Itself a controversial diagnosis, MCI is a descriptive term used to refer to a set of symptoms in people with increased risk for Alzheimer's disease. By no means do all MCI cases change from MCI to AD (only 10-15% progress to AD per year). With the proposed changes, before the appearance of any behavioral or cognitive symptoms a person could receive the dire and potentially inaccurate, name of "Pre-Clinical Alzheimer's Disease."

The press has recently publicized that these proposals suggest that biomarkers be used as the sole diagnostic tests for detecting Alzheimer's disease (see Vemuri et al., 2010). These proposals include detecting abnormal levels of neuroproteins in spinal fluid and PET scans to identify markers in the brain known as amyloid plaques. Needless to say, these tests are not generally available to diagnosticians because they require specialized equipment. What's more, the accuracy of spinal fluid tests ("spinal taps") to predict clinical signs of AD is unknown. Furthermore, spinal taps are invasive and themselves can cause discomfort or harm to the patient. Medicalization of the diagnosis of Alzheimer's disease implies that such invasive tests provide infallible diagnoses-- a claim that is far from legitimate. Researchers and clinicians in the National Academy of Neuropsychology are mobilizing a response to this change in diagnosis as are psychologists specializing in aging.

This July, the National Institute of Aging and the Alzheimer’s Association co-sponsored the International Conference on Alzheimer’s Disease.  Reports from the conference contained a “consensus” statement which concluded that physical and mental exercise as well as diet control are ineffective in preventing Alzheimer’s.   However, this was not a consensus because it was not a unanimous conclusion and the statement contradicts previous scientific studies which suggest that exercise and dietary intervention strategies are beneficial in the early stages of the disease.

If the AAICAD recommendations are followed, a scenario can emerge in which individuals with mild memory symptoms are subjected to expensive and harsh biomedical testing with methods that are themselves not proven to provide reliable or valid diagnoses. In fact, they could be given this testing even if they have no symptoms if it is concluded that they are genetically at risk. Then there will be nothing the patient can do but wait 5, 7, or 10 years for the “inevitable” to occur—the development of increasingly severe symptoms and death from the complications of the disease. But these biomarker tests have questionable accuracy, so the outcome is not inevitable. Some people will never get symptoms of the disease despite living in fear with the diagnosis for years. 

Well, there is one thing the patient can do according to these recommendations. Take the medications that the pharmaceutical companies are promoting as "treatments." Aricept, for instance, which is widely advertised on television commercials as a way to stave off the deterioration of the disease, is one such supposedly therapeutic agent. Unfortunately, the scientific evidence to support these medications is not compelling (e.g. Farlow et al., 2010). If they work at all, it is only for a short time and even then do not lead to complete remission of symptoms even temporarily. Furthermore, they carry with them uncomfortable side effects that may warrant against their use. (Note: ginkgo biloba won't help you either).

Why are respected organizations providing consumers with this unfounded advice? To find out, just "follow the money." The Alzheimer’s Association and even the National Institute on Aging are partnered with the pharmaceutical companies. It is the pharmaceutical companies who help support many of the Alzheimer’s Association and NIA studies, as can be seen for example here, (scroll down to “Study Funding”). In the Vemuri et al. (2010) study, funding was provided by the Foundation for the National Institutes of Health which coordinates private sector funding including some $27 million from major pharmaceutical companies including Eisai, makers of Aricept.  

Pharmaceutical companies have long been behind the hype surrounding the prevalence data for Alzheimer's disease. Their influence plays out indirectly through the Alzheimer's Association. The most recent report of the Alzheimer's Association from March of 2010 claims that there are 5.5 million Americans suffering from "dementia." Supporting data for these prevalence figures come from studies funded by the Alzheimer's Association—which as I showed above in turn has close ties to pharmaceutical companies. Though the Alzheimer's Associations in many communities provide valuable services, this self-promotion on the part of the national organization leads many skeptics to question the Association's motives if not their evidence. In addition, their rhetoric reinforces the view in the mind of the public that aging inevitably brings “senility.”

The National Institute on Aging itself was criticized as far back as 1998 by the U.S. Government Accountability Office (then called the General Accounting Office) for providing inflated estimates of AD’s prevalence in the U.S.  

There are good scientific reasons to question the report’s conclusion. Its own fine print states that many of the “5.5 million” have dementia due to other causes than Alzheimer's disease, though this nicety is usually lost in press reports. One of the most significant of these other causes is vascular dementia related to cerebrovascular disease. And how do we prevent many cases of cerebrovascular disease? Diet control and exercise are just two of these preventative methods. These methods can also contribute to the treatment of cognitive effects of depression in older (and younger) adults. Remember, the consensus statement discounted the value of such approaches.