How Is Alzheimer’s Disease Diagnosed And Treated

Treatment For Mild To Moderate Alzheimers

Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.

Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.

Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.

Brigham And Women’s Hospital Neurology Team

The Department’s multidisciplinary staff of more than 65 clinical faculty and over 350 department members strives to provide patient-focused, world-class medical care for the entire spectrum of neurological diseases. We have a strong focus on developing new treatments and cures for neurologic diseases, and we offer a variety of teaching programs that train the next generation of neurology professionals.

Alzheimer’s Disease Diagnosis At Brigham And Women’s Hospital

Comprehensive care of patients at the Brigham and Women’s Hospital Alzheimer Center begins with a thorough evaluation of a patient’s Alzheimer’s disease symptoms. By establishing an accurate diagnosis from the beginning and identifying all the conditions that may be contributing to a patient’s impairment, we lay the groundwork for an effective treatment plan.

During the first meeting, one of our physicians will take the time to gather a comprehensive medical history from the patient. We encourage patients to bring family members to appointments and include them in this process, as they can be a vital part of the evaluation and treatment plan.

After a detailed history is obtained, a series of assessments will be performed to identify the underlying neurological condition and to determine whether other medical conditions are contributing to a patient’s cognitive impairment.

These evaluations used in determining an Alzheimer’s disease diagnosis may include:

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Clinical Features/stages Of Ad

The core feature of AD disease is impairment of recent memory. As the disease advances, various other cognitive domains are involved. The disease progresses over seven stages; however, there is an overlap between these.

Stage 1 : Like other neurodegenerative diseases, this stage can precede the memory loss by many years where the affected individual is clinically okay without any memory abnormality

Stage 2 : This mimics the forgetfulness associated with normal ageing, where an individual misplaces objects and can eventually find them after a period of search. Most of the patients relatives are not even aware of this mild forgetfulness

Stage 3 : Recent memory worsens, which is now apparent to the relatives. They suffer in daily functioning and maybe confused occasionally. They can, however, still be independent in all their daily activities

Stage 4 : Memory worsens further with difficulty doing tasks that need multitasking. They start losing their way around unfamiliar places and become socially withdrawn. Denial of their disease and becoming progressively dependent for even simple tasks on their caregiver is expected at this stage

Stage 5 : They may even forget their current surroundings, home address/telephone number and need assistance for simple tasks like dressing. Losing way in familiar surroundings also happens

Stage 7 : During this stage, most of them lose the ability to speak, communicate and even ambulate by now.

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 Alzheimer’s, 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.

Researchers and doctors working in clinical settings may employ imaging scans that can reveal telltale changes in the brain. PET scans, for instance, can detect abnormal levels of beta amyloid and tau.

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What Is The Treatment Of Ad

There is no specific treatment for reversing or stopping the progression of AD. Although, drugs are available which can symptomatically improve cognition. One must take medication keeping in conjunction with the following,

Home Remedies And Lifestyle

Non-drug approaches focus on treating the behavioral, psychological, and emotional symptoms of Alzheimer’s by changing the way you understand and interact with the person with the disease.

These approaches recognize that behavior is often a way of communicating for those with Alzheimer’s. The goal of non-drug approaches is to understand the meaning of the challenging;behaviors and why they are present.

Non-drug approaches should generally be attempted before using psychotropic medications since they do not have the potential for side effects or medication interactions.

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How Is Alzheimer’s Disease Diagnosed And Evaluated

No single test can determine whether a person has Alzheimer’s disease. A diagnosis is made by determining the presence of certain symptoms and ruling out other causes of dementia. This involves a careful medical evaluation, including a thorough medical history, mental status testing, a physical and neurological exam, blood tests and brain imaging exams, including:

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:

• Donepezil
• 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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When Is Alzheimers Treatment Started

Treatment may be started once the disease is officially diagnosed, but it can sometimes take years before a person meets the diagnostic criteria for Alzheimers. In the early stages, changes to the brain may only be recognized on a PET scan, and any signs of mild cognitive impairment may be dismissed as signs of aging.

How Alzheimers Is Diagnosed By A Doctor

At one time, an Alzheimers diagnosis was only able to be confirmed after a person had passed away and doctors were able to perform an autopsy on the brain. Today, however, a physician can diagnose the disease with 90% accuracy while the person is still living.

It is important to note that there is no single test that can diagnose Alzheimers or dementia.

A medical evaluation will often include the following:

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Treatment Of Alzheimer Disease

BRADFORD T. WINSLOW, MD, Swedish Family Medicine Residency, Littleton, Colorado

CHRISTIAN M. STOB, DO, Denver Health Medical Center, Denver, Colorado

KATHLEEN A. HAZLEWOOD, PharmD, University of Wyoming School of Pharmacy, Laramie, Wyoming

Am Fam Physician.;2011;Jun;15;83:1403-1412.

