How Do The New Guidelines Change The Way Clinicians Diagnose Mci Or Alzheimers Disease Should They Still Use The Same Tests And Screening Tools Should They Use Any New Tests Or Screening Tools
Clinicians should continue to use the many validated neuropsychological tests currently available. These include formal tests that assess various cognitive functionsepisodic memory, executive function, language, visual and spatial skills, and attention. Interviews with the person as well as a family member, friend, or caregiver about changes in the persons thinking skills are also helpful.
Clinicians should also consider augmenting the evaluation process they have been using. To learn more about a variety of simple, informal techniques that can be used to assess cognitive function, go to: www.alzheimersanddementia.com/article/S1552-526000104-X/fulltext.
If a problem is suspected, more extensive evaluation by a specialist should be recommended to the patient and family. The Alzheimers Association, Alzheimers Foundation of America, local Area Agency on Aging offices, and a variety of organizations offer information and help with planning for the future.
Is Alzheimers Diagnosed With A Blood Test
The other biomarker test, uses either a blood sample or, more commonly, a cerebral spinal fluid sample. The CSF sample is obtained via a spinal tap.
We look for markers of Alzheimers disease in the blood and the spinal fluid samples. These are pieces of the plaques and tangles that might be circulating in the blood or spinal fluid.
Therefore, the patient can have a thinking and memory test, and then typically the physician will add on additional tests. One could be a PET scan of the brain and the other one could be a test of either the blood or cerebral spinal fluid.
Diagnosing Alzheimers disease is a process. And its typically a combination of these three approaches: Cognitive Testing, PET biomarkers and fluid either blood or spinal biomarkers.
In all cases, personal results are compared to norms. The person is compared to other healthy people in the population that are approximately just like them. Neurologists look at the levels of all of the things that they are measuring to determine if they think its Alzheimers disease.
And thats how a diagnosis goes.
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Were really excited by the ICA what it can do for our dementia assessment services, Derek Tobin, associate director at Birmingham and Solihull Mental Health NHS Foundation Trust said in a news release. We always strive to deliver better value and improved outcomes for our patients, and I am confident that Cognetivitys technology will help us to do that in this area. I greatly look forward to seeing it at work in the hands of clinicians and patients.
The best thing about an algorithm-based test, Kalafatis said, is that it improves itself over time: By adding more data about individual risk factors into the machine learning model, the accuracy of the ICA will be further improved.
Early diagnosis is the holy grail for Alzheimers, he added. In the future, he hopes, the ICA and similar diagnostic technology will allow physicians to diagnose Alzheimers 10 years earlier than they do today, leaving more time for treatment and hopefully improving quality of life for people living with Alzheimers and their loved ones.
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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.
New Blood Marker Renews Hope For Blood Test To Detect Alzheimers
Another study from the University of Otago has also revealed another blood marker that could help diagnose Alzheimers through a simple blood test. Researchers found that participants with a small number of molecules found in the blood and brain called microRNAs can correctly detect Alzheimers with 86% accuracy.
This study involved participants that had been diagnosed with the disease, as well as neurologically healthy individuals. Researchers found that three microRNAs were different between the two groups and detecting these microRNAs would be possible through a simple blood test. Dr. Joanna Williams, who led the screening of microRNA in blood samples of participants, says, Although there are other known markers of early Alzheimers disease, such as an accumulation of the protein beta-amyloid in the brain, testing for these involves expensive or invasive procedures that cant be used in routine clinical practice.
Dr. Williams went on to state, We know that the levels of these microRNAs differ in people who have Alzheimers and people who dont. So if a general practitioner took a blood sample from a patient who was beginning to show symptoms of memory loss, what wed do is analyze that blood and see how that patients pattern of microRNA compares against established patterns.
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Who Is This Dementia Quiz For
Below is a list of 10 questions designed for people who are concerned about memory loss. The questions relate to life experiences common among people who have been diagnosed with dementia, a neurocognitive disorder, and are based on criteria in the DSM-5 .
Please read each question carefully, and indicate how often you have experienced the same or similar challenges in the past few months.
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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Could You Begin With Self
Yes, you may start with a self-assessment test. Many people who have memory loss concerns might want to start there.
Even though this is very hard for all humans to do, its best to listen to your friends and family members who might be recognizing things about your memory that you dont.
If they are expressing concerns about your memory. thats probably a good indication to get it professionally checked by a geriatrician, neurologist or a mental health professional.
Information For Your Doctor
Itâs a good idea to put together the following for your first appointment:
- A list of symptoms — include everything youâre feeling, even if you donât think it could be related to dementia
- Any sources of major stress or recent life changes
- A list of all medications you take, including vitamins and supplements, and the dosage
- A list of any questions you have
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What Kind Of Doctor Tests For Dementia
A primary care doctor can perform a physical exam and find out more about your symptoms to determine what may be the cause. They will likely refer you to one or several specialists that can perform specific tests to diagnose dementia. Specialists may include neurologists, who specialize in the brain and nervous system psychiatrists or psychologists, who specialize in mental health, mental functions, and memory or geriatricians, who specialize in healthcare for older adults.
What Is The Sage Test
In an attempt to find early detection methods for more treatment options, the Ohio State University Wexner Medical Center developed the SAGE test.
The Self-Administered Gerocognitive Examination is a paper test that evaluates your thinking abilities, problem-solving and other aspects of cognition and brain function.
It was designed to help doctors understand how the brain is functioning and is a helpful screening tool for mild cognitive impairment .
MCI can sometimes be a sign that can help with the early diagnosis of Alzheimers disease.
