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New Definition of Alzheimer’s Would Expand Diagnosis to People Without Memory Problems

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A debate has simmered in the world of Alzheimer’s research and treatment: Should the disease’s definition be expanded to older adults who have a higher risk of dementia, but currently lack memory problems?

The answer to that question, at least according to certain researchers, is yes. As noted in a recent Los Angeles Times article, a panel of experts discussed a proposal at the Alzheimer’s Association International Conference to expand the disease’s definition to millions of older adults who test positive for elevated levels of two proteins, amyloid or tau.

The proposal would classify certain people who test positive for abnormal protein levels as living with stage 1 Alzheimer’s. They would move on to stage 2 if they develop “neurobehavioral difficulties” like depression or anxiety, according to the Times. When older adults start to experience mild cognitive changes, they would be at stage 3 of the disease.

The plan could be published in a medical journal and approved soon, according to the Los Angeles Times.

According to researchers, someone with elevated levels of those proteins has a 23% higher risk of developing Alzheimer’s in their lifetime. But they are not guaranteed to develop the disease, either – hence part of the controversy of the new definition.

Proponents of the change, according to the Los Angeles Times, say it is aimed at diagnosing and treating older adults as early as possible, including with new drugs, before more severe symptoms develop. Blood tests are also now accurate enough to detect higher levels of the proteins involved in the diagnosis.

In a response, the American Geriatric Society has said that expanding the definition of Alzheimer’s in such a way could risk overdiagnosis, which “could lead to initiation of treatments with limited benefit and high potential for harm.” Older adults with a dementia diagnosis might additionally face discrimination from employers or insurers.

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The organization also criticized what it saw as “wholly inappropriate” conflicts of interest within the working group that proposed the change, which had ties to the pharmaceutical industry.

In recent years, the memory care industry has seen an influx of exciting and novel treatments for memory care. But some such treatments also carry the risk of serious side effects.

Dr. Madhav Thambisetty, a senior researcher at the National Institute of Aging, told the Los Angeles Times that the plan lies in “untested, uncharted territory.”

“I’m not at that stage where I would be able to make a diagnosis of Alzheimer’s disease in somebody who’s cognitively normal based on the presence of a single biomarker,” he told the publication.

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