6 - Diagnosing Early Stage Pre-Clinical Alzheimer's Disease: Clinical Advances and Ethical Considerations

Progress in understanding the biological expression of Alzheimer’s disease (AD) has led to the recent revision of the diagnostic criteria for the disease, which is defined by the biology present and, to a far lesser extent, the clinical phenomenology. These criteria recognize the full disease continuum and invite the possibility of arriving at an early diagnosis of AD when the condition is clinically silent and potentially at a point in the disease many years in advance of the emergence of any symptoms. Absent any effective treatment for either preventing the disease onset or slowing its rate of progression, a diagnosis of biomarker-determined preclinical (silent) AD poses a number of ethical considerations for the practicing clinician. In this session, we will: 1) review the recent advances in AD biomarkers and their implications for diagnosis and treatment; 2) consider the ethical issues that arise from an early diagnosis, including both the merits of early detection and the risks of having a diagnosis before symptoms have manifested; and, 3) conclude by discussing the implications of a biological diagnosis of AD for the practice of clinical neuropsychology, including the types of referral questions we might expect, the impact on our inferential approach, and the normative data we select.