How Is Alzheimers Disease Diagnosed
It can be hard to recognize or admit to possible signs of Alzheimers. Often, its family or friends who notice signs first. If you or your loved one are experiencing dementia-like symptoms, its important to see a doctor as soon as possible. Early diagnosis and intervention improve treatment options and quality of life.
Alzheimers / Dementia Testing Alternatives
Despite the lack of an FDA-approved blood test, families who suspect their loved one may have Alzheimers have a well-trod, if meandering, path to a diagnosis. To begin the process, there are online tests for Alzheimers that can be downloaded, printed, completed and taken to your doctor, and even some interactive tests that might provide immediate results. However, these online tests do not actually test for Alzheimers or dementia. Instead, they offer families answers to these questions: Are my concerns about my loved one justified?Is this just normal aging or is there something more going on? Officially, the tests are looking for Mild Cognitive Impairment . These tests are not definitive, but they can help a family figure out what their next step should be.
If a doctor suspects a patient may have Alzheimers, there are more definitive approaches. Brain scans and tests on extracted spinal fluid when coupled with multiple physicians consultations can make a diagnosis of Alzheimers with upwards of 90 percent accuracy. Families should expect their loved one to be evaluated by a neurologist, a psychiatrist, and very likely a psychologist as well. Since Alzheimers is so common among the elderly, a diagnosis is less about finding a condition which fits and more about eliminating other possibilities.
How Long Do Dementia Patients Live After Diagnosis
Dementia symptoms typically progress slowly. People with dementia will progress from mild to severe dementia at varying speeds and may be diagnosed earlier or later in life. Some people with dementia may live for up to 20 years after their diagnosis, though according to the Alzheimer’s Association research shows that the average person lives for four to eight years after a diagnosis of dementia. It’s important to point out that the diagnosis of dementia is often missed, delayed, or diagnosed when the illness is moderate or advanced. The impact of that variable may not be accurately reflected in the research regarding the years of life post-diagnosis.
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Comparison Table Of Dementia Tests
|Types of Online, At-Home and Clinical Dementia & Alzheimers Tests|
|7-10 minutes||11||SLUMS has shown sensitivity to mild cognitive impairment, like the MoCA, but has not been studied as much as other tests on this list to determine reliability.||Shorter than other tests taken in doctors offices. Not as widespread but probably reliable.|
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.
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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.
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.
Read:A Dementia Diagnosis: Bane or Blessing?
So, when should one seek medical attention for suspected Alzheimers?
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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.
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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Ivalzheimer’s Diseasea Progressive Neuropathologic Syndrome
The clinical diagnosis of AD depends upon the development of memory impairments along with changes in other cognitive functions that impair day-to-day activities, leading to the clinical syndrome of dementia. However, it is clear that dementia does not begin at a single moment but instead has a rather long preclinical sequence, leading to the full syndrome. This idea, of a prodromal phase of the disease, began to take shape as it was realized that cognitively normal individuals develop the same pathological hallmarks of AD in the same regional distribution, but to a quantitatively far lesser extent . Imaging-based assessment showed that atrophy of the hippocampus and entorhinal cortex precede clinical onset of memory impairments by at least several years , which was supported also by quantitative neuropathological studies .
J. Peter, S. Klöppel, in, 2015
Are There Any Other Blood Tests For Alzheimers
There is another blood test for dementia that is showing great potential for diagnosing the progressive illness.
It is known as Simoa which stands for single-molecule array.
This is also designed to test if there are any proteins in the blood plasma. This test can detect a protein known as ptau181 which has been linked to some of the changes that dementia causes in the brain.
Various studies revealed that Simoa is as effective at predicting dementia development as a spinal tap and PET scans.
The Simoa blood test, however, ELIMINATES the pain, cost, and radioactivity that are associated with the other tests.
Simoa can also detect upcoming changes in the brain that are caused by dementia for both short and long-term i.e. 15 months and 4 years respectively.
At the moment, researchers are using this technology to identify ideal candidates for clinical trials because it is not yet available for many people with the illness.
Apart from Simoa, there are other types of blood tests that are still in development.
Other blood tests
Some are looking into fatty amides or protective fats in the blood.
Studies indicate that if there are increased levels of fatty amide in the blood, it may be an indication of the accumulation of beta-amyloid in the brain.
Researchers are also working on blood tests that will measure other proteins like the NfL and tau proteins.
