How Dementia Is Diagnosed
There is no single test for dementia, and it can be difficult to diagnose the specific type of dementia that a person has. If you want to find out if your parent has dementia or, specifically, Alzheimerâs disease, the first step is to schedule an appointment with your parentâs family care provider.
The primary care provider can do a screening that can help rule out whether your parentâs memory issues are being caused by any treatable conditions. Then, the doctor can refer your parent to a neurologist, neuropsychologist, geriatrician or geriatric psychiatrist for additional screening and tests. Snow suggests talking to the providers your parentâs doctor recommends as well as other providers in the same field to find the best fit for your parent. The Alzheimerâs Association has a guide to choosing a doctor to evaluate memory problems.
If the process is rushed and the provider misdiagnosis your parent, you might not be able to persuade your parent to be tested again. âYouâll get one shot at this,â Snow says. âDonât blow it.â
You want someone who is willing to do a thorough assessment and has experience diagnosing a variety of dementia-related diseases. A thorough exam typically will involve the following:
Planning For A Parents Future
Early diagnosis is crucial for allowing dementia patients and their families to effectively prepare legally, financially and medically. Ideally, most of these preparations and discussions will have taken place long before you suspect changes in their mental state. If not, helping your parent spell out their wishes while they are still capable of participating is an important step in planning for their future. Clarifying what is happening to a parents memory, judgement, moods and behaviors also makes it much easier for their loved ones to accept these changes and come together to create a care plan that accommodates them.
Hope For A New Generation
Although this news may at first be dispiriting to caregivers who have watched their parents suffer from the disease, it may also lead to new methods of detection and prevention. Dr. Lisa Mosconi from the New York University Langone Medical Center said, Studies show that by the time people come in for a diagnosis, there may be a large amount of irreversible brain damage already present. This is why it is ideal that we find signs of the disease in high-risk people before symptoms occur.
If patients and doctors know that a family history of Alzheimers can mean a higher risk for children, the disease is more likely to be found earlier.
Does Alzheimers run in your family? Would you want to know your chances of developing the disease?
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Testing For Familial Alzheimers Disease
The decision to undergo testing for FAD is very complex and the advantages and disadvantages must be carefully considered. The test does not produce a relative risk of acquiring the dementia, but is a definitive prediction of whether a person will get a profound and progressive illness in ones middle years. The test can only be completed with the informed consent of the person being tested. No one should ever be pressured to have such a test.
Knowing that you are carrying the gene may help some people plan for the future. It enables them to consider future lifestyle choices and to let their wishes be known to someone they trust. However, given that no cure is available an individual has to consider whether they want to know that they will develop dementia at some time in the future.
To help people consider these issues specialised genetic counselling is essential. The doctor can provide details of this service. In the future, when preventive treatments for Alzheimers disease become available, there may be increased reasons to seek testing.
Understand That The Conversation May Not Go Well
Someone experiencing early dementia might not see the symptoms in themselves. Even though the diagnosis is accurate, your loved one may show signs of denial and withdrawal and be unwilling to discuss it. Or they could even get angry or defensive. Forcing the conversation will likely be ineffective. Instead, take a break and plan to reopen the discussion after your parent has had some time to digest the news.
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Dementia Affects The Person Diagnosed But Also Raises Fears For Siblings And Children Here Are The Facts
After a diagnosis of Alzheimer’s disease, families face fears and difficult medical decisions.
Alzheimer’s disease represents a personal health crisis, but it’s also a family concern. What does it mean for your children or siblings if you are diagnosed with Alzheimer’s? What does it mean for you if a close relative develops the condition?
“People think that if their dad or aunt or uncle had Alzheimer’s disease, they are doomed. But, no, that’s not true,” says Dr. Gad Marshall, assistant professor of neurology at Harvard Medical School. “Even though family history adds to the overall risk, age still usually trumps it quite a bit. It means your risk is higher, but it’s not that much higher, if you consider the absolute numbers.”
Genes And Frontotemporal Dementia
Frontotemporal dementia , originally called Picks disease, is a rarer type of dementia mostly affecting people under the age of 65 years. The symptoms of FTD can be quite varied but include changes that mostly affect behaviour or language. There are different types of FTD, and these are likely to have different causes.
Some people with FTD have a family history of dementia and the condition may be inherited in some of these families. For behavioural variant FTD, a third to half of people could have a family history. This figure is thought to be much lower for other types of FTD.
