Alzheimer's diagnosis revamp embraces rating scale similar to cancer
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[July 17, 2023]
By Julie Steenhuysen
(Reuters) -Alzheimer's disease experts are revamping the way doctors
diagnose patients with the progressive brain disorder - the most common
type of dementia - by devising a seven-point rating scale based on
cognitive and biological changes in the patient.
The proposed guidelines, unveiled by experts on Sunday in a report
issued at an Alzheimer's Association conference in Amsterdam, embrace a
numerical staging system assessing disease progression similar to the
one used in cancer diagnoses. They also eliminate the use of terms like
mild, moderate and severe.
The revamp - replacing guidelines issued in 2018 - was prompted by the
increased availability of tests detecting key Alzheimer's-related
proteins such as beta amyloid in the blood and new treatments that
require confirmation of disease pathology prior to use.
The new system is designed to be more accurate and better reflect a
person's underlying disease, according to Dr. Clifford Jack of the Mayo
Clinic in Rochester, Minnesota, lead author of the report sponsored by
the Alzheimer's Association and the National Institute of Aging, a part
of the U.S. government's National Institutes of Health.
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The change comes at a time when doctors are preparing to identify and
treat patients with Eisai and Biogen's drug Leqembi, which won Food and
Drug Administration approval this month, and Eli Lilly's experimental
drug donanemab, which is now under FDA review.
"We really are getting into an era of much more personalized medicine,
where we're starting to understand that there are certain biomarkers
that are elevated to certain degrees in people in different stages,"
said Dr. Maria Carrillo, chief scientific officer for the Alzheimer's
Association.
Under the new diagnostic approach, patients would receive a score of 1
to 7 based on the presence of abnormal disease biomarkers and the extent
of cognitive changes. The system also includes four biological stages
ranked a, b, c and d. For example, Stage 1a is when a person is
completely asymptomatic but has abnormal biomarkers.
"Stage 1a is really the beginning of evidence that someone has the
disease," Jack said.
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![](../images/071723PIX/health31.jpg)
Dr. Seth Gale points out evidence of
Alzheimer's disease on PET scans at the Center for Alzheimer
Research and Treatment (CART) at Brigham And Women's Hospital in
Boston, Massachusetts, U.S., March 30, 2023. REUTERS/Brian
Snyder/File Photo
![](http://archives.lincolndailynews.com/2023/Jul/17/images/ads/current/peasleymemorials_lda_2022.png) In Stage 2, an individual may have
abnormal biomarkers and very subtle changes in cognition or
behavior. Stage 3 is roughly equivalent to the current
presymptomatic stage known as mild cognitive impairment, while
stages 4, 5, and 6 are equivalent to mild, moderate and severe
dementia.
The new scale also includes a Stage 0 for people who carry genes
that guarantee they will develop Alzheimer's. This category includes
people with Down Syndrome, 75% of whom develop Alzheimer's as
adults.
Noting the new system's similarity to cancer stages, Jack said,
"There's no such thing as mild breast cancer. They're numeric
stages." Jack also noted that many other conditions can cause
dementia but not all dementia is Alzheimer's disease.
The proposed guidelines are intended for doctors to use in clinical
practice as many face the prospect for the first time of offering
patients treatments that can slow the course of the disease, rather
than just treat symptoms.
The draft guidelines are open for expert review and comment and will
be revised later to reflect that input, according to a spokesperson
for the Alzheimer's Association.
Alzheimer's, which gradually destroys memory and thinking skills, is
characterized by changes in the brain including amyloid beta plaques
and neurofibrillary, or tau, tangles that result in loss of neurons
and their connections.
The 2018 guidelines, which were intended for research use,
incorporated existing technologies for detecting Alzheimer's
proteins based on PET scans of the brain and tests of cerebrospinal
fluid, which were only accessible via a lumbar puncture. Such tests
were costly and not typically used in standard medical practice.
(Reporting by Julie Steenhuysen in Chicago; Editing by Will Dunham)
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