What Is The Test For Alzheimer’s Disease

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.

What Are The Benefits Of An Early Alzheimer’s Diagnosis

Alzheimers disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimers, when they first notice symptoms, to severe, when they are completely dependent on others for care.

Early, accurate diagnosis is beneficial for several reasons. While there is no cure, there are several medicines available to treat Alzheimers, along with coping strategies to manage behavioral symptoms. Beginning treatment early in the disease process may help preserve daily functioning for some time. Most medicines work best for people in the early or middle stages of the disease. Learn more about Alzheimers medications.

In addition, having an early diagnosis helps people with Alzheimers and their families:

The Brief Alzheimer’s Screening Test

This short screening asks the test taker to repeat three words immediately after hearing them. Next, two tasks that distract from those three words are performed: a short version of the verbal fluency test where the person is asked to name as many animals as they can in 30 seconds and spelling “WORLD” backward. Finally, the person is asked to remember and recite the three words from the beginning of the screening process.

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Saint Louis University Mental Status Exam

The Saint Louis University Mental Status Exam is an 11-item Alzheimer’s screening test that is especially good at identifying people with milder cognitive problems that don’t yet rise to the level of dementia. It has been studied with hundreds of veterans and includes items such as the naming of animals and recognition of geometric figures.

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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Medical History And Mental Status Examination

Clinical assessment of a patients history and performing a mental status examination are necessary steps in the evaluation of cognitive disorders. In identifying the presence of AD, the presence of a typical slow and insidious progression of symptoms is sought. Other factors capable of producing cognitive impairment are identified, including medical disorders, substances or medications that can cause cognitive impairment, or psychiatric conditions associated with cognitive changes. The characteristic clinical syndrome of AD includes a prominent disturbance of what is known as episodic memory .

Memory of recent events is particularly impaired, and evidence that reminders are of limited benefit is consistent with the memory storage problem typically found in AD. Language and visuospatial problems may also be reported or identified. In less common variants of AD, the disturbance of language or visual functions may be more prominent than memory difficulties in the diseases early stage.

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.

02/2013

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Diet And Exercise May Help Prevent Alzheimer’s And Slow Its Progression

Though there is currently no cure for Alzheimer’s disease and scientists have yet to confirm that there are ways to prevent AD or slow its progression, some evidence suggests that eating a healthy diet and exercising regularly could be among the best ways to do just that.

“Exercise may directly benefit brain cells by increasing blood and oxygen flow in the brain. Because of its known cardiovascular benefits, a medically approved exercise program is a valuable part of any overall wellness plan,” explains the Alzheimer’s Association.

Limiting your intake of sugar and saturated fats in favor or whole foods such as fruits, vegetables, and whole grains can also be neuroprotective. Though many healthy eating plans may help reduce your risk of Alzheimer’s, the Mediterranean diet and the DASH diet are the two most commonly recommended for better brain health.

How Is Alzheimer’s Disease Diagnosed And Evaluated

No single test can determine whether a person has Alzheimer’s disease. A diagnosis is made by determining the presence of certain symptoms and ruling out other causes of dementia. This involves a careful medical evaluation, including a thorough medical history, mental status testing, a physical and neurological exam, blood tests and brain imaging exams, including:

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Gathering A Complete Medical History

As with the treatment of any medical condition, physicians will ask for a rundown of a patients past and present health issues and all medications they are currently taking. The doctor will also take a brief family medical history to assess the patients risk of developing certain conditions due to genetic, lifestyle and environmental factors. For example, if a patients parent had early-onset Alzheimers disease, it increases the likelihood that the patient will also develop this disease.

How To Take The Sage Test

If you are taking the paper version of the test, youll find four slightly different variations of the test on the official website. It doesnt matter which one you take. The test consists of four pages. Print it out and answer the questions in ink without the assistance of others. Don’t look at a clock or calendar while taking the test and just do the best you can.

You can take the test in virtually any setting. It will usually take about 10 to 15 minutes but theres no set time limit.

Its important not to cheat in order to get a better assessment.

In some cases, you might choose to take the test at your doctors office where it can be evaluated right away.

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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.

Blood Test For Alzheimers Highly Accurate In Large International Study

When combined with genetic risk factors, test up to 93% accurate at identifying people at risk of Alzheimer’s dementia

Neurologist Randall J. Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology, inspects a mass spectrometry machine at Washington University School of Medicine in St. Louis. Using mass spectrometry, Bateman and colleagues have developed a blood test that is up to 93% accurate at identifying people at risk of Alzheimer’s dementia.

A blood test developed at Washington University School of Medicine in St. Louis has proven highly accurate in detecting early signs of Alzheimers disease in a study involving nearly 500 patients from across three continents, providing further evidence that the test should be considered for routine screening and diagnosis.

The study is available in the journal Neurology.

Our study shows that the blood test provides a robust measure for detecting amyloid plaques associated with Alzheimers disease, even among patients not yet experiencing cognitive declines, said senior author Randall J. Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology.

