In a recently published article, “Routine Early Dementia Screening ʻA Disaster in Slow Motionʼ,” Dr. Chris Fox, a dementia expert from UEAʼs Norwich Medical School, is reported as advocating for the avoidance of early detection of dementia. Dr. Fox argues that the diagnosis of early dementia long before symptoms are significant can result in both psychological and practical issues for the patient while placing an undue burden on the healthcare system. His solution is to delay the implementation of routine screening for early dementia.
Reading this article inspired me to respond with a total different perspective where early diagnosis and treatment of dementia is considered critical to maintaining quality of life, reducing disability and minimizing costs. As an Alzheimerʼs Disease specialist treating hundreds of patients at all different levels of severity, aggressive medical treatment of early dementia is one of the most exciting aspects of my practice. The benefits of a comprehensive treatment approach for early cognitive loss are far exceeding my expectations.
Arguments against early treatment are based on the traditional perspective of Alzheimerʼs Disease as a disease of the elderly due to the accumulation of amyloid plaques and treatment is of little value. The traditional position is supported by numerous pharmaceutical trials of medications now prescribed for the treatment of dementia. Consistently, the drug trials demonstrated significant but minimal benefits. Although research continues, few scientist are now predicting any new and exciting treatments in the near future.
From the new perspective, effective treatment already exists and early detection is fundamental to its success.The problem with the pharmaceutical data on dementia medication is the trials were performed on people with severe cognitive deficits and disability due to Alzheimerʼs Disease. It is becoming increasingly clear that Alzheimerʼs Disease is strongly correlated with aging and the cause is multifactorial. Amyloid plaques, long believed to be the cause of Alzheimerʼs Disease, are now considered by many experts to be the end product of an aging dying brain. Cognitive deficits are a product of brain cell atrophy and death. Alzheimerʼs Disease medications impact living cells thus one would not expect much benefit for the original patients with severe cognitive deficits due to severe cell loss.
On the other hand, evidence is rapidly accumulating supporting the position that it is possible to intervene and slow down the aging of the brain thus reducing the progression of cognitive deficits. Patients with early dementia still have an abundance of brain cells associated with cognition therefore one would expect a much greater benefit from medication. Physician who adhere to the new perspective of early detection and treatment are finding significant and obvious benefits.
My patients are benefiting in a multitude of ways. A significant majority are experiencing a marked reduction in the expected progression of memory loss. Psychologically, hope dominates, with the knowledge that their dementia was diagnosed and treated early when treatment is most beneficial. Legal and financial issues still exist but with the confidence that there is time to resolve them appropriately. Healthy lifestyle changes, such as diet and exercise, are more acceptable due to their positive impact on brain health and longevity. Relationships are more valued, wanting to maximize the quality of time remaining. Early detection and treatment have replaced the stigma of Alzheimerʼs Disease with a sense of control and empowerment.
The extent of the personal, social and financial benefits of early medical treatment of Alzheimerʼs Disease are debatable. My evidence, although based on scientific data, is anecdotal. Some argue more empirical studies need to be done. Those studies would require decades of research. Who will fund the studies when some of the generic Alzheimerʼs Disease medications cost less than ten dollars per month? What will a physician say to a 70 year old with early Alzheimerʼs Disease… I wonʼt know for ten years whether you need medication now? Dr. Fox advocates waiting. Today, my patients with early Alzheimerʼs Disease are receiving a comprehensive treatment protocol with multiple medications. Dr. Fox refers to early screening as “a disaster in slow motion.” As a physician who daily deals with pain and suffering of a horrible disease, I see early diagnosis and treatment as “a rising tide of hope.”
The debate will continue for many physicians until more definitive studies are published, but at my medical clinic, the debate is over.