NEWS RELEASE April 25, 1997
American Psychiatric Association
1400 K Street, NW
Washington, DC 20005
CONTACT: Gus Cervini; (202) 682-6142; [email protected]
EMBARGOED UNTIL MAY 1, 1997
NEW ALZHEIMER'S GUIDELINE URGES USE OF
PRESCRIPTIONS AGAINST DRIVING AND VITAMIN E USE
A doctor's written prescription against driving and the use of vitamin E to slow mental deterioration are among the recommendations in the American Psychiatric Association's Practice Guideline for Treatment of Alzheimer's Disease and Other Dementias of Late Life, to be published May 1 as a supplement to the American Journal of Psychiatry.
Based on a comprehensive review of the scientific literature, the new guideline is the first for treatment of patients with Alzheimer's disease and the eighth in the APA series of practice guidelines for mental illnesses and substance use disorders. Other guidelines have dealt with Alzheimer's diagnosis and recognition. The guideline cites a broad belief among psychiatrists that demented patients with moderate or severe impairment (such as those who cannot prepare simple meals, or do household chores, yard work, or simple home repairs) pose an unacceptable risk and "should not drive." The psychiatrist can "lend moral authority and support to family members who wish to restrict driving but are reluctant to take responsibility for the decision." For example, the psychiatrist or other physician can write on a prescription pad, "DO NOT DRIVE."
The guideline cites a recent New England Journal of Medicine (4/24/97) study on use of vitamin E. The guideline states, "vitamin E may be used in moderately impaired patients with Alzheimer's disease in order to delay the progression of disease." Vitamin E is inexpensive, has been shown to be safe in conventional low doses, and doesn't adversely react with other medications, the guideline notes. These factors help make it a promising treatment for patients with moderate Alzheimer's Disease. _________________________________________________________________
Media: See separate sheet on "How to Interview the Experts on the May 1, 1997, Release of the American Psychiatric Association's Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias of Late Life." Note: For those media who do not yet have the full Alzheimer's guideline backgrounder kit, the sheet on how to interview the experts (who will be available by phone Monday 4/28 through Wednesday 4/30) is available through APAFastFAX (our toll-free fax-on-demand service). Call 1+888-267-5400, and select document No. 6124.
The guideline highlights the potential benefits of a variety of treatments for Alzheimer's Disease patients, including the use of cognition enhancing and other medications. In addition, the benefits of providing education and emotional support to caregivers is highlighted.
The guideline is the work of an eight-member work group led by Peter Rabins, M.D., M.P.H. It was developed by psychiatrists who are involved in research as well as clinical practice. Over 50 individuals and more than 10 professional and consumer organizations reviewed and commented on it. The guideline was approved for publication by the APA's Board of Trustees in December, 1996.
The scientific evidence-based Alzheimer's guideline is designed to help psychiatrists tailor treatment for individual patients. The guideline indicates the extent of scientific evidence available to support the effectiveness of each type of treatment. Treatments are recommended with "substantial clinical confidence," with "moderate clinical confidence," or "on the basis of individual circumstances."
VIEWPOINTS OF THE EXPERTS Deborah A. Zarin, M.D., Director of APA's Practice Guideline Program, and a member of the APA Steering Committee on Practice Guidelines, on the purpose of APA's practice guidelines:
"The strength of the guideline is in its presentation of all treatments -- a range of choices that shows Alzheimer's complexity and the care needed in treating patients. Our practice guidelines are part of a movement within organized medicine to create treatment guidelines for doctors in all the major specialties.
The Alzheimer's guideline will help psychiatrists by laying out a clear, concise, and medically sound presentation of the range and quality of available psychiatric treatments for that illness and other dementias. Psychiatrists still bear the ultimate responsibility for choosing the best treatment strategy for each patient."
John S. McIntyre, M.D., chair of the APA Steering Committee on Practice Guidelines, on the guideline development process and the value of practice guidelines:
"The guideline provides psychiatrists with evidence-based suggestions about treatment of patients with Alzheimer's and other dementias. The development process for this guideline included a comprehensive literature review and several drafts. Each draft was reviewed by psychiatric experts and others in the field. Like the APA's other guidelines, the Alzheimer's guideline will be reviewed and updated every three to five years.
