“Expert Panels” convened by the National Institute on Aging and the Alzheimer’s Association have offered new guidelines for diagnosis which include earlier stages of the disease. The new guidelines establish three stages: early brain changes, mild cognitive impairment and full-blown Alzheimer's. The new guidelines are being published in Alzheimer's and Dementia: The Journal of the Alzheimer's Association.
The question now being hotly debated is whether these new guidelines are positive and helpful, broadening awareness that the effects of brain aging take place over a wide spectrum, or whether they reinforce the clinically-unproven argument that all persons diagnosed with MCI will inevitably convert to Alzheimer’s. For example, Debbie Benczkowski, head of the Alzheimer’s Society of Canada, fears that if these guidelines are accepted in Canada they will label and stigmatize people as Alzheimer’s sufferers who will never develop the disease.
But Danny George argues that there may be important hidden benefits from the new guidelines because they place AD in a continuum: "Metaphorically, the notion of a continuum moves us away from the “you have it or you don’t” mentality that has for decades separated persons with the unified condition of “AD (mild, moderate & severe)” from the rest of us who live in fear of acquiring “it”. Instead of categorical “boxes” we are now presented with a continuum featuring differing degrees of severity. Generally speaking, the DSM-V seems to be drifting more towards continuum based classification of conditions (as evidenced by conditions such as autism spectrum disorders and others)."
Clearly this debate will need some time to unfold; the new guidelines offer both potential risks and rewards. If the number of persons diagnosed with AD suddenly doubles to include many persons with no clear signs of memory loss or cognitive decline, will that lead to these persons being stigmatized? Or will it have the opposite effect? Will it bring wider understanding that we are all living within a continuum of brain changes as we age, and therefore those experiencing AD (or other dementias) do not exist on the other side of a hard line between those who "have it" and those who do not? One can hope for the latter, but we need to be very careful not to permit the former.