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In 1983, President Ronald Reagan designated November as National Alzheimer's Disease Awareness Month. At the time, only 2 million Americans were known to have the disease. The president, himself, was later diagnosed with Alzheimer's, and today more than 5 million people have AD.

In the past 25 years, there has been a great deal of research and public education conducted around Alzheimer's disease. What was once completely unknown is now a familiar diagnosis for many who have either been personally touched by the disease or have been made aware of the illness through media coverage. However, a recent survey found a significant disconnect between beliefs about early screening and detection and actual behaviors in pursuing medical intervention.

"Alzheimer's Disease: Current Attitudes, Perceptions and Knowledge," an online survey of 1,040 U.S. adults age 55 and older released in late September, found that while nearly 95 percent agreed they would encourage a loved one to seek early diagnosis upon suspicion of AD, the reality didn't match up. Of the 34 percent who previously thought a loved one might be showing signs of the disease, only about one-quarter prompted that person to take a screening test and less than 40 percent encouraged initiating a conversation with a physician.

Furthermore, 90 percent of the participants were unable to identify the difference between early and late disease symptoms and symptoms unrelated to AD … despite the fact that 78 percent believed they could recognize signs of the disease in themselves or a loved one. Adding to the issue, nearly one-third of those surveyed were unaware there are AD medications currently available, and about 85 percent of those who did know medications exist, didn't understand how treatment works.

The online survey was conducted between May 12 and June 4, 2008, by Harris Interactive and commissioned by the Alzheimer's Disease Screening Discussion Group, a consortium of multi-disciplinary experts in AD and senior health.

"This new survey shows us that close friends and relatives are not encouraging their loved ones to take action, and perhaps that's because they aren't confident in their ability to identify Alzheimer's symptoms," said Richard Stefanacci, DO, survey co-chair and founding executive director of the Geriatric Health Program for the University of the Sciences in Philadelphia. "The unfortunate result is that many patients may not get diagnosed until the disease is in its later stages."

In Nashville, survey results were very similar to the larger national pool. Of the 77 percent who believed they could recognize signs of the disease, nearly everyone was unable to differentiate between the stages of AD or symptoms unrelated to AD. About half of those in Middle Tennessee who previously thought a loved one had the disease did prompt that person to take a screening test and 46 percent encouraged a conversation with a physician … both figures higher than the national numbers.

Richard Garman, MD, a partner with Nashville Medical Group who is board certified in Internal Medicine and has additional certification in geriatrics, said the unfortunate result of the gap between beliefs and behavior is that those who could benefit from treatment often miss out or receive interventions too late.

Garman, who serves as medical director for three area nursing homes, as well as Guardian Hospice in Franklin, said the disconnect isn't limited to the general public but exists among physicians, too.

"You wouldn't believe how many doctors say, 'I don't treat Alzheimer's disease,'" he said, adding there is "some therapeutic nihilism out there."

While readily admitting there is no "cure" for AD, Garman said Alzheimer's is no different from many diseases and conditions that we routinely treat. He pointed out, there is no "cure" for high blood pressure or diabetes. However, he continued, "When we treat them aggressively, sometimes it changes the outcome."

For those who have Alzheimer's, Garman said there are clear therapeutic benefits to aggressively treating the disease.

"Over the last 10 years or so, we've had medications that have been shown to delay the inevitable decline," he said.

Not only do medicines help with behavioral symptoms, treatment plans can significantly impact the cost of care by delaying admission to a skilled nursing facility. Slowing the disease's progression also allows patients to accept the diagnosis and make important end-of-life decisions and plans such as protecting assets and assigning a power of attorney. Additionally, he pointed out, it is invaluable to family members and friends to have a longer period of meaningful interaction with their loved ones.

"A lot of physicians wait for someone else to treat them," Garman continued, adding the belief is that the psychiatrist or gerontologist or neurologist will diagnose and treat AD. However, he continued, simple screens make it easy … in most cases … for the diagnosis to be made in the primary care setting.

"We'd like to get the physician to realize, 'Hey, these are serious issues, and this is not a normal part of aging.'"

As with other diseases, Garman said having a first degree relative who was diagnosed with AD is an increased risk factor. Ideally, he added, everyone over age 65 would be screened for Alzheimer's. Garman said there are a number of acceptable cognition and executive functioning screens that are readily available and cost little to administer. He noted that a primary care physician or nurse practitioner could spend five or 10 minutes on a screening and come up with a pretty accurate clinical diagnosis or at least a suspicion.

He noted there are some cases that are more medically complex. In patients with a mixed presentation, referral to a geriatric psychiatrist or neurologist would certainly be in order.

The nation's rapidly aging population lends urgency to the message. Garman called the statistics "scary" and noted that 60-65 percent of dementia is Alzheimer's … as many as 50 percent of Americans over the age of 85 may develop dementia … and the "85 and over" group is the fastest growing population segment in the country.

"It's going to be this avalanche of patients," he warned, adding there wouldn't be enough nursing homes or caregivers to handle the increased demand for services. "Everyone's going to be scrambling for solutions."

Increasing awareness among the general public and healthcare professionals should at least ensure more people are diagnosed and treated early.

"If you can delay a degenerative disease … if you can have a higher level of functioning for a longer period of time, that's a win/win for the patient and the families," he concluded.

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