The Alzheimer's guideline isn't a standard' of medical care, to be applied across the board. The psychiatrist is the final judge of what is appropriate care, based on the individual patient's case and the options available for treatment."
Peter Rabins, M.D., Chair of the APA's Work Group on Alzheimer's Disease and Related Dementias, on the tools psychiatry can bring to bear in dealing with Alzheimer's Disease and other dementias:
"Before treating a patient for Alzheimer's disease, the psychiatrist has already determined that the patient's dementia-like symptoms are not caused by depression or an adverse reaction from other medications the patient may be taking -- this can be common in older patients. Once a diagnosis has been made, as a medical doctor the psychiatrist can bring to bear a range of treatments from cholinesterase inhibitors for cognitive impairment as well as other medications and supportive psychotherapy for concomitant behavioral and emotional symptoms. The psychiatrist directs the patient and family to vital support organizations, and helps them confront the sensitive and highly charged issue of when the patient should limit or stop driving."
FACTS ABOUT ALZHEIMER'S AND OTHER DEMENTIAS (from the guideline)
To be diagnosed with dementia, a patient must have memory problems and at least one of the following: loss of the ability to use or understand words, inability to handle objects, failure to recognize or identify objects, or a problem with thinking abstractly, planning, starting, and stopping complex behavior. Early signs may include having difficulty in balancing a checkbook or preparing a meal. To be diagnosed, the combined problems must be severe enough to interfere with work or social functioning and must represent a decline from a previous level of functioning.
Some patients with dementia show inappropriate social behavior, have overwhelming emotional reactions to minor changes in routine, depressed mood, and trouble sleeping. They may have beliefs not grounded in reality, for example, believing that misplaced possessions have been stolen. Some with dementia patients experience hallucinations. Greater than usual agitation during the evening hours (sometimes called "sundowning") is common.
Alzheimer's disease is the most common dementia, affecting approximately 5-8% of individuals over age 65, 15-20% over age 75, and 25-50% over age 85. Alzheimer's disease accounts for 50-75% of all dementias. Others include vascular dementia, and dementias due to Parkinson's disease, Lewy Body disease, and Pick's disease.
Alzheimer's disease has a subtle beginning and a gradual progression. Depression can be prominent In the middle and late stages, psychotic symptoms are common. Patients eventually may develop incontinence and walking and muscle problems. Finally, they become mute and bedridden, and are prone to infectious diseases, which often proves fatal.
In addition to this release, the APA offers to media a backgrounder kit on the new practice guideline. The kit includes:
o the guideline
o a separate sheet on "How to Interview the Experts on the May 1, 1997, Release of the American Psychiatric Association's Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias of Late Life" -- Note: For those media who do not yet have the full backgrounder kit, the sheet on "How to Interview the Experts" is available through APAFastFAX (APA's toll-free fax-on-demand service). Call 1+888-267-5400 and select document No. 6124. Experts will be available for interviews Monday, April 28, through Wednesday, April 30 (the day before the guideline's release).
o backgrounder on the APA practice guideline development process
o reprint of an American Journal of Psychiatry editorial on APA's practice guidelines
o photocopy of the section on Alzheimer's disease from the APA's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
APA Practice Guidelines -- as of Spring 1997
Guideline: Published:
Eating Disorders February 1993 Major Depressive Disorder April 1993 Bipolar Disorder December 1994 Substance Use Disorders November 1995 Psychiatric Evaluation November 1995 Nicotine Dependence October 1996 Schizophrenia April 1997 Alzheimer's Disease and Other May 1997
Dementias of Late Life
Media, please note: The Practice Guideline for Treatment of Patients With Alzheimer's Disease and Other Dementias of Late Life is embargoed until 5/1/97. Journalists may obtain free copies of the new practice guideline and be put in contact with national and local psychiatric media speakers who are experts on the treatment of patients with Alzheimer's and other dementias. Please contact Gus Cervini, APA Media Coordinator, at (202) 682-6142 (voice), e-mail:
Journalists should refer the public (non-media) to the American Psychiatric Press, Inc. (APPI), 1+(800) 368-5777, from which the guideline may be purchased for $22.50.
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The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 42,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.
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