Ruling Out Other Conditions
The process of ruling out similar conditions is referred to as differential diagnosis. Alzheimers has symptoms in common with Parkinsons disease, dementia with Lewy bodies, frontotemporal dementia, and Huntingtons disease.
The doctor may be able to quickly rule many of these conditions based on medical and family history or simple blood tests. Other disorders may require time and repeated tests before they can be confirmed or ruled out. The presence of other diseases in addition to Alzheimers may complicate the differential diagnosis and eventually result in multiple diagnoses.
Condition Guide
What About Amyloid Brain Pet Scans
Maybe youre thinking about having an FDA-approved amyloid brain PET scan. These tests involve the injection of a radioactive dye attached to a molecule that sticks to amyloid plaques in the brain. The radioactivity is then measured by special imaging technology, similar to a CT scan.
Should you get one? You could, but there are two issues to consider. First, they are not paid for by insurance and they cost about $5,000 so you either have to pay out of pocket or join a research study at a National Institute on Aging Alzheimers Disease Research Center, where you might get one for free. Second, how would the information help you?
No special amyloid brain scans are needed for the straightforward diagnosis and treatment of memory loss. If you are having significant symptoms of memory loss, such as those mentioned above, talk with your doctor about them. Your doctor will likely evaluate your overall health and the medications you take, then do some standard blood tests and brain scans as well as pencil and paper testing. Based on the results of those tests, your doctor may start you on a medication intended to boost your memory function.
Perhaps you dont have any symptoms of Alzheimers disease today, but one of your parents had it. Should you get an amyloid brain scan to find out if you are likely to develop Alzheimers in the future?
Looking For More Affordable And Reliable Tests
Be sure to check with your doctors office on insurance coverage of tests, since some costly technologies do not yet qualify for insurance coverage. For example, a scan test known as brain amyloid PET imaging has been denied coverage by the Centers for Medicare and Medicaid Services for clinical use . Such a scan can cost $3,000 or more. Since most private insurers follow CMS recommendations and many Alzheimers patients are on Medicare, this ruling impacts patients screening options, for now.
Additional studies are underway to determine the scans usefulness in diagnosing Alzheimers disease and other dementias. Many scientists are researching new ways to inexpensively and reliably diagnose Alzheimers disease earlier and more accurately. Efforts include:
- Creating sophisticated brain imaging systems to help measure the slightest changes in brain function or structure, to diagnose Alzheimers before any noticeable symptoms occur
- Examining the correlation between early brain damage and outward clinical signs
- Looking at changes in the blood and cerebrospinal fluid to track the progression of the disease
- Testing of personality changes and cognition, measured through memory and recall tests that might predict which individuals are at higher risk for the disease
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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 Does The Sage Test Work
SAGE evaluates your thinking abilities by asking you questions related to language, reasoning, problem-solving, and memory.
Scharre explains that the questions cover a wide range of cognitive domains, especially those abilities that are early predictors of mild cognitive impairment.
SAGE measures cognitive function by assessing the following areas:
- Orientation
- How many nickels are in 60 cents?
- Write down the names of 12 different animals
In addition to the scored items on the test, SAGE asks questions about your medical history, such as “Have you suffered a stroke?” The test asks if youve had a family history of cognitive impairment. Youre also asked about any current symptoms you may be having, such as problems with memory, balance, or if you’ve experienced any personality changes. These answers can help your clinician identify possible causes of cognitive decline.
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What Is The Alzheimers Disease
Alzheimers disease was originally identified by a German physician called Alois Alzheimers in 1907. It is a progressive neurodegenerative condition and one of the most common types of dementia that slowly declines a persons memory, behavior, thinking and reasoning capabilities. The overall effect is that the patient is unable to fully perform simple day to day task and to effectively communicate.
The illness usually afflicts 1 in every 9 adults aged 65 and above and an overall estimation of about 5 million Americans. Alzheimers symptoms may appear in the 30s and mid-60s ages. The symptoms if not noticed and treated early develop slowly and can get worse over time causing the patient condition to get severe.
What Does Sage Stand For
The Self-Administered Gerocognitive Exam, known as SAGE, is a brief, pen-and-paper cognitive assessment tool designed to detect the early signs of cognitive, memory, or thinking impairments. The test evaluates your thinking abilities. This can help your doctors understand how well your brain is functioning.