This test is offered for free at their facility and is practiced worldwide.
You can also download test varieties online, with four different versions of cognitive assessments to choose from.
Other cognitive assessments that can be used include online assessments that can be completed at home such as the CPCOG screening tool for dementia.
The General Practitioner Assessment of Cognition , the Memory Impairment Screen, and the Mini-COG are 3 screening tools recommended by the Alzheimers Association.
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How Should Clinicians Approach The Question Of Preclinical Alzheimers With Patients
Preclinical Alzheimers disease is an experimental concept at this time. While imaging and biomarker studies strongly indicate a preclinical phase for the disease, it is not yet possible to predict which cognitively healthy individuals will and will not progress to MCI or dementia. Researchers hope to develop a biomarker profile that will identify individuals most likely to develop Alzheimers dementia and benefit from early treatments when they become available.
What Are The Benefits Of Early Diagnosis
Early planning and assistanceEarly diagnosis enables a person with dementia and their family to receive help in understanding and adjusting to the diagnosis and to prepare for the future in an appropriate way. This might include making legal and financial arrangements, changes to living arrangements, and finding out about aids and services that will enhance quality of life for people with dementia and their family and friends. Early diagnosis can allow the individual to have an active role in decision making and planning for the future while families can educate themselves about the disease and learn effective ways of interacting with the person with dementia.
Checking concernsChanges in memory and thinking ability can be very worrying. Symptoms of dementia can be caused by several different diseases and conditions, some of which are treatable and reversible, including infections, depression, medication side-effects or nutritional deficiencies. The sooner the cause of dementia symptoms is identified, the sooner treatment can begin. Asking a doctor to check any symptoms and to identify the cause of symptoms can bring relief to people and their families.
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Is There A Test For Alzheimers Disease
- By Andrew E. Budson, MD, Contributor
After spending 30 minutes hunting for your car in a parking lot, or getting lost on a familiar route, have you ever considered asking your doctor for a blood test or brain scan to find out if you have Alzheimers disease?
A number of factors contribute to Alzheimers disease. By definition, this form of dementia involves the buildup of a protein in brain called beta-amyloid. Beta-amyloid forms plaques that disrupt communication between brain cells, and ultimately destroys them. For this reason, tests for Alzheimers disease focus on beta-amyloid.
Computed Tomography And Magnetic Resonance Imaging
- Structural imaging such as Computed Tomography or Magnetic Resonance Imaging yields a picture of the brain that allows identification of such features as volume loss or abnormal structural features such as white matter disease, masses, or vascular abnormalities, which are considered indications of neuronal degeneration. Newer techniques such as diffusion tensor imaging reveal subtle structural changes that may precede more easily identifiable volume loss in the brain. Functional imaging such as fMRI can be used to identify abnormal patterns of brain activation or metabolic activity.
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Why Would Anyone Want An Early Alzheimers Diagnosis
The SAGE test is useful because it helps you understand if your concerns are something to be worried about.
If the results seem to indicate that there could be a problem, you might think theres no point in talking with the doctor because theres no cure for dementia.
The most important is that a treatable condition could be the cause of cognitive impairment. Finding out sooner means getting treatment ASAP to eliminate the cognitive symptoms.
If the cognitive impairment is caused by Alzheimers or dementia, a major benefit is that starting treatment early is far more effective in managing symptoms and delaying progression of the disease.
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?
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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?
Dementia Care Tips From Experienced Caregivers
Caring for someone with dementia isnt intuitive and doesnt come naturally. Theres a lot to learn, but you dont have to figure everything out the hard way.
In a helpful article at Verywell, social worker Esther Heerema shares 12 dementia care tips that caregivers have learned and wished theyd known sooner.
This advice isnt meant to add pressure or expectations to your already tough job. Theyre tips from caregivers who have been there and done that that can lighten your load, reduce stress, and help you cope with the challenges.
Here, we share highlights from Esthers article along with some of our own insights.
1. Its not worth it to argue with someone who has dementiaAlzheimers and dementia causes your older adults brain to malfunction. When they say things that dont make sense or are clearly untrue, they believe what theyre saying because its what their brain is telling them.
Its frustrating to hear things that arent true and instinctive to try to correct or remind. But that will only lead to both of you arguing or getting upset. And you simply cant win an argument with someone who can no longer use reason or logic consistently.
2. Ignoring symptoms wont make them go awayWhen you notice your older adult struggling with memory, thinking, or judgement, its scary to think that they might have dementia. Because it can be so hard to accept, many people hope that the symptoms will go away on their own or that theyre mistaken.
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Related Video And Images
- Illustration of amyloid beta and tau proteins in the brain. Image credit: National Institute on Aging, NIH
- Illustration of how Alzheimer disease spreads in the brain. Image credit: National Institute on Aging, NIH
- A comparison of a healthy brain and a brain from a person with severe Alzheimer disease. Image credit: National Institute on Aging, NIH
A Need For An Early Alzheimers Test
Current Alzheimers testing tools are poorly accessible which makes diagnosis and further research a challenge.
A spinal tap or beta-amyloid PET scans are currently the most accurate early-stage diagnostic tests for Alzheimers disease.
Unfortunately, these elaborate tests are expensive, not widely available, and can be very painful for the patient.
Inexpensive testing could help to diagnose patients and update them and their caregivers or family members about their disease status.
Getting a diagnosis of Alzheimers in the early stages can help to delay future memory loss.
It is also imperative in helping to find better treatment options for the development of Alzheimers disease, such as potential medications that could help with delaying cognitive impairment.
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