Alzheimer's expert publishes new findings

A Long Island Alzheimer's researcher says he can predict with a high degree of accuracy which patients will develop full-blown dementia within two years by using verbal information recall tests.

Reporting in Tuesday's Archives of General Psychiatry, Dr. Terry Goldberg of the Litwin-Zucker Center for Research in Alzheimer's disease and Memory Disorders in Manhasset found that a special battery of tests was better at predicting the disease than attempting to isolate Alzheimer's-related proteins in spinal fluid.

To obtain those proteins, known as biomarkers, patients undergo a spinal tap, an invasive procedure that, though safe, has some risks, Goldberg said.

Diagnosing Alzheimer's years before it begins has long been a goal of medical and advocacy groups because patients can then be active in their financial, medical and end-of-life planning, experts say.

Goldberg and colleagues wanted to know if a gentler testing method could predict Alzheimer's disease with the same or greater degree of accuracy as biomarker testing.

Goldberg said he sought a cognitive marker -- evidence of forgetfulness -- that could be quantified. He compared the predictive value of his cognitive markers to results from biological testing. He discovered his tests, which asked people to recall verbal information, prevailed because Alzheimer's biomarkers are not always found in spinal fluid, even in a moderately advanced stage of impairment. "This was the first time the two [markers] were compared head-to-head," Goldberg said.

In his analysis, he included people with mild cognitive impairment, a stage well beyond the forgetfulness of normal aging. People with mild impairment have trouble with memory, language and judgment.

In one test, patients were asked to recall as many words as possible 30 minutes after reading a list of 15 simple, unrelated nouns. Anyone with normal cognitive function can recall eight to 10 words. People with mild cognitive impairment recall only three to four, sometimes less.

In another exam, researchers told patients a brief story and, after a delay, asked them to recall as much as possible.

Out of 320 patients with mild cognitive impairment, Goldberg and colleagues were able to accurately predict that 116 would develop Alzheimer's disease within two years -- and they did. They were compared with 197 cognitively healthy people.

Mary Ann Malack-Ragona, executive director of Long Island's division of the Alzheimer's Association, applauded the analysis.

"This is something we support as an organization," Malack-Ragona said. "We strongly support early diagnosis, especially when there is an easier way and a less invasive way to do it."