Future Directions In Diagnosis Research
Considerable research effort is being put into the development of better tools for accurate and early diagnosis. Research continues to provide new insights that in the future may promote early detection and improved diagnosis of dementia, including:;
- Better dementia assessment tests that are suitable for people from diverse educational, social, linguistic and cultural backgrounds.
- New computerised cognitive assessment tests which can improve the delivery of the test and simplify responses.
- Improved screening tools to allow dementia to be more effectively identified and diagnosed by GPs.
- The development of blood and spinal fluid tests to measure Alzheimers related protein levels and determine the risk of Alzheimers disease.
- The use of sophisticated brain imaging techniques and newly developed dyes to directly view abnormal Alzheimers protein deposits in the brain, yielding specific tests for Alzheimers disease.;
Spect Scan Or Pet Scan
A SPECT or PET scan is usually only used if the CT scan or MRI scan fail to reveal anything conclusive and are usually requested by a specialist. They both produce images that show how the organs actually work, revealing which areas of your brain are more or less active than others, and therefore which if any areas of the brain are being affected by dementia.
What actually happensDuring a SPECT or PET scan you lie on a bed that moves into a doughnut shaped x-ray machine and produces 3D images of the brain. It takes around 30-40 minutes.
Did you know? A new brain scanning technique to rule out Alzheimers is now available on the NHS. It involves giving the person a tiny amount of a radioactive chemical called Amyvid before scanning them. The chemical then shows up the plaques of Alzheimers on the brain scan. However you will only be offered this sort of scan if your diagnosis of dementia is complex or unclear.
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Mental Ability Tests To Diagnose Dementia
People with symptoms of dementia are given tests to check their mental abilities, such as memory or thinking.
These tests are known as cognitive assessments, and may be done initially by a GP.
There are several different tests. A common one used;by GPs is;the General Practitioner Assessment of Cognition .
Although;these tests cannot diagnose dementia,;they may show there are memory difficulties that need further investigation.
Most;tests involve a series of pen-and-paper tests and questions, each of which carries a score.
These tests assess a number of different mental abilities, including:
- short- and long-term memory
- language and communication skills
- awareness of time and place
It’s important to remember that test scores may be influenced by a person’s level of education.
For example, someone who cannot read or write very well may have a lower score, but they may not have dementia.
Similarly, someone with a higher level of education may achieve a higher score, but still have dementia.
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Can A Ct Scan Show Dementia
After extensive research, we look into the commonly-asked-question of whether or not can a CT scan show dementia.
It IS POSSIBLE to detect the condition by watching for telltale signs in loved ones or yourself.
The cause of action, in this case, is to visit a physician right away so that they can perform brain imaging procedures TO DETECT the progressive neurologic disorder.
That begs the question, can a CT scan show dementia?
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Alzheimers Disease Is Getting Easier To Spot
Portable, head-mounted positron emission tomography scanners could make it easier to diagnose Alzheimers disease.Credit: Aira Burkhart
Frank Fiamingo was in medical limbo. In 2013, after struggling to find where he had parked his car and forgetting how to spell common words, the retired accountant underwent a brain scan to determine whether he might be suffering from mild cognitive impairment , a frequent precursor to dementia but the test was inconclusive.
I knew I had a problem, says Fiamingo, now 64 and living near his daughter and grandchildren in Concord, North Carolina. But I couldnt convince my neurologists that I did.
Fiamingo endured this diagnostic uncertainty for years, until his brain was scanned again as part of the screening protocol for a drug trial that required all participants to show evidence of plaques comprising the peptide amyloid-. In March 2018, doctors examined Fiamingos brain using a specialized form of the imaging technique positron emission tomography , known as amyloid PET. They injected Fiamingo with a radioactive dye that binds to the harmful clumps of amyloid- that are associated with Alzheimers disease. Inside a large, doughnut-shaped PET scanner, the dye lit up in four distinct regions of his brain.
Mri Scans Can Show Dementia
According to researchers from Perelman School of Medicine at the University of Pennsylvania, the answer to can an MRI detect dementia is to some extent yes.
The scientists explained that doctors have an easier time telling whether a person has dementia through MRI scans.
This gets rid of the need to carry out invasive tests that people find unfriendly like the lumbar puncture where a doctor must stick a needle in the spine.
Additionally, it also helps to speed up the diagnosis process which is important seeing that dementia diagnosis for the longest time has been a struggle for medics often leading to delayed treatment.
In addition to telling whether a person has dementia, MRI scans may in the future help doctors determine whether an individual is at risk of dementia according to new research.
Research from the University of California San Francisco and the Washington University School of Medicine in St. Louis conducted a small study where MRI brain scans were able to predict with 89% accuracy the people who were going to develop dementia in three years.
