Commentary on “Diagnosis of Alzheimer's disease: Two decades of progress.” Perspectives on “Perspectives”

t m The article by Dr. Zaven Khachaturian is a superb, conise summary of the development of our understanding of ementias in general and of Alzheimer’s disease (AD) in articular. It documents that good leadership from the Fedral Government can be part of the solution. It also provides ound counsel on what needs to be done now. As indicated in that article, improvement in the diagnosis f AD or other dementia in the clinical setting is not now a ressing problem. Dementia can be recognized with confience on the basis of medical history (anamenusis) and europsychological testing. Treatable conditions that conribute to cognitive disability can be detected by the nowtandardized dementia workup, given reasonable clinical cumen on the part of the examiner. Serial brain imaging tudies can indicate whether there is evidence of accelerated trophy even before symptoms become debilitating, in time or people to make appropriate practical arrangements. The iagnosis of AD can be made with more than 90% confience on the basis of a careful evaluation, as documented by number of studies in which patients were followed up until utopsy. The course of AD is hard to predict in any indiidual patient, except for the generalization that worse illess tends to progress more rapidly, ie, that the best availble predictor of the future is the past. However, there is no urrent clinical reason to make the diagnosis in the earliest tages of the disease. People in the age range at risk for AD re also at risk for other debilitating illnesses, such as trokes. They should make sound financial and personal lans including a living will and a health care proxy regardess of whether they might be in the early stages of AD. More pressing problems are scientific: