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Clinical Aspects of Alzheimer’s Disease

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By Report by the AD Educ and Referral Ctr • • March 1, 1999

In her overview of the clinical aspects of the disease, Dr. Marilyn Albert, professor of psychiatry and neurology at the Harvard Medical School, Boston, Massachusetts, and head of the Gerontology Research Unit at Massachusetts General Hospital, schooled the journalists in the differences between functional changes with normal aging and those that occur in the progression toward and during AD. On average, she pointed out, noticeable memory changes appear in the 50s, but these are not usually precursors to the disease and there is great variability among individuals. One of the ways to tell whether the changes may be AD-related is to test a person’s ability to retain information after a delay. "If you are healthy and you have learned something very well, you don’t tend to forget it," she noted. In AD, she said, the performance on these tests is "very much worse."

These functional changes correspond to changes in the brain, Dr. Albert explained. She showed dramatic slides illustrating how neurons in the entorhinal cortex, the area of the brain that scientists believe is among the first to be affected by AD, die. The photos provided a stark, graphic view of how the plaques and tangles associated with AD lead to cell death.

The journalists were particularly intrigued with Dr. Albert’s discussion of advances in diagnosing AD. Today, she said, diagnostic accuracy is 90 percent at major medical centers where complex AD workups are done on a regular basis. Elsewhere, though, the clinical diagnosis of AD by the medical community generally has been less reliable. To improve the odds, Dr. Albert noted, efforts to provide diagnostic tools and insights to the ranks of primary care physicians have been stepped up. She pointed to development of clinical practice guidelines by the Agency for Health Care Policy and Research and others, and the journalists were provided copies of some of these guidelines.

While Dr. Albert acknowledged that the ability to treat AD is very limited at this point, she stressed the increasing importance of accurate and early diagnosis in light of "more effective treatments on the horizon." In fact, she pointed out, scientists are now aiming to intervene sooner in the disease process, even seeking to attack AD well before clinical signs of full-blown disease occur. A great deal of effort is underway to find "biomarkers," for the disease, she said, noting that research involving brain imaging and genetic testing show great promise. In Dr. Albert’s own lab, for example, she reported that the use of advanced brain imaging technologies to ascertain changes in the entorhinal cortex looks "encouraging." Ending her talk on a more personal note, Dr. Albert said "I am astonished to be telling you this story today." After 20 years of research, "to really feel that we are on the verge of effective treatments is enormously gratifying," she told the audience.

Source: Connections Magazine [Volume 8(1), Spring 1999]

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