Alzheimer’s disease is being redefined to include three phases. An early phase where there are no obvious symptoms but changes are occurring in the brain. A middle phase where the problems are mild and the diagnosis would be called Mild Cognitive Impairment. A third phase where the changes are severe enough to be called dementia (i.e., independence is lost).

The most sticking, and hopefully controversial, change is the addition of the early phase where there are changes in the brain but no symptoms of cognitive decline. This phase is defined by the use of biomarkers such as brain scans and tests of cerebral spinal fluid. The problems with this early phase include the fact that there are no standardized biological tests or results defining this phase. Second, 30% of people with amyloid plaques never develop clinical signs of Alzheimer’s disease. Third, the biomarkers are only to be used for persons enrolled in clinical trials.

The objective of the early phase is to encourage more research to develop possible drugs that attack the disease early. The failure of the Lily drug should cause caution in aggressive pursuit of amyloids as the cause of Alzheimer’s disease. Furthermore, although early drug interventions are a great ideal, they beg several questions. How early in life should the trials begin? 30s? 40s? 50s? 60s? How safe is early intervention? Will there be unintended and damaging side effects of altering brain chemistry so early in life? Why are we setting up formal diagnostic criteria to feed clinical trials? Are we really on the cusp of a medical breakthrough for Alzheimer’s disease?

The criteria will soon be published and I look forward to seeing the specifics. In the meantime, we have excellent cognitive and memory tests that are not invasive and allow us to assess and monitor brain function just as we use bold tests to determine the functioning of thyroid, kidney, and liver. These tests are the gold standard but the medical community ignores their utility in diagnosis and tracking. Alzheimer’s disease is diagnosed by its course over time. Not everyone who has memory decline will have Alzheimer’s disease. Not everyone who has Alzheimer’s disease will become demented. Not everyone who becomes demented has Alzheimer’s disease.

Finally, reducing Alzheimer’s disease to molecular biology only adds to the sense of fear and futility. We sit and wait for a medical cure. We worry if we cannot find our keys. There are caveats with the articles on the new criteria indicating caution as there is “nothing medically that can be done.” I feel that this misses the point. While we wait for science to find more answers, we need to be proactive about our memory. Schedule memory evaluations just as you do physicals. Be proactive and protect your future. There is so much that can be done if the focus is on memory rather than Alzheimer’s disease.