Developed by Bateman and colleagues, the blood test assesses whether amyloid plaques have begun accumulating in the brain based on the ratio of the levels of the amyloid beta proteins A42 and A40 in the blood.

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Types Of Tests For Dementia

The first type of tests are called mental status scales.

These are short bedside tests administered by the doctor that assess memory and other cognitive domains.

They provide a score, which is used to distinguish people with normal vs. impaired cognition and even screen for mild cognitive impairment .

Examples of the most widely used include the Montreal Cognitive Assessment and the Mini-Mental State Examination .

These are screening tests, meaning they are not diagnostic of any particular dementia or diagnosis, but when abnormal definitely can hint that cognition is impaired.

Moreover, these tests can be repeated over time to track the progression of the disease as well.

These tests assess memory, language, executive function, visuospatial skills, and attention/concentration.

MMSE test

The MMSE is scored on a 30 point scale. Specific items include orientation , memory , attention/concentration , language , and visuospatial function . A score of < 23 is abnormal and indicates cognitive impairment.

Note: you can find only MMSE test here.

MOCA test

The MOCA is also scored on a 30 point scale.

It assesses delayed word recall/memory , visuospatial function , language , attention/concentration , and orientation . A score of < 25 is abnormal and indicates significant cognitive impairment.

Note: you can also access MOCA test online.

SLUMS test

Another similar test is the Saint Louis University Mental Status Examination which is scored similarly.

Alternative shorter tests

Comparison Table Of Dementia Tests

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Clinical Tests For Alzheimers & Dementia

Montreal Cognitive Assessment

The Montreal Cognitive Assessment is also 30 questions, like the MMSE above, and takes about 10 minutes. The MoCA includes the Clock Drawing Test and also has questions and small tasks to assess someones understanding of time and place, as well as their short-term memory and ability to concentrate. MoCA is similar to the MMSE but about 30 years newer. Studies have shown MoCA is more reliable for identifying dementia, and better at identifying early-stage dementia or mild cognitive impairment. The MoCA is also better at indicating dementia in people with Parkinsons disease. The test is meant to be administered and scored only by a doctor, and is harder to find online than the MMSE.

Mini-Mental State Exam

While originally designed to be administered by medical professionals, family members can now administer the MMSE using their phone or laptop and receive accurate scoring results. Start here.

The SLUMS

Genetic Testing For Alzheimer’s Disease

A blood test can identify which APOE alleles a person has, but results cannot predict who will or will not develop Alzheimer’s disease. Currently, APOE testing is used primarily in research settings to identify study participants who may have an increased risk of developing Alzheimer’s. This knowledge helps scientists look for early brain changes in participants and compare the effectiveness of possible treatments for people with different APOE profiles.

Genetic testing is also used by physicians to help diagnose early-onset Alzheimers disease and to test people with a strong family history of Alzheimers or a related brain disease.

Genetic testing for APOE or other genetic variants cannot determine an individuals likelihood of developing Alzheimers diseasejust which risk factor genes a person has. It is unlikely that genetic testing will ever be able to predict the disease with 100 percent accuracy, researchers believe, because too many other factors may influence its development and progression.

Some people learn their APOE status through consumer genetic testing or think about getting this kind of test. They may wish to consult a doctor or genetic counselor to better understand this type of test and their test results. General information about genetic testing can be found at:

• Genetic Testing FAQ

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What Causes Alzheimers Disease

Apart from the few people with familial Alzheimers disease, it is not known why some people develop Alzheimers disease and others do not.

Health and lifestyle factors that may contribute to the development of Alzheimers disease include:

• physical inactivity

• changes in ability to plan, problem solve, organise and think logically
• taking longer to do routine tasks
• language and comprehension difficulties, such as problems finding the right word
• increasing disorientation in time, place and person
• problems in becoming motivated and initiating tasks
• changes in behaviour, personality and mood.

Someone experiencing symptoms may be unable to recognise any changes in themselves. Often a family member or friend of someone affected will observe changes in a person.

Symptoms vary as the condition progresses and as different areas of the brain are affected. A persons abilities may fluctuate from day to day, or even within the same day. Symptoms can worsen in times of stress, fatigue or ill-health.

Stages Of Alzheimers Disease

Some features of Alzheimers disease are commonly classified into three stages, or phases. Not all these features will be present in every person, and they might occur at different stages.

Mild Alzheimers disease

Sometimes this stage is only apparent in hindsight. The onset of Alzheimers disease is usually gradual and it is often impossible to identify exactly when it began.

Someone might:

• have difficulty shopping or preparing meals.

Moderate Alzheimers disease

At this stage, the impacts of the condition are more apparent and prevalent. A person may experience significant challenges to their independence and require daily support.

Someone might:

• be forgetful of current and recent events, although generally remember the distant past, even if details may be forgotten or confused
• often be confused regarding time and place
• become lost more easily
• forget the names of family or friends, or confuse family members
• forget saucepans or kettles left heating on the stove
• be less able to perform simple calculations
• show poor judgement and make poor decisions
• see or hear things that are not there or become suspicious of others

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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.