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Neurodegenerative Diseases Alzheimer’s Disease
patients with early-stage AD are increasingly requesting involvement programme.
26
Additionally, mean net social benefits of US$94,000
in future treatment planning.
23
Among the cognitive domains, the level were reported for 10,000 trials for a particular Monte Carlo analysis,
of awareness affects the efficacy of some interventions.
24
As this assuming a drug treatment effect (MMSE/L) for a 70-year-old
cognitive function deteriorates with advancing disease, a diagnostic married woman with a starting MMSE score of 26.
26
These analyses
and interventional strategy could be beneficial if carried out quite show that early detection of AD followed by pharmacological
early in the disease process, when the level of awareness is near intervention and care-giver support results in large, positive net
normal. By contrast, if the diagnosis is not made at all or only when social benefits. These findings also indicate that the attitude of
the patient experiences severe health problems, the patient would healthcare professionals towards AD will have to change, with
have various complications, for example aggression, agitation, physicians aiming to diagnose and treat AD as early as possible,
delusions, hallucinations and weight loss. At this point, the family paying particular attention to the oldest sufferers as they are most
would be confused and would not be able to understand the patient’s likely to experience the greatest problems and be the largest
condition or why the diagnosis was not made earlier. This could also consumers of LTC services.
cause problems for the physician; for instance, the family could blame
or question the physician’s decision to make a diagnosis only when Conclusions
the patient’s health had significantly deteriorated. While some physicians and health professionals may be reluctant to
diagnose AD, this lack of diagnosis can result in numerous problems
Patients with AD, their family members and their care-givers can be related to the symptoms of disease, with advancing disease resulting
placed under great emotional and financial burden due to the in significant deterioration in clinical symptoms, dependence on care-
patient’s declining cognitive and functional abilities. The burden on givers and the need for professional LTC services. Diagnosing AD
family members and care-givers, plus the deteriorating cognitive as early as possible will allow the opportunity to achieve a good
ability of the patient, often leads to the latter requiring formal LTC quality of life for patients, family members and care-givers for a
services, which can be costly to the patient and family members. longer period of time. For all of these reasons, it is important to
Instead, if AD is diagnosed as early as possible, there would be a diagnose AD early in the course of the disease, regardless of the
high chance of managing disease progression and reducing the patient’s age. Once detected, AD can be managed by the medical
symptoms, leading to either delayed or reduced need for entry into staff, the patient and the family circle. The worst situation would be to
nursing homes and consequently cost savings for the patient and handle impairment, suffering and end-of-life care for an unknown
family members. Other benefits would include improved economic diagnosis. The GP has a special role in detecting and following up
efficiency and better quality of life for the patient and the individuals patients with AD, especially the oldest of the aged patients. A task
supporting him or her. In one study, Monte Carlo cost–benefit force discussed the importance of an early diagnosis of AD at the
analyses evaluated the costs and benefits of the early identification world congress of the International Association of Gerontology and
and treatment of AD patients.
25
The analyses used LTC cost data Geriatrics in July 2009. The speakers provided an update on
from Wisconsin and data about the potential benefits of biomarkers, imaging technologies and the usefulness of various early-
pharmacological and non-pharmacological therapies (e.g. care-giver stage diagnostic tools as part of therapeutic monitoring, and
support). The net benefits have been shown to be the highest when discussed neuroradiological biomarkers that could enable
cases are identified at earlier stages, e.g. at an MMSE score of 28,
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assessment of disease progression during clinical trials using new
and when drug therapy is combined with a care-giver intervention compounds that target amyloid protein or other lesions. n
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