Catching Alzheimer's early

By Sheryl Theessen

Alzheimer’s is often perceived as an old-person disease, but a new checklist is hoping to detect it when the person is still young.

That new patient status, which was introduced at the July Alzheimer’s Association International Conference in Toronto, is resonating with those who live with Alzheimer’s disease.

This new status is called mild behavioural impairment (MBI) and is defined as a pre-dementia syndrome in people who are younger than the typical dementia sufferer.

MBI may be an indicator of a later diagnosis of mild cognitive impairment (MCI), when neuro-degeneration is identified. If behavioural issues can be identified in the early stages of the illness, before any other changes are apparent, there is more information to work with.

It appears MBI develops many years before cognitive decline becomes apparent, and researchers have proposed an initial checklist to identify behavioural impairment symptoms.

With the checklist, they hope to take the focus on cognitive and memory-based issues and broaden it to assist physicians identify changes in behaviour — changes that are visible to close friends and family members, such as disorientation, confusion, depression and anxiety.

That information might lead to a treatment to stop this illness in its infancy, before the damage to the brain cannot be undone.

The draft of this checklist looks at five categories, or domains, of behavioural symptoms.

The questions in each category are meant to address a younger population and to emphasize behavioural changes that are a significant change from prior behaviour and have existed for a period of six months.

The first domain describes interest, motivation and drive.

  • Some questions look at loss of interest in friends, family or activities, loss of spontaneity, loss of motivation, a decrease in affection and a lack of care about aspects of life that were once important.

The second domain describes mood or anxiety issues.

  • Questions look at any development of sadness or low spirits, discouragement, worry, tension or the inability to relax, feelings of panic, feelings of failure.

The third domain describes behaviour control, impulses, delaying of gratification, and changes in reward.

  • The questions concern agitation, aggression, unreasonableness, frustration, argumentativeness, recklessness, and changes in eating habits, hoarding, and repetitive behaviours.

The fourth domain looks at societal norms and social graces

  • Questions are about insensitivity to other’s feelings, openly talking about private matters not usually brought up in public, lack of social judgment, treating strangers in a familiar manner, making rude, crude or lewd remarks that are out of character.

The fifth and last domain describes strongly held beliefs and sensory experiences.

  • The questions look at whether there are beliefs about being in danger or thatothers are planning to harm or steal from them and suspiciousness about the intentions of others, unrealistic beliefs about themselves, talking to imaginary people or seeing things that are not there.

It is hoped that a final checklist may become available as a tool for caregivers of older adults with dementia to assist them with documenting the changes they may be witnessing inthose they care give for.

This checklist has been developed by the International Society to Advance Alzheimer’s Research and Treatment (ISTAART).

Remember, that this checklist is only a proposal and is not being administered by physicians at this time.

To view the complete checklist of 34 questions, Google MBI checklist.

More information about MBI can be found online. 

Sheryl Theessen was the primary caregiver to her husband, an early onset Alzheimer’s patient, until his move in to a care facility earlier this year. She can be reached at [email protected]

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