Doctors Talk Frankly About What Encourages and Impedes Early Diagnosis of Alzheimer's

Doctors Talk Frankly About What Encourages and Impedes Early Diagnosis of
Alzheimer's

VIENNA, Austria, July 12 /PRNewswire-USNewswire/ -- A doctor's positive
attitude to Alzheimer's diagnosis and their trusting, personal relationships
with local dementia support service providers are powerful enablers for early
diagnosis of Alzheimer's, according to new research reported today at the
Alzheimer's Association 2009 International Conference on Alzheimer's Disease
(ICAD 2009) in Vienna.

(Logo: http://www.newscom.com/cgi-bin/prnh/20090529/ICADLOGO )

Current data suggests that less than 35 percent of people with Alzheimer's
disease or other dementias have a diagnosis of the condition in their medical
record (Boise et al., 2004; Boustani et al., 2005; Ganguli et al., 2004;
Valcour et al. 2000). While there is currently no cure for Alzheimer's, early
detection and diagnosis is critical to ensuring that people living with
Alzheimer's have the power to plan their own healthcare and future, according
to the Alzheimer's Association.

"By getting diagnosed late in the progression of the disease, opportunities
are missed to make key decisions about treatment, care and, future planning.
Being diagnosed early is vital to receiving the best help and care possible,
living one's life to the fullest, and capitalizing on opportunities such as
participating in clinical studies," said William Thies, PhD, Chief Medical &
Scientific Officer at the Alzheimer's Association.

Dr. Nerida Paterson, Senior Lecturer in the Discipline of General Practice at
the University of Newcastle, Australia, and colleagues are interviewing more
than 100 general practitioners (GPs) from four Australian research sites,
taping and transcribing the interviews, and analyzing the content for themes
and insights that can improve the diagnostic process.

"Increasing evidence suggests that early diagnosis of Alzheimer's and timely
intervention is beneficial, both for people with the disease and their
caregivers," Paterson said. "Because doctors are the primary entry way to
healthcare services for the elderly and the usual point of contact with the
health system for individuals with dementia and their caregivers, there
remains a need to overcome their attitudes of 'therapeutic nihilism'
surrounding dementia."

According to Paterson, "therapeutic nihilism" is a belief that there is no
recognized cure or effective treatment for an illness, and therefore treatment
or intervention in any form is not important.

At ICAD 2009, Paterson reported an interim analysis including interviews with
25 GPs.

The most cited enabler to early Alzheimer's diagnosis is a doctor's positive
attitude to the diagnosis and treatment of dementia. In addition, GPs reported
that having a trusting, personal relationship with individuals who provide
dementia support services is a powerful enabler for dementia diagnosis and
management. Most of the GPs reported that referral to support services for
legal and financial planning, patient education, and caregiver support is an
important part of disease management.

Additional factors that encourage early Alzheimer's diagnosis include: support
from relatives and caregivers, belief in the patient's right to know, and the
desire of GPs to be honest and open with their patients.

According to the researchers, the most frequently cited barriers to diagnosis
of dementia in this study are that patients and GPs have differing health
priorities, GPs are largely dependent on being alerted by either the patient
or a relative about symptoms of memory loss, and GPs' challenges with properly
timing referral to support services. Also reported by GPs was fear of damaging
the doctor-patient relationship, especially around the issue of declaring the
patient's inability to drive safely.

"Older patients frequently have complex and overlapping illnesses involving
multiple body systems. Often these diseases are having a bigger impact on
their day to day lives than mild cognitive impairment. As a result, when they
see the doctor, their priority is to have their non-cognitive health needs
addressed," Paterson said.

According to the study, this is especially true if the person is also a
caregiver. GPs reported that caregivers tend to downplay their own needs and
behave as though they cannot afford to become ill and give up their caregiving
role. They reported that caregivers spend most of their appointments
discussing the person for whom they are a caring, and not their own health
needs.

If a patient appeared to be functioning well, GPs in this study were less
likely to suspect cognitive impairment. GPs reported that a cognitive deficit
is more often brought to their attention by a relative or caregiver than by
the patient; an informant is seen as vital for early diagnosis.

GPs also identified that they find it difficult to remember to re-offer
referral to Alzheimer's support services to patients and caregivers. GPs
generally suggest these services soon after the diagnosis is made. However,
patients and caregivers are still adjusting to the diagnosis at this time and
may be suffering from denial, anger and guilt and often reject the referral.
When they are ready to accept support, the GP is often unaware that their
attitude has changed.

The researchers recommend that doctors should be educated to have a higher
level of suspicion for symptoms of cognitive decline, especially in caregivers
and people with complex, multi-system diseases, and that GPs should offer
referrals to support services for people with dementia and caregivers on
multiple occasions during the diagnostic and treatment process.
A literature review on early diagnosis of dementia and diagnostic disclosure
in primary care conducted by the same researchers and also presented at ICAD
2009, reinforced these themes and suggested that the involvement of practice
and community nurses in the diagnostic process may overcome some of the
barriers and improve detection rates.

About ICAD 2009
The 2009 Alzheimer's Association International Conference on Alzheimer's
Disease (ICAD 2009) brings together more than 3,000 researchers from 70
countries to share groundbreaking research and information on the cause,
diagnosis, treatment and prevention of Alzheimer's disease and related
disorders. As a part of the Association's research program, ICAD 2009 serves
as a catalyst for generating new knowledge about dementia and fostering a
vital, collegial research community. ICAD 2009 will be held in Vienna, Austria
at Messe Wien Exhibition and CongressCenter from July 11-16.

About the Alzheimer's Association
The Alzheimer's Association is the leading voluntary health organization in
Alzheimer care, support and research. Our mission is to eliminate Alzheimer's
disease through the advancement of research, to provide and enhance care and
support for all affected, and to reduce the risk of dementia through the
promotion of brain health. Our vision is a world without Alzheimer's. For more
information, visit www.alz.org.

-- Nerida E. Paterson, et al - Early diagnosis of dementia in primary
care
in Australia: A qualitative study into the barriers and enablers
(Funder: National Health and Medical Research Council, Australia.)

-- Nerida E. Paterson, et al - The barriers to the early diagnosis of
dementia and diagnostic disclosure in primary care (Funder: Dementia
Collaborative Research Centres, Australia.)

SOURCE Alzheimer's Association

Alzheimer's Association media line: +1-312-335-4078, media@alz.org; or ICAD
2009 press room, July 11-16: +43 (0)1 931020 7501