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Alzheimer’s diagnosis revamp embraces rating scale similar to cancer

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16 July (Reuters) – Alzheimer’s disease experts have revamped the way doctors diagnose patients with progressive brain damage, the most common type of dementia, to improve their cognitive and biological health. We have devised a seven-point rating scale based on change.

Draft guidelines released by experts in a report presented at the Alzheimer’s Association’s conference in Amsterdam on Sunday include measures to assess disease progression similar to those used to diagnose cancer. A numerical staging system is incorporated. It also eliminates the use of terms such as mild, moderate, and severe.

Revisions to replace guidelines published in 2018 call for greater availability of tests to detect key Alzheimer’s disease-associated proteins, such as beta-amyloid in blood, and confirmation of disease pathology before use. A new treatment method was triggered.

According to Dr. Clifford Jack, of the Mayo Clinic in Rochester, Minnesota, and lead author of the report sponsored by the Alzheimer’s Association and the National Institute on Aging, the new system is more accurate and should better reflect a person’s underlying medical conditions. It is said that it is designed to Part of the US government’s National Institutes of Health.

The change would allow doctors to screen patients using Eisai’s (4523.T) and Biogen’s (BIIB.O) drug Rekenbi, which received Food and Drug Administration approval this month, and Eli Lilly’s experimental drug donanemab. was identified and prepared for treatment. Currently under FDA review.

“We are really entering an era of more personalized medicine, where we are starting to see that there are certain biomarkers that are elevated to some extent in people at different stages of life,” he said. said Dr. Maria Carrillo, the Institute’s Chief Scientific Officer. Alzheimer’s Society.

In the new diagnostic approach, patients will receive a score from 1 to 7 based on the presence of aberrant disease biomarkers and the degree of cognitive change. The system also contains four biological stages ranked a, b, c, and d. For example, stage 1a is when you are completely asymptomatic but have abnormal biomarkers.

“Stage 1a is the beginning of evidence that someone actually has the disease,” Jack said.

In Stage 2, individuals may have abnormal biomarkers and exhibit very subtle changes in cognition and behavior. Stage 3 roughly corresponds to the current presymptomatic stage known as mild cognitive impairment, while stages 4, 5 and 6 correspond to mild, moderate and severe dementia.

The new scale also includes Stage 0 for people with a definitive gene for developing Alzheimer’s disease. This category includes people with Down syndrome, 75% of whom will develop Alzheimer’s disease in adulthood.

Noting that the new system resembles cancer stages, Jack said, “There is no such thing as low-grade breast cancer. They are numerical stages.” Jack also noted that many other conditions can cause dementia, but not all dementia is Alzheimer’s disease.

The proposed guidelines are intended for use in clinical practice by physicians, as many face the prospect of offering their patients for the first time treatments that not only treat symptoms but also slow the course of their disease. .

A spokeswoman for the Alzheimer’s Association said the draft guidelines are open for expert review and comment and will be revised later to reflect their input.

Alzheimer’s disease is characterized by brain changes, such as amyloid-beta plaques and neurofibrillary (tau) tangles, that lead to the gradual destruction of memory and thinking abilities and the loss of neurons and their connections.

The 2018 guidelines intended for research use incorporated existing techniques for detecting Alzheimer’s disease proteins based on PET scans of the brain and examination of cerebrospinal fluid, but these techniques do not include the lumbar spine. It was accessible only by puncture. Such tests were expensive and were not typically used in standard medical practice.

Reported by Julie Steenheisen of Chicago.Editing: Will Dunham

Our criteria: Thomson Reuters Trust Principles.

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