Older adults who have become uncharacteristically sad, irritable, anxious, rude, or disinterested in friends or family—and who have been that way for at least six months—could be exhibiting warning signs, they say. The group of experts is proposing a new diagnosis, called Mild Behavioral Impairment (MBI), which could hopefully help doctors recognize brain changes that may lead to neurodegenerative conditions like Alzheimer’s disease. Identifying this progression sooner, they say, might help to pave the way for earlier treatments and better care for at-risk patients. Along with the new diagnosis, the team also designed an “MBI Checklist” for doctors, which looks at behaviors involving the patient’s mood, level of motivation, impulse control, social appropriateness, and sensory experiences. Caregivers may also be able to use a version of the checklist once it’s finalized. The checklist asks 34 questions about qualities that many people may recognize in the older adults in their lives. It suggests that doctors consider any behavior that has “been present for at least six months (continuously or on and off) and is a change from their longstanding pattern of behavior.” A few of these questions include:
“Does the person lack curiosity in topics that would usually have attracted her/his interest?““Has the person become more easily frustrated or impatient?““Does the person seem to lack the social judgment she/he previously had about what to say or how to behave in public or private?““Has the person developed suspiciousness about the intentions or motives of other people?”
Maria C. Carrillo, PhD, chief science officer, Alzheimer’s Association, said in a press release that the new checklist could help change the way doctors evaluate patients for possible early dementia. “Alzheimer’s is a deadly brain disease, and while memory loss is a hallmark of the disease, early symptoms such as anxiety, confusion and disorientation are often more common, troubling, and obvious to family members,” she said. It is important to note, however, that not every older adult who becomes cranky or loses interest in certain activities is on the road to dementia. And some experts do worry, the New York Times reports, that making MBI an official condition could lead to over-diagnosis, expensive and unnecessary treatments, and needless worry for patients and their loved ones. Zahinoor Ismail, MD, a neuropsychiatrist at the University of Calgary and co-author of the proposed guidelines, says more research is required before the diagnosis and checklist can be put into practice. “We are still in the very early stages of understanding this new syndrome,” he says. “Clinical trials still need to be set up to see if treating patients identified earlier this way makes a difference in terms of the time on onset of dementia.” He is hopeful, however, that patients identified with MBI will be monitored more closely by their doctors; previously they might have been ignored. And while patients and concerned family members shouldn’t jump to conclusions or self-diagnose, he does believe that a shift in a person’s mental or emotional state is worth checking out. “Yes, later life changes in personality should be brought up with one’s doctor,” he says. The new checklist isn’t the only exciting news coming out of the Alzheimer’s Association conference this week. Additional new and novel ways the disease may soon be detected earlier have been proposed, as well. For example, University of Waterloo scientists unveiled a non-invasive eye-scan technology that may help recognize dementia-specific proteins in the brain before a person develops symptoms. And a team from Columbia University reported that a scratch-and-sniff smell identification test might also be useful in predicting cognitive decline.