Douglas Scharre, MD, director of the division of cognitive neurology at The Ohio State University Wexner Medical Center in Columbus, developed the test over a five-year period based on clinical experience and review of literature.
Questions were designed to evaluate every part of a patients brain,” Dr. Scharre explains.
The scoring for SAGE was designed to give equal weight for questions that assess brain function for the front, the back, the left, and the right side of the brain, so that no area was overrepresented.
SAGE will not diagnose any specific condition. It will not tell your doctor if you have Alzheimers disease or any other condition that can impact your thinking.
But it is a helpful screening tool for mild cognitive impairment from any cause and early dementia.
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Spinal Fluid Tests Are Available Now And Paid For By Insurance
Perhaps Ive convinced you that you dont need to rush out and have an expensive amyloid brain scan. But there are situations when it is important to find out if you or a loved one has Alzheimers, versus another brain disease that would be treated differently. In these situations, we often use a spinal fluid test that is quite good at being able to distinguish Alzheimers from other brain diseases affecting thinking and memory.
To obtain the spinal fluid, you need to undergo a lumbar puncture, more commonly known as a spinal tap. Although it may sound frightening, it is actually a perfectly safe test. You simply sit or lie down on your side with your back to the doctor and curl into a little ball by bringing your shoulders down and your knees up. The doctor finds the right spot, cleans the area well, gives you some numbing medicine, inserts a thin needle, and takes out a small amount of spinal fluid, which is sent to a lab for analysis.
Assessment For Dementia Usually Includes The Following:
Personal history
The doctor usually spends some time discussing your medical history and gathering information about your changes in memory and thinking.
Physical examination and laboratory tests
The symptoms of dementia can be due to a number of other possible causes, such as vitamin deficiency, infection, metabolic disorders and side effects from drugs.
These other causes are often easily treated.
Therefore, an early step in diagnosing dementia is to rule out these causes through a physical examination, blood tests and urine tests.
Routine laboratory tests used in the diagnosis of dementia include:
- Blood tests to investigate:
- Drug interactions and dosing problems
Cognitive testing
Cognitive tests are used to measure and evaluate cognitive, or thinking, functions such as memory, concentration, visual-spatial awareness, problem solving, counting and language skills.
Most doctors use short cognitive screening tests when assessing these functions. If more detailed testing is required you will be referred to a neuropsychologist a psychologist specialising in the assessment and measurement of cognitive function.
Cognitive tests are vital in the diagnosis of dementia and are often used to differentiate between types of dementia. They can also be used to assess mood and may help diagnose depression, which can cause symptoms similar to those of dementia.
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What Diagnosis Falls Under Alzheimer’s Disease
Alzheimers disease is a diagnosis in itself. When it is noticeable clinically and identified early on, the formal diagnosis may be Mild Cognitive Impairment due to Alzheimers disease which may later develop into a diagnosis of dementia due to Alzheimers disease.
How Is Alzheimers Diagnosed
Diagnosing dementia is the first step. Dementia is a collection of symptoms and signs characterized by loss of memory and cognitive function. Alzheimers is the most common cause of dementia, accounting for between 60 and 80 percent of cases. Dementia can be caused by other brain disorders, cardiovascular conditions, lead poisoning, and thyroid problems.
Dementia is diagnosed when at least two of the following mental functions are found to be significantly impaired:
- Memory
- Judgment
- Visual processing such as perception of motion, depth, or color
After dementia is diagnosed, the doctor will evaluate possible causes. Criteria for probable Alzheimers includes:
- Symptoms began gradually and have worsened over time.
- Work or other daily activities are impaired.
- Several aspects of cognitive ability have declined, as confirmed by someone who knows the person.
- The changes cannot be explained by any other condition.
Criteria for possible Alzheimers includes:
- Symptoms began suddenly, or it is difficult to be certain how they began.
- There is evidence of another condition that can cause the symptoms.
Based on all of the above criteria, the doctor will decide how probable a diagnosis of Alzheimers disease is. Since several diagnostic criteria may involve waiting to see whether and how certain symptoms progress, the process of diagnosis can take time.
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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.
