by PAM BELLUCK
Padmaja Genesh with the Calgary Alzheimer’s Society, left, stands with Dr. Zahinoor Ismail whose research has produced a rating scale that could help with early detection of dementia PHOTO/Natasha Frakes/CBC
Amyloid plaques in the brain tissue of a patient who died of Alzheimer’s disease PHOTO/Yankner Laboratory, Havard University
“Has the person become agitated, aggressive, irritable, or temperamental?” the questionnaire asks. “Does she/he have unrealistic beliefs about her/his power, wealth or skills?”
Or maybe another kind of personality change has happened: “Does she/he no longer care about anything?”
If the answer is yes to one of these questions — or others on a new checklist — and the personality or behavior change has lasted for months, it could indicate a very early stage of dementia, according to a group of neuropsychiatrists and Alzheimer’s experts.
They are proposing the creation of a new diagnosis: mild behavioral impairment. The idea is to recognize and measure something that some experts say is often overlooked: Sharp changes in mood and behavior may precede the memory and thinking problems of dementia.
The group made the proposal on Sunday at the Alzheimer’s Association International Conference in Toronto, and presented a 34-question checklist that may one day be used to identify people at greater risk for Alzheimer’s.
“I think we do need something like this,” said Nina Silverberg, the director of the Alzheimer’s Disease Centers program at the National Institute on Aging, who was not involved in creating the checklist or the proposed new diagnosis.
“Most people think of Alzheimer’s as primarily a memory disorder, but we do know from years of research that it also can start as a behavioral issue.”
Under the proposal, mild behavioral impairment (M.B.I.) would be a clinical designation preceding mild cognitive impairment (M.C.I.), a diagnosis created more than a decade ago to describe people experiencing some cognitive problems but who can still perform most daily functions.
Dr. Zahinoor Ismail, a neuropsychiatrist at the University of Calgary and member of the group proposing the new diagnosis, said studies and anecdotes suggested that emotional and behavioral changes were “a stealth symptom,” part of the dementia disease process, not separate from it.
Whatever is eroding memory and thinking skills in the dementia process may also affect the brain’s systems of emotional regulation and self-control, he said.
If two people have mild cognitive impairment, the one with mood or behavior changes develops full-blown dementia faster, he said.
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