Some Questions You May Wish To Ask You Doctor Regarding Tests Used In Diagnosing Dementia
- What tests will be conducted?
- Who will be performing the tests and how long will it take?
- Should I prepare for the tests in any way?
- Will any of the tests involve pain or discomfort?
- Will there be any cost involved?
- What follow-up will be necessary and who will follow up?
- How will I be informed of the test results and the diagnosis?
Why Are Some Of The Guidelines Limited To Research Settings
Some of the new guidelinesspecifically, those for using biomarkers to assess preclinical Alzheimers disease and to increase the certainty of diagnoses of MCI and dementia due to Alzheimers diseaseare to be used only for research. Before doctors can use these guidelines in clinical practice, more research is needed to make sure biomarkers can help predict who will or will not develop Alzheimers dementia. Biomarker tests also must be standardized to ensure they can be measured correctly and consistently in all clinical settings.
: 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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Challenges For Implementation At Clinical Research Sites
The goals of biomarker inclusion in newer diagnostic criteria include making a more accurate diagnosis of dementia. However, multiple barriers to implementation of innovative diagnostic methods and biomarkers limit their clinical application. These barriers include patient access to medical care, feasibility, cost, and third-party coverage.
Many individuals with dementia are never diagnosed by clinicians. Diagnostic nihilism stems in part from a widely-held perception that currently available drug treatments for AD are inadequatethat they have minimal, if any, benefits, and that risk-benefit and cost-benefit analyses are negative. This current situation with dementia mimics a long-ago time when clinicians chose not to tell patients if they had terminal cancer. Clinicians should make an accurate dementia diagnosis, or refer to a specialty center as needed. If possible, biomarkers should be added to support a dementia diagnosisas third-party coverage permits. An accurate diagnosis will determine prognosis, guide clinical care and management, enable a discussion of genetic risk with family members, and raise the possibility of clinical trial participation. Newer diagnostic technologies may be available if an individual screens or enrolls in a clinical study .
Robust Enough For The Real World
“We want to develop automatic tools that are robust enough for diagnosing patients in a real clinical setting,” says Aviles-Rivero. But in order to do this, these tools need to be ready to handle real life data.
For example, if the same person had two medical images taken, say two MRIs, these images won’t necessarily be identical even though they should hold the same information about that patient’s brain. Two MRIs could be slightly different if they were taken by different machines, or they might have slightly different orientations, or there might be small distortions in an image due to how it was handled or digitally saved.
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Is There A Blood Test For Diagnosing Alzheimers
Researchers are working to diagnose Alzheimers disease at its earliest stages, before the onset of symptoms and even before toxic changes in the brain begin to cause damage.
Their efforts involve the search for new biomarkers measurable, accurate, and reliable indicators of disease that might appear on a blood test, for instance.
These biomarkers may one day help doctors and other clinicians detect Alzheimers early in the disease process, in the same way that increased cholesterol levels in the blood indicate heart disease risk.
For now, the use of Alzheimers biomarkers is mainly limited to research studies, although doctors sometimes use them in clinical practice to help confirm an Alzheimers diagnosis.
Researchers currently use blood tests to look for the presence of certain proteins associated with Alzheimers, including beta amyloid and tau . Scientists are getting closer to developing blood tests that could be used as a routine tool for identifying Alzheimers or screening people who are at risk of developing the disease.
Another biomarker involves cerebrospinal fluid , the clear liquid that surrounds the brain and spinal cord, which can be analyzed for the presence of Alzheimers-related proteins. Tests measuring CSF biomarkers are more sensitive than blood tests and are particularly useful for the diagnosis of early onset Alzheimers.
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What Are The Benefits Of Early Diagnosis
While there is no cure for Alzheimers disease, an early diagnosis means theres more time to work through all the implications and devise strategies to meet the day-to-day challenges of dementia.
Doctors can offer drug and nondrug therapies that slow cognitive decline for a while and help with other changes.
Plus, an early Alzheimers diagnosis offers the best opportunity to begin making decisions about caregiving, finances, and advanced directives and access the many resources available for people with this disease.
An Alzheimers diagnosis also opens up the possibility of participating in clinical trials of new drugs and other interventions.
