Diagnosis of Alzheimer s Disease

Transcription

1 Diagnosis of Alzheimer s Disease At the age of 58, Matthew Blair began to have difficulty reading, speaking, and performing daily tasks at work. His wife, Isabel, was convinced that he had Alzheimer s. Believing Matthew was too young to have Alzheimer s their primary care physician did not screen for the disease. After seeking help from a specialist Matthew was eventually diagnosed as having probable Alzheimer s disease. The Blair s situation is certainly not unique. Families usually turn to their primary care physicians first to diagnose Alzheimer s. Unfortunately, many physicians have not had the proper training to mange the multiple health care problems of older adults or to recognize signs of dementia in younger individuals. There is a gap in education for primary care physicians about Alzheimer s disease, especially in the early stages, says Sandra Weintraub, PhD, head of neuropsychology and director of the clinical core at the Northwestern University Alzheimer s Disease Center in Chicago. If you are not getting the answers you need from your physician, you made need to request a referral to a specialist in Alzheimer s diagnostics. Let your primary care physician know that you are aware there are resources in the community that evaluate memory loss and that memory loss can be a precursor for subsequent dementia, says Weintraub. Keep a Journal Note the changes that have occurred in your loved one s behavior and memory and the time span during which they occurred. Also, provide a list of all the medications and herbal remedies the person is taking. Look beyond memory loss for signs of the disease, says Weintraub. Consider personality and mood changes as possible symptoms. Learn About How Alzheimer s is Diagnosed

2 There is no one diagnostic test that can detect if a person has Alzheimer s disease. However, new diagnostic tools and criteria make it possible to make a positive clinical diagnosis of Alzheimer s with an accuracy of percent. A complete diagnosis is based on a number of factors. A Medical History provides information about current mental or physical conditions, prescription drug intake, and family health history. A Mental Status Evaluation assesses a person s sense of time and place and his or her ability to remember, understand, talk, and do simple calculations. In early stages, screening of mental status may not detect symptoms. A Physical Examination includes the evaluation of a person s nutritional status, blood pressure, and pulse. A Neurological Examination tests the nervous systems (brain and spinal cord) for evidence of other neurological disorders. A magnetic resonance imaging (MRI) study of the brain is used to search for other possible causes of dementia, (i.e. stroke). In the early stages of Alzheimer s the results are often normal or unremarkable. Laboratory Tests, such as blood and urine tests, provide additional information about problems other than Alzheimer s that may be causing dementia. A Neuropsychological Evaluation tests memory, reasoning, vision-motor coordination, and language function. This evaluation may provide the only evidence of dementia, especially in the early stages. A Psychiatric Evaluation provides an assessment of mood and other emotional factors that could mimic dementia or that may accompany Alzheimer s disease. Seek Help from Alzheimer s Specialists Your local Alzheimer s Association can help you locate professionals in your area who specialize in diagnosing Alzheimer s disease. Other resources include Alzheimer s Disease Centers (ADCs) at major medical institutions nationwide. Supported by the National Institute on Aging, most ADCs offer

3 diagnostic services and medical management (costs may vary; many centers accept Medicare, Medicaid, and private insurance). People with Alzheimer s can participate in drug trials and other clinical research projects being conducted at the centers. The ADCs are the best source for accessing practitioners who can assist in making the diagnosis, says Weintraub. ADCs usually act as consultants by providing a diagnosis and follow-up care, and working side-by-side with the patients primary care physician. Understand the Diagnosis A diagnosis of Alzheimer s usually falls into one of the following three categories: A diagnosis of probable Alzheimer s indicates that the physician has ruled out all other disorders that may be causing dementia and has come to the conclusion that symptoms are most likely the result of Alzheimer s disease. A diagnosis of possible Alzheimer s indicates the presence of another disorder that may be affecting the know progression of Alzheimer s, so that the disease process is somewhat different that what is seen normally. In this case, however, Alzheimer s disease is still considered the primary cause of dementia symptoms. A diagnosis of definite Alzheimer s can be made only at the time of autopsy because it requires examination of brain tissue. Autopsy confirms the presence of plaques and tangles in the brain, which are the characteristic lesions to diagnose the disease with 100 percent accuracy. A brain autopsy provides a vital record for your family s medical history. If you are experiencing memory, judgment, or reasoning problems, difficulty with dayto-day functions, or changes in your mood or behavior, it is important to visit a physician to determine if you have Alzheimer s disease or another dementia. An Early Diagnosis is Important Recognizing symptoms early and obtaining an accurate diagnosis is extremely important and it may: Maximize the quality of your life Resolve anxiety

4 Give you a greater chance of benefiting from existing treatments Give you more time to plan for the future Another important reason to get a diagnosis is to identify the actual cause of the dementia so that you receive the proper care. Dementia related to depression, drug interaction, thyroid problems, and certain vitamin deficiencies, for example, may be reversible if detected early. Other causes of dementia include strokes, Huntington s disease, and Parkinson s disease and are not reversible. Information Your Physician Needs to Know You and a family member can help by providing the physician key information, including: Changes that have occurred in yourself, possibly documented in the form of a journal Signs of the disease beyond memory loss and personality and mood changes A list of all the medications and herbal remedies you are taking Questions to Ask Your Physician about Testing Which tests will be performed, and what is involved? How long will the tests take? How long will it take to learn results? Common Tests There is no one diagnostic test that can detect if a person has Alzheimer s disease. Standard clinical methods combine physical and neuropsychological testing with caregiver input and the physician s judgment, and the diagnostic process may take more than one day. New diagnostic tools and criteria make it possible for physicians to make a positive clinical diagnosis of Alzheimer s with around 90 percent accuracy.

5 The diagnostic process will involve your primary care physician and possibly other specialty physicians, such as a psychiatrist or neurologist. Questions to Ask Your Physician About the Diagnosis: If your physician gives you a diagnosis of Alzheimer s or another form of dementia, asking the following questions may help. What does the diagnosis mean? Are additional tests needed to confirm the diagnosis? What changes in behavior or mental capacity can I expect over time? What care will I need, and what treatment is available? What else can be done to alleviate symptoms? Are there clinical trials being conducted in my area? Alzheimer s Association Minnesota North Dakota 24/7 Information Helpline: Website: Minneapolis / Duluth / RochesterSt. Cloud / Fargo / Bismarck Contact the Information Helpline for Regional Contact Information