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 Checklist For Behaviors May Flag Alzheimer’s Early

Certain behaviors may identify individuals at risk of Alzheimer’s disease (AD) even before memory problems become apparent, according to researchers at the University of Calgary’s Hotchkiss Brain Institute in Canada. By using a symptom checklist they have developed, as well as other tools, physicians may be able to diagnose and treat AD earlier in patients who are functionally independent and have normal cognition.

“The vast majority of Alzheimer’s disease drug trials have failed, generally—it is believed—because we are capturing people too late in the disease course for these medications to have any real benefit,” said Zahinoor Ismail, MD, FRCPC. “It is important to identify Alzheimer’s at its earliest stages, and data consistently show that individuals with later-life onset neuropsychiatric symptoms are more likely to develop dementia.”

To help identify mild behavioral impairment (MBI) that may suggest the presence of or risk for AD, Ismail and colleagues developed the Mild Behavioral Impairment Checklist (MBI-C) that clinicians can complete with input from caregivers, including family members and certified nurse assistants (CNAs). The checklist addresses domains that describe interest, motivation, and drive; mood or anxiety symptoms; the ability to delay gratification and control behavior, impulses, oral intake and/or changes in reward; following societal norms and having social graces, tact, and empathy; and strongly held beliefs and sensory experiences.
“From family members we gather information on function, neuropsychiatric symptoms, and caregiver burden,” said Ismail. “With the MBI checklist, like any caregiver-reported scale, there can be errors. For instance, if family members are in denial, their responses will be skewed accordingly.” Therefore, it is useful to ensure consistent instruction in using the tool and training team members to use it as well as combining impressions from clinicians and caregivers, he said.
“Especially in isolation, behaviors often are dismissed as a normal part of aging, when—in fact—they may be the initial manifestation of dementia. When these symptoms—such as social withdrawal, angry or aggressive actions, anxiety, and/or hoarding—appear, they increase the likeliness that the person will develop dementia,” said Ismail. He noted that initial response to the checklist has been positive. “I’m hearing that families and loved ones are feeling heard, and that is important,” he said. “Now we need to increase physician awareness and get them engaged.”
By identifying AD and those at high risk for the disease earlier, Ismail suggests that it may help elders age in place longer and even delay skilled nursing center placement and moves out of assisted living and other independent or semi-independent care settings.
“Earlier identification of dementia’s onset and progression allows us the opportunity to modify symptoms and hopefully change the progression of the illness,” he said. These patients can be involved earlier in brain training, social activities, exercise programs, healthy diets, and other efforts that may stave off or minimize symptoms and keep them alert, functioning, and healthier longer.
Perhaps most significant, Ismail said, “We can address their dementia before there is an incidence or crisis that leads to hospitalization or the need for a higher level of care.”
Ismail admits that this tool needs more validation. “The MBI checklist is so new, much more research needs to be done.” However, he said, “This enables us to identify this at-risk group, study them more closely, and look at how to treat them to prevent cognitive decline.” He added, “It’s a good tool to help caregivers identify these behaviors as clinical flags and get them worked up to rule out a urinary tract infection, untreated pain, or other problems.”
To request a copy of the MBI-C, write to MBIchecklist@gmail.com.
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