Alzheimer's disease. AMA Council on Scientific Affairs Reference Committee D

Abstract

Objective: This report responds to Substitute Resolution 518, I-96, which asks that the AMA, in cooperation with appropriate medical specialty societies, study Alzheimer's disease (AD) and other dementias, with particular emphasis on their diagnosis and treatment, issues relating to patient and caregiver education, the financing of care of affected individuals, the identification of research needs, and consideration of issues pertaining to the quality of life of individuals with these conditions.

Methods: This report is based on a review of guidelines produced by the Agency for Health Care Policy and Research (AHCPR), the American Academy of Neurology (AAN), the Veterans Health Administration (VHA), and the American Psychiatric Association (APA), combined with review of the latest published literature on AD and related disorders and consultation with experts in the field. This analysis was used as a basis for policy formulation.

Result: The guidelines reviewed were: (1) Recognition and Initial Assessment of Alzheimer's Disease and Related Disorders, published by the AHCPR; (2) Dementia Identification and Assessment, published by the VHA; (3) Practice Parameter: Diagnosis and Evaluation of Dementia. published by the AAN; and (4) Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias of Late Life, published by the APA. These documents are targeted for the following audiences: primary care physicians (VHA and AHCPR), neurologists (AAN), and psychiatrists (APA). Only the APA guide makes provision for continuity of care. The literature review revealed that ongoing research into AD focuses on three broad areas: etiology/risk factors, diagnosis and treatment.

Conclusions: AD is a common and costly public health problem. With the increase in life expectancy in the United States, AD is expected to afflict approximately 14 million people within the next few decades. Irreversible dementia takes a heavy economic, social, physical, and psychological toll on patients and families. The financial costs to society are enormous. There is currently no cure for AD, only interventions that can temporarily ameliorate the profound cognitive losses and behavioral manifestations of the disorder. Community services for AD patients and families are fragmented and underutilized. As traditional gatekeepers for services, physicians can encourage more families to use supportive services. Several valuable guidelines exist related to the diagnosis and treatment of AD and related disorders.