Clinical trials provide access to cutting-edge treatments not yet in widespread use and offer the chance to help future generations fight this devastating, incurable disease.
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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?
The Importance Of An Early Diagnosis
Historically, a diagnosis of AD has been one of exclusion, and one only made in the latter stages of disease however, the disease process can take years to play out, exacting a significant toll on the patient, caregiver, and healthcare system along the way .
To mitigate this burden, the early and accurate detection of AD-associated symptoms in clinical practice represents a critically needed but challenging advancement in AD care . Usually, a patient with early signs/symptoms of AD will initially present in a primary care setting . For some patients, minor changes in cognition and/or behavior may be detected during a routine wellness visit or an appointment to discuss other comorbidities . As the PCP is often the first to observe a patients initial symptomatology, it is vital they recognize the early signs and symptoms, and understand how to use the most appropriate assessment tools designed to detect these early clinical effects of the disease.
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Some Of The Commonly Used Cognitive Tests Include:
Mini-Mental Status Examination
This test is usually conducted by your doctor or specialist in their office and takes around 5 minutes to complete. The MMSE is the most common test for the screening of dementia. It assesses skills such as reading, writing, orientation and short-term memory.
Alzheimers Disease Assessment Scale-Cognitive
This 11-part test is more thorough than the MMSE and can be used for people with mild symptoms.
It is considered the best brief examination for memory and language skills.
It takes around 30 minutes and is usually conducted by a specialist in their office, or you may be referred to a psychologist for the test.
Neuropsychological Testing
This involves a number of very sensitive tests administered by a neuropsychologist .
A typical testing session will take at least 2 hours and may be conducted over more than one visit.
A variety of tests will be used and may include tests of memory such as recall of a paragraph, tests of the ability to copy drawings or figures and tests of reasoning and comprehension.
Radiological tests
Standard X-rays may be taken and those who smoke will commonly require a chest X-ray to rule out lung cancer, which may be causing a secondary brain tumour. \
Brain imaging techniques
Various brain-imaging techniques are sometimes used to show brain changes and to rule out other conditions such as tumour, infarcts and hydrocephalus these include:
Different Kinds Of Laboratory Tests
Blood and urine tests might be done to check for vitamin deficiencies, thyroid disorders, anemia, infection, inflammation, electrolyte imbalance, drugs that may influence cognition. chemicals, hormone levels, and deficiencies. Sometimes these laboratory tests are done routinely for older adults because of risk for various illnesses, including2:
- Electrolyte panel
- Liver function tests (for example, bilirubin, albumin
- Kidney function
Medications can interact with each other in a variety of ways, and adverse interactions can cause symptoms similar to those of Alzheimers disease. Laboratory tests can show if there is a potentially treatable condition that can reverse symptoms. If laboratory tests come back normal, then various ailments can be ruled out, narrowing down the diagnosis even further.
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Alzheimer’s Disease Diagnostic Guidelines
In 2011, clinical diagnostic criteria for Alzheimers disease dementia were revised, and research guidelines for earlier stages of the disease were characterized to reflect a deeper understanding of the disorder. Development of the new guidelines was led by the National Institutes of Health and the Alzheimers Association. Read more about the updates to the guidelines.
What Are The Main Differences Between The 1984 Diagnostic Criteria For Alzheimers Disease And The 2011 Guidelines
The 2011 guidelines differ from the 1984 diagnostic criteria in a few key ways. They:
- Recognize that Alzheimers disease progresses on a spectrum with three stagesan early, preclinical stage with no symptoms a middle stage of mild cognitive impairment and a final stage marked by symptoms of dementia. The 1984 criteria addressed only one stage of diseasethe final stage of dementia.
- Expand the criteria for Alzheimers dementia beyond memory loss as the first or only major symptom. They recognize that other aspects of cognition, such as word-finding ability or judgment, may become impaired first. The 1984 criteria focused on memory loss as the central emerging characteristic of Alzheimers dementia.
- Reflect a better understanding of the distinctions and associations between Alzheimers and non-Alzheimers dementias, as well as between Alzheimers and disorders that may influence its development, such as vascular disease. In 1984, these relationships were not well recognized or understood.