Overall, around one in ten cases of FTD are thought to be caused by a faulty gene passed down in families. Several genes have been found that can cause these inherited types of FTD, including:
Mutations in the MAPT gene can cause the tau protein to behave abnormally, forming toxic clumps that can damage brain cells. We still need to understand more about how mutations in progranulin and C9ORF72 cause the disease.
The C9ORF72 gene can cause people to develop motor neurone disease, FTD or both conditions, and may affect members of the same family differently.
In cases of FTD that are not caused by faulty genes, the risk factors are not yet fully understood, and research is ongoing.
Is genetic testing available for frontotemporal dementia?
If Familial Alzheimers Disease Is Suspected
Genetic testing can identify specific changes in a persons genes. This test can tell if a person has FAD and if a child has inherited the changed gene from a parent and will develop the disease in the future. It cannot determine when the symptoms will begin. It is essential to ensure that suspected cases in the family have, or have had, Alzheimers disease and not some other form of dementia. This can only be done through a medical examination, or a careful analysis of past medical records if the person is no longer alive.
The Truth About Genetic Testing
Genetic testing can help identify mutated genes and risks for certain disorders that can be prevented or treated, but when it comes to genetic testing for Alzheimers disease, support is not quite universal.
In some cases, it can be appropriate to be tested for the presence of the deterministic genes that will cause Alzheimers disease. However, since there is currently no cure for Alzheimers, there are not a lot of valid reasons for this testing unless it is to participate in research trials. At this time, most experts do not recommend routine genetic testing for Alzheimers disease as the results have no practical impact on medical treatment or health care decisions.
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Maternal History Of Alzheimer’s
The results showed a substantial reduction in glucose metabolism in the maternal history group, compared with both the paternal and the no-history groups.
Also, there was a substantial increase in the amount of plaque present in the maternal group, compared with both the paternal and the no-history groups.
“When we looked at both scans together, we found a significant correlation between the area of the brain where the plaque was and where there was a slowing of glucose metabolism,” Cumming says.
While the researchers tried to take into account whether study participants had other risk factors for Alzheimer’s, “they couldn’t control for everything” that could explain the apparent link, she says, citing diabetes and heart disease as examples.
One question that the study presents, Carrillo and Cummings agree, is whether the tendency to develop dementia is somehow being passed on through mitochondrial DNA, which is only inherited from the mother.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.
A Gene That Can Affect Alzheimers Risk
Scientists have identified more than 20 genes that appear to influence the development of Alzheimers disease.
With one exception, these genes are not considered to be significant risk factors, either because they are rare or because their effect is too limited.
The gene that matters most is apolipoprotein E . There are three different APOE forms, called alleles:
- e2 is an uncommon, protective form of the gene.
- e3, the most prevalent form, is believed to neither decrease nor increase risk.
- e4 raises Alzheimers risk and also makes it more likely the disease will develop at an earlier age.
Still, some people with APOE-e4 never develop Alzheimers, while others who develop Alzheimers dont have the gene.
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Extended Family History May Tell Bigger Story About Chances Of Developing The Disease
- American Academy of Neurology
- Having a parent with Alzheimer’s disease has been known to raise a person’s risk of developing the disease, but new research suggests that having second- and third-degree relatives who have had Alzheimer’s may also increase risk.
Having a parent with Alzheimer’s disease has been known to raise a person’s risk of developing the disease, but new research suggests that having second- and third-degree relatives who have had Alzheimer’s may also increase risk. The study is published in the March 13, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.
First-degree relatives include parents and siblings who share both parents. Second-degree relatives include grandparents, blood-related aunts and uncles, and siblings who share one parent. Third-degree relatives include great-grandparents, great uncles, great aunts and first cousins.
“Family history is an important indicator of risk for Alzheimer’s disease, but most research focuses on dementia in immediate family members, so our study sought to look at the bigger family picture,” said study author Lisa A. Cannon-Albright, PhD, of the University of Utah School of Medicine in Salt Lake City. “We found that having a broader view of family history may help better predict risk. These results potentially could lead to better diagnoses and help patients and their families in making health-related decisions.”
What To Do If You Think Your Parent Has Dementia
Caregivers who are worried about their aging parents cognitive health should ensure they make an appointment with a doctor as soon as possible for a thorough physical and mental health evaluation. This comprehensive checkup should include bloodwork and urine tests to rule out other causes of cognitive decline as well as a series of mental assessments to check their memory, problem solving skills, and math and language skills. Diagnostic imaging may be necessary as well.
A complete medical exam for memory loss should review a persons medical history, including their use of prescription and over-the-counter medications, diet, past medical problems and general health. A correct diagnosis depends on accurate details. Sometimes dementia patients cannot recognize their impairment , so the doctor may request additional information from a family member, caregiver or close friend.
It is important to note that there is no single, definitive diagnostic test for dementia. Physicians like neurologists, geriatricians and psychiatrists typically use a combination of tests and assessments to diagnose dementia.
Although a dementia diagnosis might not be made when symptoms initially present, the results of these tests can be used as a baseline for comparison against the results of future testing. Establishing a cognitive baseline is important for anyone who is concerned about their future cognitive health.
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Your Genes Can Increase Your Risk For Dementia
Having a family memberespeciallya first-degree relative like your mother, father, sister, or brotherwithsevere memory problems, Alzheimers disease, or another form of dementia makesyou 3.5 times more likely to develop symptoms. Similarly, if you have one ortwo copies of the APOE4 gene, you have a greater chance of memory problems.
Many people in the medical community contend that there is nothing anyone can do to mitigate genetic risk. Theyre wrong. There are many things you can do to reduce your risk even if you have a genetic predisposition for the disease. Just look at Bud.
What You Can Do
While it can be alarming to know that Alzheimers disease runs in your family, fortunately, there are several things you can do to prevent this condition or slow down its symptoms. By incorporating a few simple lifestyle changes and activities, you can support brain health and potentially prevent Alzheimers. Here are a few strategies for promoting healthy brain functions:
- Get plenty of exercise
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Genes That May Influence Alzheimers
The above-linked Alzheimers Society article is informed by responses from Professor Nick Fox, Honorary Consultant Neurologist at the Institute of Neurology in London. The article tells us:
- 99% of Alzheimers cases are not hereditary. And since the most significant risk factor is age, its not uncommon to have a parent or grandparent with Alzheimers disease who is in their late 70s and 80s. In that same 99% of Alzheimers cases, your risk of inheriting of Alzheimers compared to the rest of the population is very slight.
- In less than 1% of all Alzheimers cases, there is a very rare type that is hereditary. Early-onset Familial Alzheimers Disease, , described here and here, affects between 2-3% of the population. If a physician diagnoses you with eFAD, one of your parents will have had the disease if they lived long enough. In addition, your siblings and children may have a 50-50 chance of inheriting eFAD. Note that early-onset Alzheimers usually occurs in individuals who are in their 30s, 40s or 50s. In rare cases, it occurs when a person is in their 20s.
- Researchers have discovered that certain genes will cause early-onset Familial Alzheimers Disease if they have a specific kind of mutation or change. Known as PS1, PS2 and APP, the full names of these genes are: Amyloid precursor protein gene APP on chromosome 21 Presenilin 1 on chromosome 14 and presenilin 2 on chromosome 1.
There Are Other Risk Factors That Are More Significant Than Genetics
While genetics and hereditary factors may or may not contribute much risk, other factors have been shown to lower your chance of developing Alzheimers. These include: controlled cholesterol and blood pressure, avoiding type 2 diabetes by maintaining your ideal body weight, and exercise. Socialization is another important risk factor mouse studies have found that even for mice that are bred to get Alzheimers, being housed with company led to the mice developing Alzheimers later in their lives. Human studies have also found that loneliness increases Alzheimers risk.
Anybody who has a thought or its crossed their mind about dementia risk, get with the exercise program, get with the Mediterranean diet, get with the weight loss, Lyden said. Youll do more for yourself in that respect than all the genetic tests in the world.
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How Can I Reduce My Risk Of Dementia
For the vast majority of people, our genes are only one factor affecting our risk of dementia. There are many other factors involved, such as age and lifestyle. While we cannot change our age or genes, research has found that up to a third of all cases of dementia could be avoided through lifestyle changes.
There are simple things we can do that may help lower our risk:
- do not smoke.
You can find more detailed information about how you can reduce your risk of dementia here.
Age And Lifestyle Play A Role In Risk
Age remains the greatest risk factor for individuals over the age of 65. One in nine people in this age group and nearly one-third of people 85 and older develop Alzheimers disease. Medical professionals continue to research the disease and uncover links between genes and Alzheimers, but lifestyle and environment also contribute to people getting the condition.
Physical activities play an important role in keeping the mind and body active, says Dr. Tcheremissine. The trick is to tailor your activity to something you enjoy like yoga, calisthenic exercises, swimming, walking and jogging, and of course, weight-lifting activities.
According to Dr. Tcheremissine, social and mental stimulations are also central to the issue. Individuals who live alone are prone to cognitive decline more that those who develop robust social networks and support systems.
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