Great public desire to seek early diagnosis of Alzheimer's, according to survey

ScienceDaily (July 20, 2011) — Results of an international survey reveal that over 85% of respondents in the five countries surveyed say that if they were exhibiting confusion and memory loss, they would want to see a doctor to determine if the cause of the symptoms was Alzheimer's disease. Over 94% would want the same if a family member were exhibiting the symptoms. The findings were presented July 20 at the Alzheimer's Association International Conference 2011 (AAIC 2011).

The survey of the U.S. and four European countries -- France, Germany, Spain and Poland -- was designed and analysed by Alzheimer Europe and the Harvard School of Public Health.

In four of the five countries, Alzheimer's disease was the second biggest health fear after cancer. The public were asked to choose which disease they were most afraid of getting from a list of seven diseases including cancer, heart disease and stroke. Around a quarter of adults in four of the five countries say they most fear getting Alzheimer's disease.

Fear of Alzheimer's gets worse with age, but even young adults are concerned, with approximately one in seven 18- to 34-year-olds reporting Alzheimer's as the disease they are most afraid of getting from the list provided.

The survey found a large proportion of the public has had some experience with Alzheimer's disease. Majorities in all five countries say that they know or have known someone with Alzheimer's disease, including about seven in ten in France (72%), Germany (73%), Spain (77%), and in the U.S. (73%), and 54% in Poland. In addition, about three in ten have personal experience with a family member with Alzheimer's disease. Experience with a family member ranges from 19% in Poland to 42% in the U.S.

This high level of contact with Alzheimer's disease is likely to have contributed to the wide recognition of common symptoms such as confusion and getting lost, which were recognised by at least 86% and 88%,respectively.

Few people recognised the severity of Alzheimer's disease with approximately 40% knowing that it is a fatal condition (33-61%). In fact, Alzheimer's is the seventh-leading cause of death in high income countries and the only cause of death among the top 10 that cannot be prevented or cured.

Many of the respondents believe there is now an effective medical or pharmaceutical treatment to slow the progression of Alzheimer's disease and make the symptoms less severe (27%-63%). Also, nearly half believe there is a reliable medical test to determine if a person suffering from confusion and memory loss is in the early stages of Alzheimer's disease (38%-59%).

The survey also found public interest in predictive testing. Approximately two thirds of respondents said that, they would get a medical test which would tell them whether they would get Alzheimer's disease before they had symptoms.

Heike von Lützau-Hohlbein, Chairperson of Alzheimer Europe, said: "The results demonstrate the importance of being honest with patients when diagnosing Alzheimer's disease. As a former carer myself, I recognise how valuable it is for people to have first-of-all a name for all the uncertainties of their condition and then have the time to get their affairs in order. It will always be difficult to receive such a diagnosis but doctors need to empower patients and their loved ones to take the appropriate steps. The findings also show there is high awareness of Alzheimer's disease, which is a testament to the success of the many awareness campaigns coordinated by Alzheimer societies."

Dr. Robert Blendon, Professor of Health Policy and Political Analysis from the Harvard School of Public Health said: "Many of the public have high expectations about the possibilities of treatment alternatives and medical testing. It is important for doctors to talk to patients about what treatment and testing options are or are not available."

Florence Lustman, Coordinator of the French Alzheimer Plan, said: "Alzheimer's is a fatal condition that affects most people's lives at some time. One of the key priorities of the French Alzheimer's Plan is early diagnosis, and the survey results support this focus. The findings demonstrate overwhelming public support for receiving diagnosis."

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Harvard School of Public Health.

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Oft-used DSM diagnosis of alcohol dependence shows reliability

ScienceDaily (June 15, 2011) — Compared to other common psychiatric disorders, the diagnostic reliability of alcohol dependence (AD) as determined by the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition (DSM-IV) is relatively high. However, when members of the general public are asked to report on past experiences or lifetime history (LTH) of psychiatric or substance use disorders, associations are often unreliable and underestimated. A new study looking at the reliability of, as well as the influence of genetic and environmental influences on, DSM-IV LTH-AD in a population-based sample has found that a diagnosis based upon a single diagnostic interview is reasonably reliable.

