Sept. 13, 2011 -- As many as three-fourths of the 36 million people worldwide who have Alzheimer's disease or other dementias have not been diagnosed, limiting access to treatment for patients and support for caregivers, a new report finds.
The report was released today by the global patient advocacy organization Alzheimer's Disease International (ADI). It highlights what the group calls the worldwide problem of underdiagnosis and undertreatment of dementias.
The group also called on governments throughout the world to develop national strategies to promote the early diagnosis and treatment of dementia.
"Failure to diagnose Alzheimer's in a timely manner represents a tragic missed opportunity to improve the quality of life for millions of people," ADI chairwoman Daisy Acosta notes in a written statement.
Alzheimer's Disease on the Rise
The global incidence of Alzheimer's disease is projected to quadruple within the next four decades. By the year 2050, it is believed that more than 100 million people will have dementias.
According to the ADI report, only about 20% to 50% of Alzheimer's cases have been identified in high-income countries like the U.S. and only about 10% of cases are diagnosed in low- and middle-income regions.
A review of the research led the investigators to conclude that patients and caregivers get significant benefits from the early treatment and diagnosis of dementia. But the usefulness of current drug therapies for Alzheimer's has long been in question.
There are five FDA-approved drugs available in the U.S. But no new drug has been approved for almost a decade.
The drugs help improve memory and address other symptoms in about 50% of patients who take them, but they typically stop working within six months to a year, Alzheimer's Association Vice President of Public Policy Robert Egge tells WebMD.
And none of the drugs modifies the course of the disease.
"Although these drugs only treat symptoms for a period of time, some patients find that they are a very effective boost for the time that they work," Egge says.
Benefits of Early Treatment
Egge says studies increasingly suggest that the available drugs may work better if they are given to patients very early in the course of disease, even before symptoms become evident.
"A key goal of this report is to raise awareness about the importance of early detection," he says. "It is important to know the warning signs for Alzheimer's and if you see these warning signs get to a physician for evaluation."
Egge says memory loss that disrupts daily life should not be accepted as a normal part of aging.
Among the other early signs that could be cause for concern:
- Having problems completing familiar tasks.
- Losing track of dates, seasons, and the passage of time.
- Having trouble understanding visual images and spatial relationships.
- Having new trouble following or engaging in conversation.
- Changes in mood and personality, and a new lack of interest in hobbies and social activities.
Early diagnosis can benefit patients and family members, Egge says, by giving them more time to plan for future needs.
It could also identify people for studies who are in the very earliest stages of the disease when drug treatments are most likely to work.
Neurologist and Alzheimer's researcher Marc L. Gordon, MD, agrees that it will be increasingly important to identify patients early in the course of their disease as new treatments become available.
Gordon is chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y. "We are hoping to have drugs that are truly disease modifying, but in order to test them we will need to find people in the earliest stages and people who have a high risk for developing dementia," he says. "We aren't there yet, but we are looking at a number of markers that could help us do this."
Effectiveness of Alzheimer's Drugs
Gordon says while the current drug treatments don't work for all patients, they do seem to help some.
"These medications have been shown to have a symptomatic benefit, albeit modest," he says. "If I were a patient with Alzheimer's disease, I would want to be on one of the available drugs."
But gerontologist R. Knight Steel, MD, contradicts some of the report, saying he is not so sure about the effectiveness of current drugs for early Alzheimer's disease.
Steel is chief emeritus for Geriatrics at Hackensack University Medical Center, N.J., and a past-president of the American Geriatrics Society. He says it is misleading to tell patients and family members that available drug treatments and interventions are likely to make a big difference in the course of the disease.
"I have treated many patients with memory loss and dementia," he tells WebMD. "I tell them we can try the drugs, but in truth I have seen very little that convinces me that they work. I'm not saying the drugs don't help some patients. I just can't say that they definitely do."
One problem, Steel says, is that it is difficult to accurately assess improvements in memory and other aspects of cognitive function in patients with Alzheimer's.
"If you give someone a drug to improve kidney function it is not hard to determine if it is working," he says. "But memory is not so easy to measure."