The researchers presented their findings in Chicago during a Radiological Society of North America meeting.
It suggested that in a few years, physicians will be able to tell people their risk of developing dementia before they start to showcase any symptoms of the neurodegenerative illness.
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Proposed Treatments Of Patients Having Ad With Ionizing Radiation
Bistolfi states that vascularcerebral amyloidosis is the hallmark of AD. Localized tracheobronchial amyloidosis has been successfully treated with beams of radiation, 20 Gy in 10 fractions of 200 cGy in 2 weeks. As 20 Gy in 2 weeks is followed by inflammatory reactions, this high dosage cannot be suggested in the hypothetical treatment of AD. An innovative alternative might be a weekly long-term low dose, say 50 to 100 cGy, fractionated radiotherapy , matching the very slow response of amyloid to radiation. Before applying it to patients with AD, the proposed schedule should be tried in patients with TBA to compare the new results of long-term fractionated RT with the results of 20 Gy/2 w. Should long-term fractionated RT prove effective, its application to patients with AD might become an effective and safe treatment.
On July 17, 2013, an application for a patent was published, titled Radiation therapy for treating Alzheimers disease. It makes 14 claims for treating human patients by a method, which is based on studies carried out using mice. The method comprises administering a relatively large amount of ionizing radiation to the brain of the patient employing a variety of different radiation sources. The total dose ranges from 300 to 1800 cGy, administered in dose fractions of 50 to 300 cGy per day. The method is claimed to treat AD by reducing the number or size of amyloid plaques in the brain of the patient.
Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.
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How A Computed Tomography Scan Can Help Diagnose Alzheimer’s
The next useful study that you can use in order to diagnose Alzheimer’s Disease would be a Computed Tomography scan, better known as the CT scan. This is an investigation that is more readily used in hospitals because of the speed and comfort for both the patient and the doctor. Unlike the MRI scan, this type of investigation does not require the use of a magnetic field, and therefore;patients with;metal implants of any type have no contraindications for this investigation.
A CT scan is an investigation that makes use of the simple X-ray but on a much larger scale. Patients will be passed through a scanner that will take pictures using multiple X-rays and the system will then actually build a picture of what the internal structures appear to be. This is a much quicker examination for patients and can be completed in as little as 15 minutes in most cases.;
Changes In Brain Structure
Diffuse cerebral atrophy with widened sulci and dilatation of the lateral ventricles can be observed. Disproportionate atrophy of the medial temporal lobe, particularly of the volume of the hippocampal formations , can be seen.
The hippocampus is one of the earliest affected brain regions in Alzheimer disease, and its dysfunction is believed to underlie the core feature of the disease-memory impairment. Changes in hippocampal volume, shape, symmetry, and activation are reflected by cognitive impairment.
Dilatation of the perihippocampal fissure is a useful radiologic marker for the initial diagnosis of Alzheimer disease, with a predictive accuracy of 91%. The hippocampal fissure is surrounded laterally by the hippocampus, superiorly by the dentate gyrus, and inferiorly by the subiculum. These structures are all involved in the early development of Alzheimer disease and explain the enlargement in the early stages. At the medial aspect, the fissure communicates with the ambient cistern, and its enlargement on CT scans is often seen as hippocampal lucency or hypoattenuation in the temporal area medial to the temporal horn.
The temporal horns of the lateral ventricles may be enlarged. Prominence of the choroid and hippocampal fissures and enlargement of the sylvian fissure may be noted. White matter attenuation is not a feature of Alzheimer disease.
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Promoting Early Diagnosis Of Dementia
The early symptoms of dementia can include memory problems, difficulties in word finding and thinking processes, changes in personality or behaviour, a lack of initiative or changes in day to day function at home, at work or in taking care of oneself. This information does not include details about all of these warning signs, so it is recommended that you seek other sources of information. If you notice signs in yourself or in a family member or friend, it is important to seek medical help to determine the cause and significance of these symptoms.;
Obtaining a diagnosis of dementia can be a difficult, lengthy and intensive process. While circumstances differ from person to person, Dementia Australia believes that everyone has the right to:
- A thorough and prompt assessment by medical professionals,;
- Sensitive communication of a diagnosis with appropriate explanation of symptoms and prognosis,;
- Sufficient information to make choices about the future,
- Maximal involvement in the decision making process,;
- Ongoing maintenance and management, and;
- Access to support and services.;;
Current Practice In Diagnosing Dementia
The remainder of this information will provide an overview of the diagnosis process and a guide to what happens after diagnosis.;
It is important to remember that there is no definitive test for diagnosing Alzheimers disease or any of the other common causes of dementia. Findings from a variety of sources and tests must be pooled before a diagnosis can be made, and the process can be complex and time consuming. Even then, uncertainty may still remain, and the diagnosis is often conveyed as possible or probable. Despite this uncertainty, a diagnosis is accurate around 90% of the time.;
People with significant memory loss without other symptoms of dementia, such as behaviour or personality changes, may be classified as having a Mild Cognitive Impairment . MCI is a relatively new concept and more research is needed to understand the relation between MCI and later development of dementia. However, MCI does not necessarily lead to dementia and regular monitoring of memory and thinking skills is recommended in individuals with this diagnosis.;;
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Early Alzheimers Detection With Digital Imaging
Digital imaging of the brain is one of the most promising areas of research being focused on for early detection of Alzheimers disease. Imaging such as an magnetic resonance imaging and positron emission tomography scans are able to show changes in the brains of patients diagnosed with Alzheimers disease. In the past, these tests were used primarily to rule out other conditions that may cause symptoms that were similar to those for Alzheimers.
Experts believe that Alzheimers is a disease that begins many years before symptoms like memory loss and personality changes even become apparent, so a test or scan for early detection is paramount. The current Alzheimers treatments can prevent further deterioration of the brain but not repair the brain. This means that once an Alzheimers diagnosis is reached, the patient has often already experienced years of irreversible brain damage.
Because of this, early detection of Alzheimers is crucial. Researchers who study the brains of Alzheimers patients have found they are different than those of patients with dementia or mild cognitive impairment. Different types of brain imaging help us to find these changes.
Here at Independent Imaging, we offer the areas most advanced diagnostic imaging equipment and technology. Call or request an appointment online with one of our board-certified radiologists in Wellington, Belle Glade, or Lake Worth today.
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Utility Of Functional Mri In The Study Of Ad
A relatively small number of fMRI studies have been published in subjects at risk for AD, including MCI subjects and genetic at-risk individuals yielding somewhat discrepant findings. Several studies have reported decreased mesial temporal lobe activation in MCI and genetic at-risk subjects . Interestingly, several fMRI studies have reported evidence of increased MTL activity in at-risk subjects, particularly among very mild MCI subjects , and cognitively intact individuals with genetic risk for AD . It is likely that these discrepant results are related to specific paradigm demands, stage of impairment, and behavioral performance. A common feature of the studies reporting evidence of increased fMRI activity is that the at-risk subjects were able to perform the fMRI tasks reasonably well. In particular, the event-related fMRI studies have found that hyperactivity was observed specifically during successful memory trials, which suggested that hyperactivity might represent a compensatory mechanism in the setting of early AD pathology .
Group map of fMRI activity showing regions that increase activity or decrease activity during successful encoding. Group map of 11C-PiB retention in a group of non-demented older individuals. Note the anatomic overlap of PiB retention to default network .
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How Is Dementia Treated
While there is no cure for some dementias, the progression of some types of dementia can be slowed or even reversed with treatment. Options include:
- Treating the cause of dementia when there is a treatable cause: This includes hormonal treatment for hypothyroidism, treating hydrocephalus with shunting, evacuation of subdural collections, etc.
- Cholinesterase inhibitors, a type of medication that may slow the progress of Alzheimer’s disease by helping people improve their attention and working memory.
- Medications to manage blood pressure, cholesterol, triglycerides, diabetes, and problems with blood clotting.
- Procedures to improve blood flow to the brain, such as carotid endarterectomy or Angioplasty and Vascular Stenting.
- Lifestyle modifications, such as following a healthy diet and adding an exercise regimen, quitting smoking and quitting or decreasing alcohol consumption.
Limitations Of Structural Mri In Ad
Structural MRI lacks molecular specificity. It cannot directly detect the histopathological hallmarks of AD and as such it is downstream from the molecular pathology. Cerebral atrophy is a nonspecific result of neuronal damage and, whereas certain patterns of loss are characteristic of different diseases, they are not entirely specific. Atrophy patterns overlap with other diseases and unusual forms of AD have atypical patterns of atrophy too. In more severely affected individuals and those with claustrophobia, MRI may not be tolerated whereas a rapid CT scan may be more feasible. In terms of measuring progression, volume changes on MRI may be produced by factors other than the progression of neuronal loss and as such assessment of disease modification may be obscured, at least in the short term, by such spurious effects. As the name implies, structural MRI cannot assess function; this is provided with increasing sophistication by functional MRI and PET.
Overall the availability, ease of use, and multiple applications of structural MRI in AD mean it will play a central role in research and practice for some years to come. Increasingly, the other modalities described in this article will address the weaknesses of MRI.
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