HEALTH & SCIENCE

Alzheimer's treatment needs intensify role of primary doctors

Experts hope dementia prevention options become as routine as those for other common medical problems.

By Victoria Stagg Elliott, AMNews staff. Aug. 11, 2003.

The incidence of Alzheimer's disease is expected to more than triple in the coming decades. And new treatments and research into prevention will put primary care physicians on the front lines of dealing with the debilitating condition.

Much of the management and treatment of the disease has been largely in the realm of the specialist. But with the emergence in the past few years of modestly effective treatments for Alzheimer's that work primarily in the early stages, primary care physicians are already under increasing pressure to diagnose the disease early.

"The most urgent thing clinically is identifying people who, by the nature of the illness, won't present themselves for care," said Richard J. Ham, MD, director of the Center on Aging at West Virginia University in Morgantown. "Most people don't get diagnosed until they've had the disease for years."

Early detection remains extremely challenging. Diagnosis of mild cognitive impairment may indicate the patient eventually may develop full-blown Alzheimer's, but it also may not. Treatment efficacy remains modest if it works at all.

"The issue that the researcher and the clinician face is trying to figure out if somebody, especially over the age of 65 or 70, is experiencing cognitive impairment because of depression, heart disease or medications they take, or are they on the way to dementia," said Steven DeKosky, MD, chair of the Neurology Dept. at the University of Pittsburgh. "With medicines that interfere with the course of the dementia earlier, you need to know whether you're giving the medicine to the right person for the right reason."

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