Alzheimer Guidelines for Diagnosis and Treatment Need to Be Standardized, Scientist Says

Professor Gunhild Waldemar, director of the Danish Dementia Research Center (DDRC), was a guest speaker at the recent Second Congress of the European Academy of Neurology (EAN) in Copenhagen, and she encouraged researchers to work together to develop standardized guidelines for early diagnosis and treatment of Alzheimer’s disease (AD).

She reinforced the notion that effective treatments for AD are possible, and said the pressure to achieve a breakthrough has never been higher, noting: “European science could play a leading role, providing that it adopts a concerted approach and sufficient funds are made available. While research is expensive, standing by helplessly is even more so.”

According to a press release, the cost of treating dementia can climb to 72,500 euros per person per year in the European Union, and up to 70% of these cases can be linked to AD. Experts expect the number of cases worldwide to rise to 75 million in 2030, from 47 million in 2015, due to population aging. In the global economy, dementia is estimated to have cost $818 billion in 2015.

Researchers have not been able to find treatments to stop or reverse AD, because they lack “a better understanding of the neurodegenerative mechanisms,” Professor Waldemar said. “The assumption that dementia is simply an unavoidable part of getting old is plain wrong: half of people aged 90 do not suffer from memory disorders.”

Early identification through biomarkers (either in the blood or spinal fluid), gene testing, and imaging is a priority, she said. The three are crucial to determining the efficacy of new drugs and treatments, and for establishing an early diagnosis of AD, even when symptoms are not evident.

But Professor Waldemar also noted the dangers of biomarker results. “In future we will need medical, ethical and legal guidelines to determine what form these tests should take, when they are appropriate and to guide pre-biomarker counseling in patients,” she said.

She also said that current care of dementia was unsatisfactory, and called for the use of comprehensive, evidence-based public health programs to prevent or delay disease onset.

A Danish study presented at the Congress also showed that dementia patients are often given unsuitable or controversial medication, such as psychotropic drugs to treat the neuropsychiatric symptoms of Alzheimer’s, even though their effectiveness has not been fully proven. In the study, register data of 35,000 patients found that one in every four took more than two antipsychotic drugs on a regular basis.

Another Danish study investigated regional differences in antipsychotic drugs prescriptions for dementia patients, and found that the prevalence of antipsychotic use in the 98 Danish municipalities studied ranged from 7.6 percent to 32.9 percent.

“The fact that some places are prescribing almost five times as many antipsychotics for dementia patients cannot be explained by variables such as age or gender,” Professor Waldemar concluded. “We need evidence-based guidelines for pharmacological treatment and more training for everyone involved in primary health care.”

But the Congress brought good news for coffee drinkers, as Finnish researchers found a mechanism that seems to show how regular coffee consumption might reduce the risk of developing AD. The CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Study presented evidence that four-to-five cups of coffee, consumed daily by middle-age adults, lowers atrophy of the medial temporal lobe — the part of the brain critical for memory function — in old age.