Alzheimer’s Disease Diagnostic Tests

What Are Options For Further Assessment And Diagnosis

If a primary care doctor suspects mild cognitive impairment or possible Alzheimers, he or she may refer you to a specialist who can provide a detailed diagnosis, or you may decide to go to a specialist for further assessment. You can find specialists through memory clinics and centers or through local organizations or referral services. Specialists include:

• Geriatricians, who manage health care in older adults. They know how the body changes as it ages and whether symptoms indicate a serious problem.
• Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems
• Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans
• Neuropsychologists, who can conduct tests of memory and thinking

Memory clinics and centers, including Alzheimers Disease Research Centers, offer teams of specialists who work together to diagnose the problem. Tests often are done at the clinic or center, which can speed up diagnosis.

You may also want to get a second opinion. Diagnosis of memory and thinking problems can be challenging. Subtle signs and symptoms may be overlooked or unclear. Getting a second opinion helps confirm the diagnosis. Most doctors understand the benefit of a second opinion and will share your records if you permit. A specialist can refer you to another doctor for a second opinion, or you may decide to find one yourself.

How Do The New Guidelines Change The Way Clinicians Diagnose Mci Or Alzheimers Disease Should They Still Use The Same Tests And Screening Tools Should They Use Any New Tests Or Screening Tools

Clinicians should continue to use the many validated neuropsychological tests currently available. These include formal tests that assess various cognitive functionsepisodic memory, executive function, language, visual and spatial skills, and attention. Interviews with the person as well as a family member, friend, or caregiver about changes in the persons thinking skills are also helpful.

Clinicians should also consider augmenting the evaluation process they have been using. To learn more about a variety of simple, informal techniques that can be used to assess cognitive function, go to: www.alzheimersanddementia.com/article/S1552-526000104-X/fulltext.

If a problem is suspected, more extensive evaluation by a specialist should be recommended to the patient and family. The Alzheimers Association, Alzheimers Foundation of America, local Area Agency on Aging offices, and a variety of organizations offer information and help with planning for the future.

What Is The Outlook For People With Alzheimers Disease

Alzheimers disease gets worse over time and is ultimately fatal. Persons with Alzheimers disease live, on average, four to eight years after diagnosis. Some patients can live as long as 20 years after diagnosis. The course of the disease varies from person to person.

Last reviewed by a Cleveland Clinic medical professional on 03/18/2019.

References

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Computed Tomography And Magnetic Resonance Imaging

• Structural imaging such as Computed Tomography or Magnetic Resonance Imaging yields a picture of the brain that allows identification of such features as volume loss or abnormal structural features such as white matter disease, masses, or vascular abnormalities, which are considered indications of neuronal degeneration. Newer techniques such as diffusion tensor imaging reveal subtle structural changes that may precede more easily identifiable volume loss in the brain. Functional imaging such as fMRI can be used to identify abnormal patterns of brain activation or metabolic activity.

How Is Alzheimer’s Disease Diagnosed

Doctors use several methods and tools to help determine if a person with thinking or memory problems has Alzheimers disease. To diagnose Alzheimers, doctors may:

• Ask the person experiencing symptoms, as well as a family member or friend, questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
• Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
• Conduct tests of memory, problem solving, attention, counting, and language.
• Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
• Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to support an Alzheimers diagnosis or rule out other possible causes for symptoms.

Doctors may want to repeat these tests to help best determine how the persons memory and other cognitive functions are changing over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.

People with memory problems should return to the doctor every six to 12 months.

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Types Of Imaging Used To Help Diagnose Alzheimer’s

Different kinds of imaging can help provide doctors with different kinds of information.

Structural imaging shows things such as shape, position, and volume of tissues.2 This can show whether the brain or parts of the brain have shrunk at all, which may be early signs of Alzheimers disease.2 Magnetic resonance imaging and computed tomography are kinds of structural imaging.

Functional imaging looks at cell activity in organs and how well cells are using sugar and oxygen.2 Positron emission tomography and functional MRI are types of functional imaging tests. Molecular imaging helps to find cellular or chemical changes that may be associated with certain types of diseases, using specialized targeted radiotracers. Tests that use molecular imaging include PET, fMRI, and single photon emission computed technology .2

Early Medical Testing For Ad

For decades, scientists have been working to develop a reliable, predictive test for Alzheimer’s disease. In 1994, genetic testing for late-onset Alzheimer’s disease became available primarily in research settings, offering patients a probabilistic measure of their risk for the disease by analyzing their apolipoprotein E genotype. Individuals with two ApoE 4 alleles have more than seven times increased risk of developing AD than those with the ApoE 3 allele . However, the ApoE 4 allele is neither a necessary nor sufficient predictor of the disease, and the association between ApoE 4 allele and AD has been shown to vary by race and ethnicity . For these reasons and others – including the test’s low sensitivity and specificity, the difficulty of interpreting probabilistic results, and the lack of prevention options – experts have largely opposed widespread clinical adoption of this genetic test .