Blood Tests Available Now
A blood test is available now, through your doctor, that delivers a result in about 10 days and accurately determines whether someone has Alzheimers disease. The Preclivity AD Test from C2N Diagnostics measures proteins in blood plasma that indicate a buildup of plaques known to cause dementia in peoples brains.
Cost
The cost of this Alzheimers blood test is $1,250, less expensive than a PET scan that looks for the same protein buildups. Unfortunately, the price tag cannot be covered by Medicare or Medicaid, but C2N says people who cant afford the test can qualify for a discount based on their income.
Does it Work?
C2N Diagnostics says they tested Preclivity AD in 686 people and compared it to the results of PET scans. When PET scans showed a high amount of amyloid-beta, a protein that turns to plaques and tangles in the brains of people with Alzheimers, the blood test agreed 92 percent of the time. When the PET scan showed no amyloid, the blood test showed the same about 77 percent of the time.
How to Get the Blood Test
The Preclivity AD Test has not been approved by the Food and Drug Administration. It is currently available only through a doctor, and can be sold by the company under rules for commercial laboratories. The test, in other words, is available despite lacking FDA approval, though C2N has said the FDA is planning on reviewing the test in 2021. The Alzheimers Association says it wont endorse the test until there is FDA approval.
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What Should You Do First
Dementia is a symptom which is caused by many different things, some of which are reversible. Especially if the memory loss has occurred quickly, it is important to be screened by a doctor. It is quite possible that a medical condition like diabetes or the side-effect of a drug is causing the forgetfulness, and not Alzheimer’s. As a matter of fact, I thought my mother was developing memory problems but found out that actually was just experiencing severe hearing loss. When she got hearing aids, she was fine. So be sure to see a doctor.
This content is accurate and true to the best of the authorâs knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
How Many Did You Get Right
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Future Of Alzheimers Blood Tests
When blood tests become mainstream, they will significantly impact the way doctors diagnose and even treat the condition.
Beyond the Preclivity AD and Simoa described above, there are multiple other types of blood tests in development some are looking at protective fats in the blood. Research shows that an increase in fatty amide levels indicates more beta amyloid in the brain. Beta amyloid plaques have been found in the brains of people with Alzheimers.
Other blood tests will measure proteins such as tau proteins and the neurofilament light chain protein. Researchers have found that neuron death, characteristic in people with Alzheimers, may be detected by the corresponding increase of these proteins in the blood.
It is also possible that the probable link between insulin resistance, diabetes and Alzheimers means blood tests could show the disease in someone well before symptoms occur. Another protein called IRS-1 is commonly associated with diabetes but has also been linked to Alzheimers. Studies have shown that someone with Alzheimers has more IRS-1 than even someone with diabetes.
Is Dementia A Mental Illness
Dementia is a mental health disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders. In 2013, the American Psychiatric Association changed the name to Major Neurocognitive Disorder, which is a mouthful. The change was made in order to provide a clearer description of the problem. Whats most important to know is that dementias can involve changes to emotions, behaviors, perceptions, and movements in addition to memory and thinking.
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What Is Alzheimer Disease
Alzheimer disease is an irreversible form of dementia characterized by memory loss, a progressive decline in intellectual ability, deteriorating language and speech skills, and personality and behavioral changes that eventually interfere with daily living. Currently, Alzheimer disease has been estimated to affect more than 5.5 million Americans over the age of 65 and about 200,000 under the age of 65.
Although some aspects of
Alzheimer disease is an irreversible form of dementia characterized by memory loss, a progressive decline in intellectual ability, deteriorating language and speech skills, and personality and behavioral changes that eventually interfere with daily living. Currently, Alzheimer disease has been estimated to affect more than 5.5 million Americans over the age of 65 and about 200,000 under the age of 65.
Although some aspects of AD mimic changes found in the brain as we age, AD is not a normal part of the aging process. Nerve cell injury and death occur due to the build-up of abnormal protein structures in the brain called amyloid plaques, also known as senile plaques, and neurofibrillary tangles. The destruction of nerve cells also results in decreased levels of substances called neurotransmitters that help transmit brain signals. Over time, AD results in decreased interaction between different areas of the brain.
Their articles expand the definition of Alzheimer disease to include three stages: