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8A Daily News – Saturday, October 1, 2011 FEATURES New Alzheimer's guidelines and earlier detection Q: My elderly mother recently got lost while out on a walk in the neigh- borhood where she's lived for more than 30 years. She's also started forgetting things. I'm worried that these may be the first signs of Alzheimer's disease. I plan to discuss my concerns with her doctor soon. In the meantime, how is Alzheimer's diagnosed, and what sort of tests might the doctor order? Dr. K by Anthony L. Komaroff, M.D. Blood tests and CT or MRI brain scans are often part of this process of elimination. In April 2011, the National Insti- tute on Aging and the Alzheimer's Association released revised guidelines for the diagnosis of A:Diagnosing Alzheimer's disease can be tricky. There's no direct test for Alzheimer's or for the risk of developing it. Your mother's doctor will likely want to evaluate her mental health and rule out other medical conditions. Typically, doctors take a two-pronged approach to diagnosing Alzheimer's. First, they ask the patient questions and may have them fill out a questionnaire used to assess memory and thinking. This helps the doctor see if the patient's functional state is consistent with Alzheimer's or if it might indicate a different brain disease. Second, doctors order various tests to rule out other conditions that can affect mental functioning. Alzheimer's disease. The new guidelines divide Alzheimer's into three phas- es. In the "preclinical" stage, there are no symp- toms but changes have occurred in the brain that might result in symptoms later on. During the "mild cognitive stage, deficits in thinking begin to surface, like diffi- culty learning new informa- tion. During this stage, peo- ple are still able to live rela- tively normal lives. The final stage is dementia caused by Alzheimer's dis- ease. The term "preclinical phase" is intended for research purposes. It's not meant to promote screening for Alzheimer's in people without symptoms. Most doctors would first suspect Alzheimer's when a person displays changes of mild cognitive impairment. The guidelines also emphasize tests that mea- overnight doesn't mean that these guidelines won't have some effect. PET scans and spinal fluid tests are likely to become more common in cases when the diagnosis isn't clear-cut. Some clini- cians envision a two-tier system for Alzheimer's diagnosis. One tier for gen- eral practice would not include PET scans and other expensive tests. The second tier, intended for specialized centers that handle difficult or unusual cases, would. impairment" sure changes in the brain that are associated with Alzheimer's disease. These tests include positron emis- sion tomography (PET) scans of the brain. Tests of the cerebrospinal fluid, which surrounds the brain and spine, may contain clues to what is going on in the brain. Most experts believe that accumulations of a protein called beta-amyloid in the brain indicate Alzheimer's disease. Companies have invested millions in devel- oping PET scans and other tests to detect beta-amyloid. But about 30 percent of peo- ple who test positive for beta-amyloid have no cog- nitive impairments. Addi- tional factors may be need- ed for Alzheimer's to devel- op. For now, the PET scans and cerebrospinal fluid tests aren't ready to be incorpo- rated into everyday medical practice. The tests haven't been standardized. Basic issues, like the cut-off points between normal and abnormal, haven't been set- tled. The new guidelines may influence how doctors think about Alzheimer's disease to some extent. But major changes in diagnostic pro- cedures often occur only after insurance companies, Medicare and other payers agree to cover the cost of new scans and lab tests. Moreover, it's not clear at this point whether more elaborate — and expensive — diagnosis would have a meaningful effect on the treatment of Alzheimer's. The drugs available to treat Alzheimer's are modestly effective at best. And the drugs don't stop the under- lying disease process in the brain. Just because diagnosis isn't going to change The outlook can seem bleak for those diagnosed with Alzheimer's. None of the drugs specifically aimed at slowing the disease's progress have panned out. But the new guidelines could lead to earlier detec- tion of the disease. Experts hope that this will lead to clinical trials involving peo- ple at earlier stages, when drugs and other interven- tions may be more effec- tive. Stay tuned for new research. But meanwhile, proceed with your plan to get your mother evaluated and then work with her doc- tor to develop a plan to bol- ster her general health, mental function and per- sonal safety and care. Whatever her diagnosis, she's likely to benefit from your help and concern. Shameless subterfuge seriously stumps seniors authorized retailer YOUR CUSTOMER SERVICE CENTERS Dear Annie: A group of us plays Mexican train dominoes every Monday at the senior center in our town. In the past few months, we have come to realize that one woman is cheating. It's not a ques- tion of money, but rather one of fairness. Each person puts in a dollar, and whoever has the lowest score gets the pot. It ranges from $4 to $6, depending on how many people play. How should we approach this? — Aggravated Domino Player Dear Player: If you know how she is cheat- ing, you should call it to her attention at the time. (''Doris, if you've had that domino in your hand all this time, why didn't you play it earlier?'') 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Dear Annie: Our mother has Alzheimer's dis- ease, and we don't think Dad is tak- ing proper care of her. Mom seems undernourished. Dad thinks a slice of toast or a cup of coffee constitutes adequate caloric intake for her. If she says ''no'' to food, he simply accepts that response without try- ing to encourage her to eat. Her clothes are now several sizes too big. Mom has emotional outbursts and periods of uncontrollable crying, and she frequently screams out, thus making a good night's sleep impossible for either of them. It is difficult for her to walk more than 15 feet. Dad doesn't assist her consistently, and she has fallen numerous times. Annie's Mailbox by Kathy Mitchell and Marcy Sugar Personal hygiene seems a thing of the past. Their home, which once sparkled, is now dirty and disorga- nized. We have offered to clean, do household chores, etc., but our offers fall on deaf ears. We gave Dad the name of a local specialist, but he refuses to call. We contacted their family doctor, who said he was unable to convince Dad that Mom needs to go into assisted living. Dad seems to relish being the martyr and con- stantly complains about having to do everything. We understand that after 50-plus years of mar- riage, this must be extremely difficult for him. My siblings, our spouses and the grand- children do not know what to do next. — Car- ing Kids in California Dear Caring: It can be traumatizing for one spouse to place another in a facility of any kind, and a certain paralysis can set in, preventing major deci- sions and changes. You and your siblings need to step up to the plate right now. Call the Eldercare Locator (www.elder- care.gov) at 1-800-677- 1116 and ask for assis- tance. If you can afford it, also try the National Association of Profes- sional Geriatric Care Managers (caremanager.org). Annie's Mailbox is written by Kathy Mitchell and Marcy Sugar, longtime editors of the Ann Landers column. Please e-mail your questions to anniesmailboxcomcast.n et, or write to: Annie's Mailbox, c/o Creators Syndicate, 5777 W. Century Blvd., Ste. 700, Los Angeles, CA 90045. KIDS' CARNIVAL FOR CHRIST at the MANTON APPLE FESTIVAL in Manton Sat., Oct. 1ST • 9 am - 4 pm Games • Prizes • Raffle Sponsored by Christians for Christ