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Why Is Alzheimer’s Disease So Difficult To Diagnose

Signs And Symptoms Of Alzheimer’s Disease

The difficulties in diagnosing Alzheimers disease and Down’s syndrome – Prof Marwan Sabbagh

Memory problems are typically one of the first signs of cognitive impairment related to Alzheimers. Some people with memory problems have a condition called mild cognitive impairment . With MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimers, but not all of them do so. Some may even revert to normal cognition.

The first symptoms of Alzheimers vary from person to person. For many, decline in nonmemory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may signal the very early stages of the disease. Researchers are studying biomarkers to detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimers. More research is needed before these techniques can be used broadly and routinely to diagnose Alzheimers in a health care providers office.

Plasma Biomarkers Of Ad

Other approaches using genomics, transcriptomics, metabolomics, lipidomics, and proteomics have been used to generate different AD biomarkers. One study showed that altered microRNAs resulting from the failure of synaptic function are potential plasma biomarkers of AD.5959. Siedlecki-Wullich D, Català-Solsona J, Fábregas C, Hernández I, Clarimon J, Lleó A, et al. Altered microRNAs related to synaptic function as potential plasma biomarkers for Alzheimer’s disease. Alzheimers Res Ther. 2019 11:46. Another study comparing AD patients with healthy controls showed decreased platelet levels of one member of the a disintegrin and metalloproteinase family: ADAM10, the primary -secretase of APP, which plays an important role in reducing generation of A peptide. The same study showed decreased presenilin levels in platelets and leukocytes. Presenilin is the catalytic site of -secretase, one enzyme in the reaction that generates A peptide. Levels of the -site APP-cleaving enzyme 1 , also known as -secretase, were also decreased in leukocytes and presented no differences in platelets.6060. Bram JM, Talib LL, Joaquim HP, Sarno TA, Gattaz WF, Forlenza OV. Protein levels of ADAM10, BACE1, and PSEN1 in platelets and leukocytes of Alzheimer’s disease patients. Eur Arch Psychiatry Clin Neurosci. 2019 269:963-72.

Knowing The Stages Of Dementia Helps You Plan

Even if the stages arent exact and symptoms can still be unpredictable, being able to plan ahead is essential.

The truth is that Alzheimers and dementia care is expensive and time-consuming. Being financially prepared for increasing care needs is a necessity.

On an emotional level, having an idea of what symptoms to expect helps you find ways to cope with challenging behaviors.

It also gives you a chance to mentally prepare yourself for the inevitable changes in your older adult.

Recommended Reading: How Fast Does Alzheimer’s Progress

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Difficulties Diagnosing Alzheimers Disease

Why diagnosing Alzheimers today is so difficultand how ...

Alzheimers disease can be challenging for physicians to detect at an early stage if patients themselves do not recognize the warning signs or are reluctant to communicate their concerns. Often, it is family members or friends who observe signs of dementia even before the patient is aware they have a problem.

There is still no definitive test for detecting Alzheimers disease, so a careful medical evaluation is needed to help lead to a diagnosis. In addition to physical exams and a review of medical history, the assessment can include cognitive testing, neurological exams, blood tests or brain imaging scans. Difficulty with memory alone does not necessarily point to Alzheimers but could indicate other treatable issues such as vitamin deficiencies, depression or a side effect from medications. But because no single test detects Alzheimers with 100 percent accuracy, diagnosing Alzheimers remains a challenge.

Experts who specialize in the diagnosis and treatment of Alzheimers disease can help ensure a proper evaluation is conducted, but recent studies have shown that as many as 1 in 5 Alzheimers cases may be misdiagnosed. Misdiagnosis includes patients who are told they have Alzheimers when they do not, as well as patients whose Alzheimers disease is not recognized.

Also Check: How Fast Does Alzheimer’s Progress

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Hope For Those With Alzheimers

Although it is difficult to receive an Alzheimers disease diagnosis, patients today have more reasons for hope than ever before. Several medications are available to slow down the progression of disease symptoms, and an Alzheimers diagnosis does not mean an immediate loss of independence.

I always tell my patients that while there are no therapies to reverse or stop Alzheimers disease it is a progressive neurodegenerative disease its earliest symptoms dont yet interfere with daily living, Dr. Grant says. Whats most important to convey is that we dont want to take away individuals independence we just want to make sure they have safety nets in place ahead of time.

Dr. Grant notes that scores of clinical trials are underway across the country, and he frequently offers his patients the option to participate in the numerous trials in progress at the Mesulam Center. As an example, one of the trials he supervises, the A4 trial, is targeting amyloid proteins in the brains of people who dont yet have any symptoms, to see if removing them prevents or delays the onset of the disease.

