A simple ten-minute, ten-word test, administered by office staff, may allow primary care physicians to detect Alzheimer's Disease (AD) in the earliest stages. Early detection and treatment can slow progression of the disease and reduce treatment costs by $200,000 per patient.
    "Current research shows that Alzheimer's is a progressive disease linked to beta amyloid," said William Shankle, MD, medical director of the Shankle clinic at the University of California at Irvine. "We need to reduce beta amyloid to slow the progression of disease just like we need to reduce blood sugar in diabetics and cholesterol in hyperlipidemia."
    Treating AD as a chronic condition is not a new paradigm, he reminded the American Academy of Family Physicians Scientific Assembly in San Francisco. It has long been known that the typical AD patient survives 14 years. The first seven years is characterized by mild cognitive impairment (MCI), which is usually unrecognized.
    The MCI is followed by two years of mild dementia during which the patient becomes increasingly disoriented. The final period is five years of moderate to severe dementia, during which patients finally become unable to care for themselves. Nearly all AD patients are institutionalized by the time they reach severe dementia and eventually die of age-related causes.
    Mild cognitive impairment is usually not recognized as anything more than normal aging, Dr. Shankle noted. As a result, patients are usually not diagnosed until they have already reached mild dementia. Treatment with cholinesterase inhibitors can reduce the rate of decline by 50% for five years or longer, but late diagnosis limits the usefulness of treatment. Patients still progress to the earlier stages of severe dementia and must be institutionalized before death.
    If AD could be detected during the MCI phase, Dr. Shankle continued, patients could be treated for ten years, perhaps longer. Longer-term drug treatment would mean that most would progress only to the moderate stage before death. That would allow most patients to continue living at home for most of their life span. There also is a cost consideration. The difference between home living and institutional living is about $200,000 per patient, he said.
    "There is a significant effect from early detection and long term treatment," Dr. Shankle said. "The problem has been early detection."
    Dr. Shankle's group found that the National Institute on Aging's Consortium to Establish a Registry for Alzheimer's disease (CERAD) 10-word memory test could detect nearly all AD patients during the MCI phase. When analyzed with an advanced algorithm, CERAD identified 97% of patients with MCI, the highest sensitivity reported to date in the literature.
    As adapted by the group, CERAD can be administered by anyone in the physician office using a computer. While the patient is being tested, the family fills out a traditional questionnaire. The total time commitment is 10 minutes by office staff and 10 to 13 minutes by the physician. Dr. Shankle recommended screening for all adults over the age of 50 in order to detect and treat AD at the earliest stage possible.