Results will be published in the September 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"People are inaccurate when interviewed about their history of psychiatric symptoms," observed Eivind Ystrom, a researcher at the Norwegian Institute of Public Health and corresponding author for the study. "The most obvious reason for this is that people just don't recall when prompted. Thus, by interviewing people several times about the same disorder it is possible to estimate to what extent people are inaccurate."

"This study is unique in that Ystrom and his colleagues report that certain variables, including a specific AD criterion, robustly predict the reliability of the diagnosis," said Alexis Edwards, a postdoctoral fellow at the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University. "Obviously, all of the symptoms are, at some level, predictive of the disorder; but that some are more useful than others at identifying a reliable diagnosis is interesting."

The researchers examined a population-based sample of male twins in Virginia (n=4,203) who had been assessed for LTH-AD on two different occasions one year apart (i.e., each pair of twins was assessed twice, at about the same ages, one year apart). Logistic regression was used to identify clinical features that might predict a reliable diagnosis. Genetic and environmental influences were also examined.

"The first key finding was that men who are diagnosed with LTH-AD using a clinical interview tend to have many symptoms of AD, they have at some point in their life sought treatment for their AD, their period of life with AD lasted a long time, or they spent much time on obtaining alcohol or recovering from alcohol use," said Ystrom. "The second key finding was that, after taking into account that people are inaccurate when reporting psychiatric symptoms, the heritability of LTH-AD was estimated to be 71 percent. Or, put another way, 71 percent of the causes as to why some people in the general population become AD, while others do not, were genetic."

"This higher heritability of the LTH-AD phenotype, a bit higher than we might have expected, confirms the importance of genetic influences," added Edwards. "Furthermore, while the reliability of the diagnosis itself is moderate, results show that we can potentially increase our confidence in the diagnosis by taking into account a few specific variables."

"Since the study identifies which characteristics are associated with a reliable diagnosis," said Ystrom, "these characteristics can be used to enhance the reliability of single measures of LTH-AD. In addition, although psychometric theory states that the heritability should go up as the diagnostic reliability goes up, this study describes the phenomenon empirically. Finally, by estimating the heritability of LTH-AD to 71 percent, the study moves AD into a class of disorders that are highly dependent on genes, such as schizophrenia or bipolar disorder."

Both Ystrom and Edwards see practical implications from these findings for various audiences.

"Researchers often want to know what characterizes people with a disorder," said Ystrom. "If the diagnoses of the cases in their sample are inaccurate, they will be less able to correctly describe the characteristics of the people with the disorder."

"Clearly clinicians would be interested in reliable diagnoses because of their goal of providing appropriate treatment for patients," said Edwards. "Clinicians need to be confident that a patient truly has a disorder before embarking on a treatment program, whether that involves counseling, pharmaceutical treatment, or something else."

"However, the finding that LTH-AD is a disorder which is to a great extent dependent on genes, is also important to the public," said Ystrom. "Some people might view AD purely as a matter of will. Since most people in the western world use alcohol regularly, but only a few become dependent on it, it is significant to know that much of the reason why this happens to people is because of individual genetic vulnerability. Genetic vulnerability is not a demerit." Edwards concurs. "Most people know someone who has struggled with alcohol problems, and this report underscores the fact that the disorder is very complicated, and is a function of both biology and the environment. While some of the nuances of the report might be too technical to be relevant to someone not involved in this research, the general findings are still of broad interest simply because AD affects so many people, directly or indirectly."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Alcoholism: Clinical & Experimental Research, via EurekAlert!, a service of AAAS.

Journal Reference:

Eivind Ystrom, Ted Reichborn-Kjennerud, Steven H. Aggen, Kenneth S. Kendler. Alcohol Dependence in Men: Reliability and Heritability. Alcoholism: Clinical and Experimental Research, 2011; DOI: 10.1111/j.1530-0277.2011.01518.x

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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