- Recognize the potential use of biomarkersindicators of underlying brain diseaseto diagnose Alzheimers disease. However, the guidelines state that biomarkers are almost exclusively to be used in research rather than in a clinical setting. These biomarkers did not exist when the original criteria were developed in 1984, so confirmation of the diagnosis was possible only through autopsy after death.
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Are Genetic Tests Part Of The Diagnostic Process
A doctor will not routinely order a genetic test to diagnose Alzheimers disease. A gene may raise your risk of Alzheimers though lifestyle and environment almost always play a role, too but a genetic test does not reveal whether you have or will ever develop the disease.
Neurologists may order genetic tests in unusual situations, such as when they suspect specific mutations in one of three genes. These rare mutations account for an estimated 1 percent or less of all Alzheimers cases and tend to result in early-onset Alzheimers, in which symptoms develop before age 65.
Anyone who wants to have a genetic assessment can now take a home screening test.
In 2017 the U.S. Food and Drug Administration announced approval of the first direct-to-consumer genetic test, from a company called 23andMe. Tests analyze a saliva sample, submitted in the mail, for the presence of gene variants that raise the odds of developing different diseases or conditions. One of these is the APOE-e4 gene, a risk factor for Alzheimers.
However, many people who have the APOE-e4 gene never develop Alzheimers, and many people who develop Alzheimers do not possess the APOE-e4 gene. So while the gene is known to increase the risk of developing Alzheimers, individuals must be very careful with how they interpret the finding.
The group advises anyone interested in home screening to consult a genetics counselor to better understand the implications of taking the test and to put any findings in context.
If You Are Diagnosed With Dementia
Obtaining an early and accurate diagnosis can improve the quality of life for people with dementia.
Talk to your doctor about treatment and ongoing assessment.
Support and information is available through the National Dementia Helpline on 1800 100 500.
Thanks to Associate Professor David Ames for reviewing this material.
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What Are The Core Clinical Criteria For The Diagnosis Of Mild Cognitive Impairment
Mild cognitive impairment refers to the symptomatic, pre-dementia phase of the disease. It should be noted, however, that MCI may be due to causes other than Alzheimers disease. A diagnosis of MCI requires all of the following:
- concern about a change in cognition relative to previous functioning
- impairment of one or more cognitive functions, like memory and problem solving, that is greater than expected for the persons age and education.
- preserved ability to function independently in daily life, though some complex tasks may be more difficult than before
Clinicians should obtain long-term assessments of cognition whenever possible to gain evidence of progressive decline. To determine that MCI is due to Alzheimers disease, a doctor must rule out other brain diseases or other causes–such as medications, depression, or major life changes–that could account for cognitive decline.
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.
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What Happens If A Doctor Thinks It’s Alzheimer’s Disease
If a primary care doctor suspects Alzheimers, he or she may refer the patient to a specialist who can provide a detailed diagnosis or further assessment. Specialists include:
- Geriatricians, who manage health care in older adults and 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. In addition, these specialty clinics or centers often have access to the equipment needed for brain scans and other advanced diagnostic tests.
Making Use Of Multiple Sources Of Data
Many different types of patient information are relevant when diagnosing Alzheimer’s disease. There are medical images, such as MRI and PET scans of a patient’s brain . Other key information also comes from non-imaging data, such as genetic data, and personal information such as the patient’s age.
One approach often used in machine learning is to analyse the relevant data to see whether it contains hidden structures that might help with the task at hand in this case diagnosing a disease. This approach normally focuses on just one type of data, but Avilies-Rivero and her colleagues wanted to make use of all the different types of information that are available about individual patients. . “How can we merge this rich heterogenous data these different modalities of data and how can we extract a meaningful of this data?”
A complicated looking graph, where each edge relates exactly two nodes represented by a line joining those two nodes.
Example of a hypergraph where the hyperedges can relate any number of nodes. Now the hyperedges are represented by coloured groupings, and can connect any number of nodes.
The resulting multimodal hypergraph provides a way of capturing the incredibly rich connections between all the different types of data. “The hyperedges allow us to make higher-order connections in the data, to go beyond pairwise data relations,” says Aviles Rivero.
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