Personality Changes Could Be the Earliest Sign of Alzheimer’s

Researchers have proposed a new diagnosis called mild behavioral impairment that would precede a mild cognitive impairment diagnosis and lead to earlier dementia detection.Personality Changes Could Be the Earliest Sign of Alzheimer's

Learn why some researchers believe this new diagnosis can help identify those at a higher risk of dementia and why others are concerned that the proposed 34-question checklist would lead to an overdiagnosis.

New Diagnosis to Precede Mild Cognitive Impairment

A group of researchers that includes neuropsychiatrists and Alzheimer’s experts are proposing a new diagnosis called mild behavioral impairment (MBI) for early detection of Alzheimer’s. The new diagnosis would identify startling changes in behavior and mood, an often overlooked sign of Alzheimer’s. Their proposal also means that a diagnosis of MBI would be a clinical designation that comes before a mild cognitive impairment (MCI) diagnosis.

The group presented their idea at the Alzheimer’s Association International Conference in Toronto, along with a 34-question checklist that could potentially be used to identify people at a greater risk for Alzheimer’s by identifying changes in behavior. The checklist includes questions such as:

  • “Does she/he have unrealistic beliefs about her/his power, wealth or skills?”
  • “Does she/he no longer care about anything?”
  • “Has the person become agitated, aggressive, irritable, or temperamental?”

If the answers to these questions is yes and lasts for months, researchers believe it could actually be a very early stage of Alzheimer’s.

Nina Silverberg from the Alzheimer’s Disease Centers Programs at the National Institute on Aging, is supportive of the new diagnosis, stating:

“I think we do need something like this. Most people think of Alzheimer’s as primarily a memory disorder, but we do know from years for research that it also can start as a behavioral issue.”

Additionally, neuropsychiatrist at the University of Calgary and a member of the research team, Dr. Zahinoor Ismail, said that studies have suggested these behavioral and emotional changes were “a stealth symptom” of dementia and not separate from the disease.

The Potential for Overdiagnosis of the Earliest Sign of Alzheimer’s 

There is cause for concern from other Alzheimer’s experts that a diagnosis and a checklist like the one proposed may lead to an overdiagnosis, resulting in extreme overspending and unnecessary tests and treatments. Dr. Kenneth Langa, professor of internal medicine at the University of Michigan states,

“There’s the potential benefit of early diagnosis, identifying people more likely to decline,” but adding, “the flip side is overdiagnosis, labeling someone and getting people in the clinical cascade, where you start doing the test and people start doing more brain imaging and being at the doctor’s more and getting more concerned. If it becomes a routine practice, that’s a huge amount of dollars.”

Dr. Langa says that many people given an MCI diagnosis do not develop dementia until 10 years later, and as many as 20% are later found to be cognitively normal with stress or medications causing the MCI diagnosis. Dr. Langa said these findings, “make me think twice” about creating a new diagnosis.

Another reason to be cautious about the new diagnosis is that there is still no cure for dementia. One caregiver said that the benefit of a diagnosis is that “there are medications which help manage mood and behavior” but he wonders if a diagnosis becomes “part of your health record that’s accessible by insurance companies. And, do you really want to know? Because there’s no cure yet.”

Other experts say the benefits outweigh the risks and we cannot risk ignoring early symptoms to learn more about the disease and to help people who at a high risk for dementia.

Have you seen a correlation between early changes in behavior and a dementia diagnosis? Share your experiences and stories with us in the comments below.

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