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The Alzheimer Cooperative Valuation in Europe (ALCOVE) recommends Alzheimer's disease (AD) diagnosis to occur earlier than common practice today; at the time when patients and their family first notice changes in cognitive function and can use the information to make sense of what is happening, make lifestyle changes, and plan for the future.2
Patients and their families are the main beneficiaries of an earlier diagnosis due to following reasons:3-6
Understanding the Cause of Mild Cognitive Impairment (MCI)
An accurate diagnosis of what is causing an individual’s cognitive decline may reduce anxiety by addressing concerns about early symptoms. Prompt evaluation and treatment of the reversible causes of MCI may also shorten the patient journey.
Improved quality of life for both patients and caregivers.
Medical Benefits
Enabling prompt treatment of symptoms and coexisting conditions that may worsen cognitive functions (including behavioral symptoms; e.g., anxiety, depression, or impaired sleep.).
Potential safety issues and challenging behavior can be addressed ahead of time, such as problems with driving or wandering, risk of falling, financial mismanagement, vulnerability to scams, etc.
Participation in a clinical trial and contribution to important research to help future generations with the disease may lead to psychological benefits. Additional benefits include receipt of high-quality care at leading institutions, close monitoring/management of symptoms, of symptoms, and opportunities for education about the disease.
Evaluation of the Alzheimer's disease profile leads to a better prognosis of expected progression and is an initial step towards a person-centered care approach.
Prevention: Risk Reduction of Cognitive Decline
Prevention of stroke and reducing vascular risk factors may reduce risk of progression from MCI to dementia through:
- Blood pressure control
- Diabetes control
- Smoking cessation
Lifestyle changes to delay and reduce cognitive decline through:
- Regular physical exercise
- Healthy diet
- Social interactions and engagement
- Mental stimulation
- Smoking cessation
- Adequate sleep
Emotional and Social Benefit
Individuals and family members can learn what to expect for the future and plan accordingly. It is important to encourage the development of coping strategies to handle future changes in a patient's function. It can also open doors to the many training, education, and support programs available to individuals and family members to facilitate relationships with others living with Alzheimer’s.
Individuals can maximize time spent engaging in activities that are meaningful to them and spending time with the important people in their lives.
Answers to the patient's & care partner's concerns about early symptoms may help reduce anxiety and emotional burdens as worrisome symptoms are finally given a name.
Planning for the Future
Multi-disciplinary support to patients and care partners helps them prepare for the future (e.g., disease education, moving closer to members of one's support network, and medical/legal/financial/social support).
During MCI stage of AD individuals are cognitively able to make decisions and understand available choices.
Development of a person-centered support within the clinic has shown to improve patient stress level and mood and to reduce depression while improving caregiver confidence.
Evolving Care Team
Primary care physicians are on the front line in caring for patients across the disease continuum and play a critical role in the referral pathway.
Continuity of care between different care providers and an integrated, patient-centered approach are required across all settings to enable optimal disease management, to improve health outcomes and enable well-being in older age.
Shared management of a person affected with MCI with a specific, individualized treatment and management plan including secondary and tertiary care.
WHAT'S NEXT
Overcoming barriers in the diagnosis of
early Alzheimer's Disease
Collaboration among all stakeholders is required to improve Alzheimer's prevention, diagnosis, and care.
References
1.Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385(9984):2255-2263.
2.Brooker D, La Fontaine J, Evans S, Bray J, Saad K. Public health guidance to facilitate timely diagnosis of dementia: ALzheimer's COoperative Valuation in Europe recommendations. Int J Geriatr Psychiatry. 2014;29(7):682-693.
3.Dubois B, Padovani A, Scheltens P, Rossi A, Dell'Agnello G. Timely Diagnosis for Alzheimer's Disease: A Literature Review on Benefits and Challenges. J Alzheimer's Dis. 2016;49(3):617-631.
4.Alzheimer’s Disease International. World Alzheimer Report 2011: the benefits of early diagnosis and intervention. https://www.alz.co.uk/research/world-report-2011. Accessed January, 2022.
5.Alzheimer's Association. Alzheimer's Association Report: 2018 Alzheimer's disease facts and figures. Alzheimers Dement. 2018;14:367-429.
6.Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines. Geneva: World Health Organization; 2019. https://pubmed.ncbi.nlm.nih.gov/31219687/. Accessed January, 2022.