Overcoming the Early Diagnosis Gap in Alzheimer's Disease

Alzheimer’s Disease (AD) qualifies as a genuine medical crisis based on the burden it imposes and the growing population at high risk for developing it. But for all the attention it commands, it may well be one of the most underdiagnosed conditions in contemporary medicine. Long before the pharmaceutical industry trained its sights on AD, neuropsychologists already knew that individual differences in baseline cognition, combined with variability in normal aging, would make it difficult to diagnose people with a neurodegenerative condition based on cognitive changes alone.

Adding to the challenge of diagnosing AD early in the disease are the elaborate patterns of denial and compensatory behaviors used by patients and their families to camouflage the problem.  For years, there was little incentive to uncover AD earlier than it could be “seen” because the interventions were largely unimpressive. But with higher aspirations for newer treatments, there is greater urgency to find relevant patients. Unfortunately, the pace of early diagnosis has yet to truly accelerate, making it difficult to recruit for clinical trials the very patients who are in the best position to benefit from treatment. Delayed diagnosis also makes it more challenging to demonstrate efficacy in the real world because many treated patients classified as “mild” are, in fact, moderately advanced in their disease trajectory by the time they begin therapy.