Substantial Alzheimer's Guideline Changes

A proposed change in guidelines for diagnosing Alzheimer's disease means patients will be examined for signs of the disease after their death even if they never exhibited symptoms suggesting the diagnosis.

Family members could find out for the first time after the death of a loved one that they showed the signs of Alzheimer's disease, marking a substantial change in the way the disease is viewed and studied.

Consult a therapist if you suspect Alzheimer's disease.

The recommendations were developed by the National Institute on Aging and the Alzheimer's Association to replace outdated guidelines adopted in 1997. They are designed to reflect recent research that suggests that the disease may actually begin developing up to 10 years before symptoms are seen.

The guidelines are expected to be finalized by the end of the year, but already have stirred debate about deciding which brain changes are important to the disease process, how they should be measured and how pathologists in different facilities and countries can work under similar standards.

The progressive brain disease is characterized by changes in the brain, including deposits of amyloid protein in clumps or plaques that pathologists could detect during an autopsy. The diagnosis would be made based on combining the scores from three sets of clinical criteria.

Under the current guidelines, a physician would determine whether a patient had signs of dementia. Then a pathologist would determine whether the suspected dementia was from Alzheimer's. The new guidelines suggest pathologists should look for those hallmarks of the disease even if there were never any signs or symptoms.