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Transforming Medical And Legal Landscapes

If an early diagnostic test is indeed developed and demand matches global interest, millions of people in each of the studied countries will become members of a new population and political advocacy group: asymptomatic adults living with a diagnosis of Alzheimer’s disease. Consequently, policymakers and clinicians should expect significant changes in the utilization of medical and economic resources and address potential legal obstacles.

In the medical realm, diagnosed but asymptomatic individuals are likely to press for follow-up testing, ongoing medical monitoring, and medical management of potential complications associated with Alzheimer’s disease . Given the uncertainty around the disease’s pathogenesis and treatment mechanisms, the clinical value of such tests is unclear, and these additional costs could strain already-overburdened health systems, making the tradeoffs involved in allocating medical resources even more difficult . However, the non-clinical benefits of testing, such as signing advanced directives and spending more time with family and friends, do provide value and should be appropriately considered in cost-benefit calculations .

Medical Tests Used To Diagnose Alzheimers Disease

There is no single Alzheimers test that can determine whether a person has the disease. Currently, Alzheimers disease can only be confirmed after death through examination of brain tissue in an autopsy. Diagnosing Alzheimers and other types of dementia while patients are still alive is not yet an exact science, but doctors do have an arsenal of tests that can narrow down the underlying reason for a patients symptoms, such as memory problems and changes in behavior. However, it is important to keep in mind that these mental and physical tests are conducted to rule out all other possible causes, not to verify the presence of AD.

Clinicians are about 80 percent accurate in determining whether someone has AD, but a lot of cases arent black and white, explains David Morgan, Ph.D., CEO and director of the Byrd Alzheimers Center and Research Institute at the University of South Florida.

While this figure may not seem reassuring, it is still crucial for patients to undergo testing as soon as they begin exhibiting symptoms. The results will help physicians provide a diagnosis and appropriate treatment suggestions, which will enable patients and their families to make plans and prepare for the future.

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So, when should one seek medical attention for suspected Alzheimers?

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What Newer Medications Are Under Study

All currently approved medications target Alzheimers disease after it develops. Scientists are currently researching ways to stop or slow the progress of Alzheimers disease before it starts.

Some of the drugs in late-stage investigation are called monoclonal antibodies. These drugs target the amyloid protein that builds up in brain cells. They work by attaching to the amyloid proteins as they float in the brain and remove them, before they form into the plaques and tangles that interfere with the brains ability to properly function.

These drugs are still in clinical trials and are several years away from Food and Drug Administration approval in the United States. Early results have been mixed, with some trials showing no improvement in brain function others showing a slight improvement . Despite the mixed results, researchers are excited about this new potential method to modify the disease process.

Scientists Diagnose Alzheimer’s Disease By Blood Test

Alzheimer’s disease is characterized by a decline in cognitive function, memory loss, and in severe cases, language impairment, and ultimately the loss of independent living ability. According to estimates by Chinese Center for disease Control and Prevention, there are about 10 million AD patients in China, which will exceed 30 million by 2050, making it the country with the largest number of AD patients in the world. However, at present, Chinese residents have low awareness and attention to AD, and there are generally low diagnosis rates and low treatment rates.

Prof. Zhang Jing’s team, from the First Affiliated Hospital, Zhejiang University School of Medicine , collaborated with researchers at the University of Washington School of Medicine on the latest scientific research results based on plasma extracellular vesicles in the early diagnosis of AD markers, “Blood Extracellular Vesicles Carrying Synaptic Function- and Brain-related Proteins as Potential Biomarkers for Alzheimer’s disease.” The study was published in Alzheimer’s & Dementia.

Specifically, the study used innovative nano-flow detection technology to develop a stable and rapid assay method, and discovered a new type of marker that can be used to assist in the diagnosis of ADperipheral blood nerve Source EVs-related marker NMDAR2A .

Explore further

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Overview / Words Of Caution

Several online tests can help families come closer to knowing whether a loved one suffers from Alzheimers disease or a related dementia. To be clear, these tests are not designed to give a diagnosis of Alzheimers. A diagnosis requires several medical experts, as well as expensive technology and potentially unpleasant procedures such as brain scans and spinal fluid extractions. Recent studies, in fact, have shown that dementia is often misclassified when using only the following tests.

A certain degree of forgetfulness is common to most aging individuals. Mild Cognitive Impairment is a condition which is more severe than normal memory decline associated with aging, but not so severe as Alzheimers. Online tests for dementia/Alzheimers should be adequate to help families distinguish between these conditions.

