Alzheimer’s Disease Experts Introduce New Rating Scale for Diagnosis
July 16 (Reuters) – Alzheimer’s disease experts have announced a significant change in the diagnosis of patients with the progressive brain disorder. The most common type of dementia will now be diagnosed using a seven-point rating scale that takes into account both cognitive and biological changes in the patient. The new guidelines were unveiled on Sunday at an Alzheimer’s Association conference in Amsterdam.
The new rating scale, which replaces the guidelines issued in 2018, is based on a numerical staging system similar to the one used in cancer diagnoses. It eliminates the use of terms like mild, moderate, and severe. The decision to revamp the guidelines was prompted by the increasing availability of tests that detect key Alzheimer’s-related proteins, such as beta amyloid, in the blood. Additionally, new treatments require confirmation of disease pathology before use.
According to Dr. Clifford Jack of the Mayo Clinic in Rochester, Minnesota, the lead author of the report, the new system aims to provide a more accurate reflection of a person’s underlying disease. With the approval of drugs like Eisai and Biogen’s Leqembi and Eli Lilly’s experimental drug donanemab, which are set to revolutionize Alzheimer’s treatment, it is crucial to have an improved diagnostic approach.
The new diagnostic system assigns a score of 1 to 7 to patients based on the presence of abnormal disease biomarkers and the extent of cognitive changes. It also includes four biological stages ranked a, b, c, and d. For example, Stage 1a signifies a person who is completely asymptomatic but has abnormal biomarkers. “Stage 1a is really the beginning of evidence that someone has the disease,” said Dr. Jack.
Stage 2 indicates that an individual might have abnormal biomarkers and subtle changes in cognition or behavior. Stage 3 is 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 individuals who carry genes guaranteeing the development of Alzheimer’s, including individuals with Down Syndrome.
Dr. Maria Carrillo, chief scientific officer for the Alzheimer’s Association, emphasized the shift towards more personalized medicine. “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,” she said.
Dr. Jack highlighted the similarity between the new system and cancer stages, stating that “There’s no such thing as mild breast cancer. They’re numeric stages.” He also acknowledged that many conditions can cause dementia, but not all dementia cases are attributed to Alzheimer’s disease.
The updated guidelines are intended for use by doctors in clinical practice as they prepare to offer patients treatments that can slow the course of the disease, rather than just treating symptoms. Alzheimer’s is a devastating disease that gradually impairs memory and thinking skills. It is characterized by changes in the brain, including the presence of amyloid beta plaques and neurofibrillary tangles.
The 2018 guidelines were primarily designed for research use and relied on costly tests such as PET scans and lumbar punctures to detect Alzheimer’s-related proteins. The new guidelines take advantage of advancements in technology and the increased availability of tests, making them more accessible for standard medical practice.
The updates in diagnosis guidelines mark a significant milestone for Alzheimer’s treatment, offering hope for better patient outcomes and more targeted therapies. As research continues to advance, a more comprehensive understanding of the disease is emerging, leading to better diagnostic tools and treatment options.
Reporting by Julie Steenhuysen in Chicago; Editing by Will Dunham