Editorial

Timely Diagnosis and Disclosure of Alzheimer Disease Gives Patients Opportunities to Make Choices

Authors: G. Richard Holt, MD, MSE, MPH, MABE

Abstract

More than 5.4 million Americans are known to be living with Alzheimer disease (AD). It is also the sixth leading cause of death in the United States. Bettelheim projected that “unless effective treatment and prevention can be found, by 2050 the number of Americans with dementias will triple to nearly 16 million.”1 Caring for AD patients is difficult and problematic in a number of ways from an ethical standpoint. As the number of individuals diagnosed as having AD increases, the issue of whether to inform a person with known or suspected AD of his or her diagnosis continues to stimulate debate, as it has for the past 2 decades or more.2 It is this author’s opinion that the timely diagnosis and disclosure of AD gives patients opportunities to make choices. Fortunately, advances are being made to improve the precision of the diagnosis of mild to moderate AD, and the therapeutic options now span a wider range of medical, psychiatric, social, and rehabilitative entities.

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References

1. Bettelheim R. America can’t afford to neglect dementia research. USA Today. Wednesday, March 16, 2001. Page 9A.
2. Drickamer MA, Lachs MS. Should patients with Alzheimer’s disease be told of their diagnosis? N Engl J Med 1992;326:947–951.
3. Werner P, Korzyn AD. Mild cognitive impairment: conceptual, assessment, ethical, and social issues. Clin Intervent Aging 2008;3: 413–420.
4. Woods RT, Moniz-Cook E, Illife S, et al. Dementia: issues in early recognition and intervention in primary care. J R Soc Med 2003;96:320–324.
5. Mattsson N, Brax D, Zetterberg H. To know or not to know: ethical issues related to early diagnosis of Alzheimer’s disease. Int J Alzheimers Dis 2010; Jun 27:pii: 841941.
6. Karlawish J. Measuring decision-making capacity in cognitively impaired individuals. Neurosignals 2008;16:90–91.
7. Spector A, Davies S, Woods B, et al. Reality orientation for dementia: a systematic review of the evidence for its effectiveness. Gerontologist 2000;40:206–212.
 
8. Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 4. approach to management of mild to moderate dementia. CMAJ 2008;179:787–793.
9. Marzanski M. On telling the truth to patients with dementia. J Med Ethics 2000;26:108–113, 111.