Before discussing the various options available to self-administer an Alzheimers test from the Internet, some words of caution are advised.

1. No online test can definitively tell if your loved one has Alzheimers. Do not believe any website saying otherwise.

2. There are many free tests, available online, produced by universities, nonprofits and reputable medical institutions. It is strongly recommended that one use the following links to find one of these tests. Do not pay for an Alzheimers test advertised online more than likely, these paid tests are not valid and can possibly be scams.

Comparison Table Of Dementia Tests

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How Should Clinicians Approach The Question Of Preclinical Alzheimers With Patients

Preclinical Alzheimers disease is an experimental concept at this time. While imaging and biomarker studies strongly indicate a preclinical phase for the disease, it is not yet possible to predict which cognitively healthy individuals will and will not progress to MCI or dementia. Researchers hope to develop a biomarker profile that will identify individuals most likely to develop Alzheimers dementia and benefit from early treatments when they become available.

Gathering A Complete Medical History

As with the treatment of any medical condition, physicians will ask for a rundown of a patients past and present health issues and all medications they are currently taking. The doctor will also take a brief family medical history to assess the patients risk of developing certain conditions due to genetic, lifestyle and environmental factors. For example, if a patients parent had early-onset Alzheimers disease, it increases the likelihood that the patient will also develop this disease.

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Other Testing & Diagnoses

Aside from online tests, it is worth mentioning both blood tests and genetic tests. Currently, a definitive blood test does not exist for the US market. However, there have been some positive developments on this front and now blood tests in the US market are expected within 3 5 years.

Genetic testing does exist but does not provide a definitive answer as to whether someone has Alzheimers or dementia. Instead, genetic tests are helpful in telling individuals if they have a propensity to develop dementia based on their genetic makeup. A medical evaluation from a doctor is currently the only way for an individual to receive an Alzheimers or dementia diagnosis. Read more about blood tests, genetic tests and the process of receiving a medical diagnosis.

DementiaCareCentral.com was developed with funding from the National Institute on Aging . The site is for educational purposes, medical decisions should not be based on its content and its authors assume no liability for errors or omissions. Content cannot be reproduced without permission.©1995-2022.

Which Medicines Are Used To Treat Alzheimers Disease

There is no cure for Alzheimers disease, but available medications temporarily slow the worsening of dementia symptoms and help with behavioral problems that may appear during the course of the disease.

Four medications representing two drug classes are currently approved by the Food and Drug Administration to treat the symptoms of Alzheimers disease. These drugs are the cholinesterase inhibitors and a NMDA antagonist.

Cholinesterase inhibitors. The cholinesterase inhibitors are all approved to treat the symptoms of mild to moderate Alzheimer’s disease . Cholinesterase inhibitors include:

• Rivastigmine and Exelon patch
• Galantamine

These drugs work by blocking the action of acetylcholinesterase, the enzyme responsible for destroying acetylcholine. Acetylcholine is one of the chemicals that helps nerve cells communicate. Researchers believe that reduced levels of acetylcholine cause some of the symptoms of Alzheimer’s disease. By blocking the enzyme, these medications increase the concentration of acetylcholine in the brain. This increase is believed to help improve some memory problems and reduce some of the behavioral symptoms seen in patients with Alzheimers disease.

These medications do not cure Alzheimers disease or stop the progression of the disease. The most common side effects of these drugs are nausea, diarrhea, and vomiting. Some people may have loss of appetite, insomnia or bad dreams.

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Clinical Tests For Alzheimers & Dementia

Montreal Cognitive Assessment

The Montreal Cognitive Assessment is also 30 questions, like the MMSE above, and takes about 10 minutes. The MoCA includes the Clock Drawing Test and also has questions and small tasks to assess someones understanding of time and place, as well as their short-term memory and ability to concentrate. MoCA is similar to the MMSE but about 30 years newer. Studies have shown MoCA is more reliable for identifying dementia, and better at identifying early-stage dementia or mild cognitive impairment. The MoCA is also better at indicating dementia in people with Parkinsons disease. The test is meant to be administered and scored only by a doctor, and is harder to find online than the MMSE.

Mini-Mental State Exam

While originally designed to be administered by medical professionals, family members can now administer the MMSE using their phone or laptop and receive accurate scoring results. Start here.

The SLUMS

: 201: 1: Moesm: Esmdocx

Additional file 1: This file includes the following information: 1. Search strategy used on MEDLINE. 2. Operational definitions of AMSTAR’s Items for DTA reviews about dementia. 3. DTA systematic reviews about dementia- Descriptive information. 4. DTA systematic reviews about dementia- AMSTAR items. 5. DTA systematic reviews about dementia- PRISMA items. 6. List of excluded studies.

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