Primary Care Physicians and Early Detection of Alzheimer's Disease Part I

Published Online: Wednesday, November 11, 2011

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Earlier this year, the National Institute on Aging and the Alzheimer’s Association laid out the first new guidelines for diagnosing Alzheimer’s disease in 27 years. Drawing on research finding that the underlying processes of the disease are set in motion years before any outward signs are evident and that the cognitive decline of those suffering from it proceeds gradually, the new guidelines distinguish between Alzheimer’s dementia and mild cognitive impairment from Alzheimer’s. In the latter, patients demonstrate reduced performance in one or more cognitive areas, but can still carry out their daily activities.
 
Primary care physicians (PCPs) are ideally situated to detect these early signs of Alzheimer’s in their patients, when medication and other therapies have the best chance of helping to slow the disease’s progression. However, studies have found that even when it has progressed to full-blown dementia, Alzheimer’s is widely underdiagnosed in the primary care setting. The challenge of diagnosing and treating Alzheimer’s will only grow as the elderly population in the US doubles over the next four decades. By 2050, the number of Americans over 65 with Alzheimer’s dementia is projected to reach between 11 and 16 million, up from 5.2 million today.¹
 
To get some insight on how PCPs can improve their detection of Alzheimer’s, MD Magazine: Peers & Perspectives spoke with Charles A. Cefalu, MD, professor and chief of geriatrics at the LSU Health Sciences Center School of Medicine at New Orleans, who coauthored a 2010 international position paper on the PCP and Alzheimer’s.² (Editor’s Note: This transcript has been edited for clarity and length. To listen to the entire interview, click here.)

References
1. 2011 Alzheimer’s Disease Facts and Figures. The Alzheimer’s Association.
2. Villars H, Oustric S, Andrieu S, et al. The primary care physician and Alzheimer’s disease: an international position paper. J Nutr Health Aging. 2010;14(2):110-120.

MD P&P: Could you briefly outline what you see as the proper role for primary care physicians in early detection of Alzheimer’s disease?
Cefalu: I think physicians need to be first aware of the frequency of dementia in general as you get up in age, and particularly of Alzheimer’s, which makes up anywhere from 65% on up of the total pie of dementias. So the physician, number one, should have a keen sense that the patient may have some hidden problems and should at least yearly do a brief cognitive assessment to make sure that they are picking up any cognitive dysfunction, and if it is indeed there, to further question the patient and possibly also interview their family members about the situation. It is also important to screen for early signs of depressive symptoms. When there’s cognitive dysfunction, there are also likely to be early depressive symptoms because of the patient’s loss of independence and realization that they’re losing control of their faculties. So I would say that if the initial screening shows evidence that there is cognitive dysfunction, there should be further investigation to determine if there have been any falls, what the nature of the cognitive dysfunction is, has it been a precipitous decline, is it a slow decline. Also, are there any other issues such as neurological deficits that might point the physician into the arena of unusual forms of cognitive dysfunction other than Alzheimer’s?

To read the second part of our interview with Dr. Cefalu, click here.

Join the discussion:

• What challenges have you faced in detecting and treating Alzheimer's disease?