We all get a little scared when we see our parents and elders gradually losing their memory as they get older. "Is this the beginning of Alzheimer's disease?" The question is in the back of our minds. Until now, Alzheimer's disease has usually been diagnosed by examining a person's memory and looking for symptoms such as behavioral changes. But now, a group of world-renowned medical experts have come up with a big proposal to change this system. They say that instead of waiting for symptoms to appear, we should use biological evidence in the body to diagnose this disease before it occurs.
Why is such a new system needed?
You might be thinking, "Why change this system? Is there something wrong with the current system?" Actually, the current system only diagnoses the disease after there has been some damage to the brain and its effects have started to manifest as symptoms. That means it's a little too late to get a diagnosis.
But this is the main idea of this new proposal.
Alzheimer's disease should be defined biologically, not based on symptoms.
Simply put, just like a detective looking for clues before a crime is committed, the goal is to detect changes in the body before symptoms appear and diagnose the disease. The reason for this is that, with the recent advances in medical science, new testing methods have been developed that can detect such biological clues. This allows patients to know about their condition much earlier, make decisions about their lives accordingly, and seek necessary treatment sooner. Also, sometimes there may be other diseases that show similar symptoms to Alzheimer's disease. Thanks to this new method, it is easier for doctors to accurately and quickly identify whether it is really Alzheimer's or another disease.
What are these biomarkers?
When you hear the word " biomarkers ," you might think it's a big, complicated word. But it's actually quite simple. Think of our bodies as cars. When something starts to go wrong with the car's engine, sometimes a warning light comes on on the dashboard, right? Similarly, when something starts to go wrong in our bodies, we see signs of it in our blood, cerebrospinal fluid, or other tissues. That's what we call biomarkers.
When it comes to Alzheimer's disease, there are two main biomarkers.
1. Beta-amyloid proteins: These accumulate in the brain and form small clumps (plaques).
2. Tau proteins: These accumulate inside nerve cells in the brain and form tangles.
Until now, the only way to accurately detect the presence of these proteins was through specialized (and expensive) brain scans. But now, new blood tests have been developed that can easily measure the levels of these proteins. This is the biggest breakthrough in this proposal.
A staging system like that of cancer
You've probably heard of cancer. After a cancer is diagnosed, doctors classify it into stages such as "Stage 1" and "Stage 2." This gives the patient and those treating them a clear understanding of the severity of the disease and how far it has spread.
Now, these experts are proposing to introduce a similar staging system for Alzheimer's disease. According to this system, a patient is classified into stages 0 to 6. This classification is based on the presence of the aforementioned biomarkers, as well as the subtle cognitive changes in memory and behavior. This will allow the patient and family to clearly understand at what stage of the disease they are.
How does this new phased system work?
This proposed system is still under discussion, but as it stands now, the classification of stages is as follows.
| Stage | Meaning and description |
|---|---|
| Stage 0 | These people have no symptoms, no biomarkers, but they do have genes that put them at higher risk of developing Alzheimer's in the future (e.g., people with Down syndrome). |
| Stage 1 | These people also have no symptoms . Their memory is fine. But they find out that they have biomarkers related to Alzheimer's during a blood test or scan. |
| Stage 2 | There are also biomarkers, and very subtle changes in memory, behavior, and thinking that begin to occur. These may not have a major impact on daily functioning. |
| Stage 3 | This is similar to what we currently call "Mild Cognitive Impairment." Symptoms such as memory loss become more apparent. |
| Stages 4, 5, 6 | These three stages are similar to what we currently call mild, moderate, and severe dementia. Symptoms are obvious, and it becomes difficult to perform daily tasks. |
There are advantages and challenges to this method.
The biggest advantage of this new method is that it can detect the disease very early . Therefore, those who are in this early stage can benefit the most from new treatments.
But there is a big challenge and a lot of controversy. Imagine if you were to tell a healthy person, with no forgetfulness or symptoms, just by looking at a blood test result and saying, "You have early-stage Alzheimer's disease," what would happen? How would that affect that person's mental health, their insurance policies, and their job? This is something that even some medical experts are questioning. Therefore, if such a diagnosis is given, it is extremely important to provide the patient with the right advice at the same time. This is still being debated among experts.
However, this proposal shows that we are about to make a big leap forward in the diagnosis and treatment of Alzheimer's disease.
Take-Home Message
- Experts suggest that the method of diagnosing Alzheimer's disease should be based on biomarkers found in blood and scans, rather than based on symptoms.
- The main goal of this is to identify the disease before symptoms appear and provide the opportunity for early treatment.
- Like cancer, it has been proposed to introduce a staging system for Alzheimer's disease from stages 0 to 6.
- There are still differing opinions among experts about the ability to diagnose "Alzheimer's Stage 1" if a person has no symptoms, but has biomarkers.
- While all of these are still at the proposal stage, if implemented in the future, they could make a big difference in Alzheimer's care. If you or someone close to you is having memory problems, it's important to talk to your doctor about it.
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