;Patient information: See related handout on Alzheimer disease, written by the authors of this article.

• References

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.

What Are The Symptoms Of Alzheimers Disease

Symptoms of Alzheimers disease vary from person to person and worsen over time. Symptoms of the disease include:

• Memory loss. This is usually one of the first symptoms of Alzheimers disease.
• Putting objects in odd places
• Confusion about events, time and place
• Repeating questions

For more information on the stage of disease, click here.

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Complementary And Alternative Therapies

We may recommend therapies that are complementary or alternative to ease symptoms. Providers at the Layton Center work with colleagues at OHSUs Oregon Center for Complementary and Alternative Medicine in Neurological Disorders.;Our research focuses on finding ways to delay or slow Alzheimers and other dementias. ;

Therapies might include:;

• Acupuncture: Inserting very thin needles at specific points on the body may relieve pain and other symptoms. Although more research is needed, a 2015 review of studies found that acupuncture is safe and effective for people with Alzheimers. ;
• Diet: A low-fat diet with plenty of fruits and vegetables can protect heart and brain health. Research with brain scans showed the benefit of the Mediterranean diet.;People who followed the diet had less buildup of an Alzheimers-related protein than those on a traditional Western diet. ;
• Meditation: A recent study showed that daily meditation for three months can help people with Alzheimers. People in the study showed improvement in memory and thinking. Those who continued for three more months maintained or improved these gains. ;
• Supplements: A few studies have shown modest benefits from taking nutritional or herbal supplements. This is an area of continued research.

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.

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How Is Alzheimer’s Disease Diagnosed

Doctors use several methods and tools to help determine whether a person who is having memory problems has possible Alzheimers dementia , probable Alzheimers dementia , or some other problem.

To diagnose Alzheimers, doctors may:

• Ask the person and 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
• Conduct tests of memory, problem solving, attention, counting, and language
• Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
• Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to rule out other possible causes for symptoms

These tests may be repeated to give doctors information about how the persons memory and other cognitive functions are changing over time. They can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, mild cognitive impairment, or a non-Alzheimers dementia, including vascular dementia. Some of these conditions may be treatable and possibly reversible.

People with memory problems should return to the doctor every 6 to 12 months.

How Are Common Eye Diseases Related To Increased Risk Of Dementia

According to a new study published in the British Journal of Ophthalmology, some common eye diseases like age-related macular degeneration , diabetes-related eye disease and cataracts can be independently linked to increased risk of dementia.

Dementia is a general term for memory loss and impaired ability of language, thinking, decision-making and problem-solving that may affect the day-to-day activities of a person. Alzheimer’s is a common type of dementia.

In this article, we will discuss how common eye diseases can lead to an increased risk of memory loss or dementia. Take a look.

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Approach To The Patient

• References

Guidelines on the treatment of Alzheimer disease are available from a number of organizations , including one developed by the American Academy of Family Physicians, in conjunction with the American College of Physicians.15; All guidelines emphasize the importance of educating patients and their families about the disease process and its expected course. Early referral to local support groups is recommended, and medicolegal issues such as driving and end-of-life planning should be addressed. Recommendations regarding pharmacologic treatment are described in Table 2,2123 and a suggested algorithm for the treatment of Alzheimer disease is presented in Figure 1. The decision to treat with medication should be shared with the patient and caregivers, including a discussion of the modest clinical benefit, adverse effects, and cost. Physicians should consider discontinuing therapy in patients who continue to decline despite maximal therapy.16 The National Institute on Aging and the Alzheimer’s Association have released recommendations on the diagnosis of dementia and mild cognitive impairment from Alzheimer disease; however, these guidelines do not address the treatment of Alzheimer disease and do not recommend the clinical use of biomarkers.52,53

Summary of Guidelines for the Treatment of Alzheimer Disease

American Academy of Family Physicians and American College of Physicians15

MMSE = Mini-Mental State Examination.

Information from references 2, and 14 through 20.

What Leads To Ad

There is progressive dysfunction of the anatomical areas involved in memory and behaviour in AD. This is due to the deposition of Senile Plaques consisting of amyloid beta and neurofibrillary tangles. The deposition of SP starts in the Hippocampus, which is the most critical structure involved with recent memory, and then spreads to other brain areas as the disease advances. Also Read – FDA Approves First Alzheimer’s Drug in Nearly 2 Decades, All You Need to Know

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What Happens If A Doctor Thinks It’s Alzheimer’s Disease

If a primary care doctor suspects mild cognitive impairment or possible 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. Tests often are done at the clinic or center, which can speed up diagnosis.

How Is Alzheimers Disease Treated

Drugs are the cornerstone of treatment for Alzheimers disease. The current medications cannot stop or cure Alzheimer’s but may slow the progression of the disease and improve symptoms. Some drugs work by improving communication between nerve cells, while others may help with behavioral symptoms or sleep problems.

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