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General News    H3'ed 4/22/11

Lost your keys: You now have Alzheimer's

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Here's the headline of the N.Y. Times article: Guidelines Allow Earlier Definition of Alzheimer's  Now the one from the A.P syndicated article: New guidelines define Alzheimer's disease, pre-dementia; hopes for earlier diagnosis and care

My headline on this diary is an exaggeration, the choosing of a title that will gain readership rather than be the most accurate.  It's no big deal that I did it, but becomes pretty important when the Associated Press and The New York Times does something similar.  Both headlines mention Pre-dementia, something that they describe as the diagnosis that is now, and will be more frequently given by general practitioners as described by one researcher:

Marilyn Albert, a Johns Hopkins University researcher who led the mild cognitive impairment panel, described this category as "people who have mild, progressive symptoms, changes in mental abilities, usually memory but not always memory" that stop short of full-blown dementia.

In doctors' offices around the country, "people are coming in with much milder symptoms," and many but not all will go on to develop Alzheimer's, she said.

How can doctors tell what's going on?

First, they try to determine how fast symptoms are progressing, and do tests to rule out an obvious cause such as a stroke or a new medication. If symptoms are gradual and progressive, doctors would likely diagnose mild cognitive impairment due to Alzheimer's. But they wouldn't know for sure without additional tests like the experimental biomarker and imaging scans rapidly being developed and researched, Albert said.

There are many mostly elderly people who, by choice, would volunteer to be studied, to engage in prospective research including cognitive tests and examination of biomarkers of every kind.  This would provide more understanding of this disease than millions of people going to minimally trained primary physicians who will diagnose this more subtle decline in memory, and prescribe drugs that do not prevent actual Alzheirmer's and are closer to being placebos from companies with political clout.

The projected cost of Medicare is unsustainable based on demographics and current effective treatments, even before this new expansion of early Alzheimer's diagnosis that assumes a cure without any evidence that it will be found.  With this announcement we have turned a universal part of aging, forgetfulness to some degree or another, into a disease. This was done without analysis of the financial cost of medicalizing this aging process, at the very moment when Medicare, the provider of treatments that are shown to actually prevent debility and death is under attack. 

The assumption of identifying pre-dementia is that a cure for this disease will be forthcoming once we expand this official diagnosis. There is no evidence of this; as this loss of cognition may be integral to the aging process that is as innevitable as death itself. 

The theoretical model that expands on this is antagonistic pleiotropy  It describes certain conditions as the evolutionary trade off between a vibrant youth and the decline of aging. While considered diseases, they are not.  And example is the evolution of the mammalian eye, that includes the specialized lens which while clear in youth, but starts to darken with age.  There was no evolutionary pressure against the adaptive mutation that may have given us a magnificent clear lens in our youth, at the cost of cataracts when older, since senescence and it's distresses is of no interest to our selfish genome.  It is simply an accident that some conditions such as replacing a cloudy lens is now easy, while the infinitely barely understood process of cognition are intractable, perhaps for a very long time. As of now, in spite of billions invested, unlike other diseases such as cancer or cardiac illness, there has been no treatment that forestalls Alzheimer's even for a short time.

Never addressed in any of the articles on this new guideline for pre-dementia is the effect on individuals of being labeled with this debility.  This official diagnosis. given its dire prognosis, becomes the primary identity of the individual.  Where is the research on how this affects one's well being, or even cognition itself, improvement of which is the justification for this massive increase those with a medical condition.  This psychological loss itself, whether or not it shortens life, certainly diminishes its quality.
I just went back to the N.Y. Times article I linked above, and read a good number of the 80 comments.  Most, like I, are angry, for most of the reasons I describe.  Does anyone here remember the earlier term for Alzheimer's, "Second Childhood."  That's what we fear, being infantilized, losing our autonomy before it's absolutely necessary.  I also see this as part of the seemingly intractable movement for expanding every type of treatment, or diagnosis, whether or not it is effective. 

The full articles I linked above are more nuanced than their headlines.  They do state that this diagnosis of pre-dementia is only for research, but that will not reach patients, and probably not doctors.  The financial rewards are too great as the numbers of such older people who fit the description is almost limitless. 

We can't reduce the aggregate cost of health care without cutting its components. The optimistic expectation that a cure must be available for this condition  is not biologically supported---and no one would want it to be so more than I.  But, I and according to the response to the Times article, the vast majority of those at risk feel that indulging in this illusion could cause immense damage, both to individuals who are stigmatized, and to our nations fiscal survival.  

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Retired Commercial Printing Executive, developer of I.T. systems for the industry. Advanced degrees in Social Psychology, now living in Southern California
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