New Alzheimer Guidelines: What They Mean for Psychiatrists and Their Patients

New diagnostic criteria for Alzheimer disease (AD)-jointly issued by the National Institute of Aging and the Alzheimer’s Association in 2011-update the guidelines that had been widely used for the last 30 years.

Here, in the first of his 2 podcasts (for Part 2, please click here), Christopher van Dyck, MD,  discusses these key advances in the new guidelines:

• The new criteria formalize different stages of AD disease
• The new criteria incorporate biomarkers of the underlying disease process

For the past 30 years, AD has been diagnosed and treated as a single stage disease (ie, dementia). In the new criteria, dementia is considered end stage disease. The focus has shifted to earlier diagnosis of AD; in the near future, the focus is expected to be on treatment at an earlier stage.

Over last several years, a number of biomarkers in AD have been studied. These fall into 2 categories:
• Amyloid deposition (reduction in soluble amyloid; increase in amyloid deposition)
• Neuronal injury (increase in Tao protein; evidence of brain atrophy on MRI scan; evidence of metabolic reduction on PET scan)

Dr van Dyck also discusses:
• Abeta42, a cerebral spinal fluid “signature” that appears to predict progression to AD
• Amyloid PET imaging just approved in April 2012 to detect amyloid plaque in the brain

Teaching points:

The new guidelines consist of 2 key advances:

(1) Formalized stages of AD now assist clinicians in making earlier diagnoses. These consist of the preclinical or presymptomatic stage; the mild cognitive impairment (MCI) stage; and the dementia stage
(2) Biomarkers for amyloid pathogenesis and neuronal injury can now be clinically identified to detect the underlying disease process

Disclosures:

Dr van Dyck is Professor of Psychiatry at Yale School of Medicine and Director of the Alzheimer’s Disease Research Unit at Yale in New Haven, Connecticut.