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How Could An Earlier Diagnosis Of Alzheimers Affect The Treatment And Care Of Patients
Kanaan: Early detection of Alzheimers disease and other dementias is a critical factor in furthering our understanding of disease etiology and progression. Indeed, identifying a disease like Alzheimers accurately and early, before significant cognitive decline occurs, could provide a therapeutic window in which administration of future therapeutics could slow or stop the disease.
When You Need A Brain Scanand When You Dont
It is normal to forget things as you age. But many older people worry that they are getting Alzheimers disease when they cant remember things.
A new drug, used with a PET scan of the brain, can help diagnose Alzheimers. But before getting this scan you should have a complete medical exam. If your exam shows serious memory loss and your doctor cannot find a cause for it, then you should have the scan. Otherwise, the results can be misleading and you should not get the scan. Heres why:
The scan does not prove that you have Alzheimers.
Alzheimers can be found in the brain because it involves abnormal cell clumps. These clumps are called plaques. A PET scanwhich is an imaging testcan show these plaques, using a radioactive drug. During the test, the drug is injected into your body, where it attaches to the plaques. Then pictures are taken of your brain. The drug highlights the plaques so they can be seen on the scan.
If the scan does not show any plaques in your brain, then it is much less likely that you have Alzheimers. However, you can have plaques in your brain but not have Alzheimers. And having plaques does not mean that you will get Alzheimers in the future.
Alzheimers is not the only cause of forgetting things.
Medicines can also cause memory loss and thinking problems. So if you have symptoms, it is important to find out what the cause is.
Finding the cause starts with a medical evaluation.
The new scan can pose risks.
It can be expensive.
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Can Dementia Suddenly Get Worse
The progression of dementia depends on the underlying disease. Some diseases have a rapid progression. Others progress more slowly. Any sudden change with either slow or rapid progression should be evaluated for another cause. In most cases, changes with dementia may seem like they came out of the blue when they actually may have been slowly developing in the background. The best way to prepare for changes and manage expectations is through information. Your doctor and medical team will be a valuable resource. There are a variety of educational resources that are also available through the Alzheimer’s Association.
What Is Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia, a loss of brain function that affects memory, thinking, language, judgment and behavior. In Alzheimer’s disease, large numbers of neurons stop functioning, lose connections with other neurons, and die.
Irreversible and progressive, Alzheimer’s disease slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks of daily living.
Although the cause of Alzheimer’s disease is unknown, scientists believe that a build-up of beta-amyloid plaques and neurofibrillary tangles in the brain are associated with the disease.
The stages of the disease typically progress from mild to moderate to severe. Symptoms usually develop slowly and gradually worsen over a number of years however, progression and symptoms vary from person to person. The first symptom of Alzheimer’s disease usually appears as forgetfulness.
Mild cognitive impairment is a stage between normal forgetfulness due to aging and the development of Alzheimer’s disease. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. Not everyone with MCI develops Alzheimer’s disease.
Other early symptoms of Alzheimer’s include language problems, difficulty performing tasks that require thought, personality changes and loss of social skills.
People with severe Alzheimer’s disease are unable to recognize family members or understand language.
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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?
Alzheimers Mice Have Distinctly Different Urine Odor Signature
For their study, the team worked with mice bred to develop amyloid plaques in the brain similar to the ones that afflict humans. To breed the mice, scientists insert human genes into their genomes then activate them with drugs. The genes carry mutations that cause the mices brain cells to make too much amyloid precursor protein.
The excess precursor protein forms amyloid plaques that clog up the brain in the modified mice in a similar way as seen in humans with Alzheimers disease. The mice develop similar behavioral symptoms of mental deterioration. These types of mice are known as amyloid precursor protein transgenic mouse models, or APP mice.
The team used three separate strains of APP mice. Using behavioral and chemical analyses, they found each strain of APP mice had different urine odor signatures that were distinctly different from those of control mice.
The differences in odor signature between the APP and control mice were not due to different compounds, but to differences in concentrations of the same compounds.
The differences in odor signature did not vary much with age, and they preceded detectable amounts of amyloid plaque build-up in the brains of the APP mice, say the researchers. They suggest this means the odor signature is tied to the underlying gene, rather than the progress of changes in the brain.
Coauthor Dr. Daniel Wesson, a neuroscientist at Case Western Reserve University School of Medicine in Cleveland, OH, concludes:
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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.
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.
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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