alzheimer's disease."

The findings suggest the disease starts much sooner than many had thought.

Calling the work "one of the most important studies that has come up in a long time," Zaven Khachaturian, chief senior medical science adviser for the Alzheimer's Association, says "the implications are quite profound."

Now retired, Khachaturian was formerly director of Alzheimer's research at the National Institutes of Health (NIH).

"Persistent memory problems should be taken seriously and evaluated by experts," Khachaturian says. "It's serious business because this is one organ, the brain, that determines who we are and our personhood. Your losing it has impact."

According to the Alzheimer's Association, 4 million Americans suffer from the disease and 400,000 are diagnosed with it each year. Dementia is described as a serious loss of the ability to think, reason or remember.

Morris' study tracked 404 people between 45 and 103 for about nine years. Of that number, 227 were diagnosed with MCI and placed in one of three categories: uncertain, suspicious and fairly confident, reflecting researchers' degree of certainty that Alzheimer's had set in. The remaining subjects were healthy at the start of the study.

After just five years, 6.8 percent of the healthy subjects had been diagnosed with Alzheimer's. The same was true for 19.9 percent of those who'd been classified "uncertain," 35.7 percent of those deemed "suspicious," and 60.5 percent of those classified "fairly confident."

And of the 25 MCI patients who had died, 21 had brains with unquestionable evidence of Alzheimer's, lesions that can only be seen in autopsies. Three of the other four suffered from other forms of dementia.

"Even very mild cognitive change may not be normal aging, but rather the initial indication of early-stage AD," Morris says.

The subjects researchers labeled as "uncertain" showed slight evidence of cognitive changes, like regularly forgetting items at the grocery store, says Mary Coats, assistant director of the memory and aging project at Washington University. To move into the "suspicious" category, a subject would need to show more significant changes, like piling up the same 10 items in a freezer.

"It's very small. You have to say that's not a big deal, but that's enough to say, hmm," says Coats, a colleague of Morris'.

To progress to the "fairly confident" category, a subject would need to show signs of problems in at least four of the six critical cognitive areas, which include memory, orientation, judgment and problem-solving, Coats says.

For more than a decade, researchers have believed Alzheimer's was a disease of the aged, says Khachaturian. But this latest research suggests something different.

"It has a long clinical course, which is good news and bad news," Khachaturian says.

The good news is that earlier diagnosis can mean earlier interventions, both Morris and Khachaturian say. Drugs can stall the disease's progress, and the sooner the better. Diagnosis currently comes late, Khachaturian notes: "By that time, so much damage has been done in the brain that it's almost impossible to save or resurrect it."

Do people really want to know they have a crippling disease of the brain?

"People will know they have the disease, and they will have a long period of knowing they have it," Khachaturian says. But it also means they and their families can make plans, he adds.

"I think that individuals with early-stage AD and their families generally prefer to know that the mild cognitive changes that have been observed are caused by something," Morris says. "At least knowing what it is can be useful; not knowing raises all kinds of fears."

When should you worry? If memory or other cognitive problems are bothering you, Khachaturian says, or if those close to you notice a change.

If you're concerned about yourself or a friend or family member, Khachaturian recommends seeing a specialist in memory disorders or a neuropsychologist.

For more information, try the Alzheimer Research Forum. You can also learn more about Alzheimer's at the Alzheimer's Association.

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