Recently, the National Institute on Aging and the Alzheimer's Association released new guidelines for diagnosing the full spectrum of Alzheimer's disease, understanding that the disease process may begin many years, even decades, before the actual diagnosis is made. This update, the first in almost 30 years, could quickly double or even triple the number of identified cases, chiefly by finding them earlier.
The new criteria establish a “preclinical stage” in which there is the possibility of brain and biomarker changes but no apparent clinical symptoms. The next, “mild cognitive impairment due to Alzheimer's,” are those individuals with memory impairment that does not affect their ability to be successful in daily life. Finally, there is “dementia due to Alzheimer's disease,” which predominately classifies those we see in our long-term care environments today. This includes individuals with not only memory deficits but additional losses that make their ability to live alone or unsupervised unsafe at best.
Right now, 5.4 million Americans are diagnosed with Alzheimer's disease; 35 million worldwide. When those numbers grow two- or threefold, the implications will be enormous and far-reaching. Aside from added demands on strained medical budgets, both personal and public, the sudden expansion of the Alzheimer's and dementia population raises concerns about the abilities of an already substandard healthcare system.
For healthcare professionals, the new guidelines demand greatly expanded education on diagnosis and its aftermath. Too few physicians and other medical professionals understand the entire spectrum of Alzheimer's. Fewer still are schooled in how to work with individuals with dementia or how to counsel and support families.
Persons with dementia can be happy and engaged if given caring, thoughtful attention. That attention can only be provided by staff members who are properly screened, trained and supported in their work. It does not take a major financial investment to achieve that ideal, but it does require a profound change in corporate culture and philosophy of care. Of all the changes that the new Alzheimer's landscape will require, better leadership practices can make the deepest, most lasting difference in how we care for millions of vulnerable people. And the time is now to not only prepare, but to ensure a better life for those who currently suffer and those who love them.
Susan D. Gilster, PhD, FACHCA, NHA, Fellow; and Jennifer L. Dalessandro, BS, NHA, developed and manage the Alois Alzheimer Center in Cincinnati, which opened in 1987 as the first freestanding dementia facility in the United States. For more information, visit
The new Alzheimer's diagnostic criteria are available at www.alzheimersanddementia.org/content/ncg.
Long-Term Living 2011 July;60(7):53