We still dont fully understand why Alzheimers disease happens at all, but weve learned that people who are physically active do better, as well as those who eat a healthy diet such as a Mediterranean diet, says Dr. Grant. Its also important to stay socially and mentally active playing games that engage the mind, and having social and cultural activities and creative pursuits.

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Called PDS, it acts like armor for your brain. In fact, its the #1 protector of the membranes that surround the delicate nerve cells in your brain.

While theres much thats still to be understood about Alzheimers disease and how it chooses its victims, one thing is for certain:

The root of all Alzheimers, dementia and memory-related diseases comes directly from those nerve cells deteriorating

So if you can build the membrane back up and protect it, the nerve cells can regain their capability and the brain thriveshealthy as can be.

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When scientists realized that PDS also exists elsewhere in nature , they extracted it and put it through a series of tests on senior volunteers.

Researchers noted that the changes were so dramatic, it was like rolling back their brains clocks 12 full years.

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149 senior patients suffering from a wide range of memory problems were divided into two groups.

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By the end of those 12 weeks, only the group taking the REAL thing found that their memory had significantly improved with the most improvement shown in their ability to remember names and faces.

Key Features Of Dementia

Why is dementia so hard to treat?

A person having dementia means that all five of the following statements are true:

  • A person is having difficulty with one or more types of mental function. Although its common for memory to be affected, other parts of thinking function can be impaired. The 2013 DSM-5 manual lists these six types of cognitive function to consider: learning and memory, language, executive function, complex attention, perceptual-motor function, social cognition.
  • The difficulties are a decline from the persons prior level of ability. These cant be lifelong problems with reading or math or even social graces. These problems should represent a change, compared to the persons usual abilities as an adult.
  • The problems are bad enough to impair daily life function. Its not enough for a person to have an abnormal result on an office-based cognitive test. The problems also have to be substantial enough to affect how the person manages usual life, such as work and family responsibilities.
  • The problems are not due to a reversible condition, such as delirium, or another reversible illness. Common conditions that can cause or worsen dementia-like symptoms include hypothyroidism, depression, and medication side-effects.
  • The problems arent better accounted for by another mental disorder, such as depression or schizophrenia.

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Why Lyme Disease Can Be So Hard To Diagnose And Treat

QUESTION: After feeling really miserable for many months, my doctor finally concluded I had Lyme disease. He put me on antibiotics for a month and my symptoms went away. But now that Ive stopped taking the antibiotics, Im feeling horrible again. Is this typical for Lyme disease?

ANSWER: Lyme disease can be difficult to treat especially when it is not identified right away.

It is caused by a bacterium called Borrelia burgdorferi, which is spread through the bites of tiny blood-sucking ticks that hide out in grassy meadows and wooded areas. The ticks originally pick up the bacteria from infected mice and deer.

Before the 1980s, Lyme disease was unknown in Canada and very few physicians have actually seen a case first-hand, says Dr. Gregory Taylor, Canadas Chief Public Health Officer.

The early symptoms are flu-like and can include fatigue, fever, chills, headaches and muscle pain. That could be virtually anything, says Dr. Taylor.

Some patients will get a distinctive bulls-eye rash around the site of the bite, but others do not.

The rather vague and varied symptoms add to the difficulty of making an accurate diagnosis. To make matters worse, the laboratory tests that check for the bodys production of antibodies to the infection can be difficult to interpret.

They are losing their jobs, their homes, their life savings everything, says Mr. Wilson, who was sick for three years before a doctor identified his symptoms as Lyme disease.

Improving Alzheimers Disease Diagnosis Rates

The progression of Alzheimers disease can be broken down into three general stages: preclinical, mild cognitive impairment, and dementia, but can be more accurately described according to a 7-Stage model . The progression of the disease may be different for each individual, but most people live between 4 and 8 years following diagnosis.

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How Alzheimers Disease Is Diagnosed

Diagnosing Alzheimers disease can involve several tests and scans. There is no simple or reliable way to diagnose this condition.

In fact, Alzheimers disease can be definitively diagnosed only after death by performing an autopsy and studying the brain’s tissues microscopically. As of now, healthcare providers can only determine whether Alzheimers is a possibility or probability.

Your healthcare provider will probably review your symptoms and medical history and then conduct a physical and neurological exam. They may also perform a series of tests to help determine whether you have symptoms like confusion, memory loss, or difficulty with reasoning or concentration.

You may undergo imaging scans and lab tests to help rule out other conditions. Your doctor may also suggest a spinal tap procedure to check for indicators of Alzheimers disease.

In addition to reviewing your symptoms and medical history, your healthcare provider may also ask close family members about your behavior and mental state.

How Is Alzheimer’s Disease Diagnosed

Why diagnosing Alzheimers today is so difficultand how ...

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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The Difficulty And Dangers Of Diagnosing Dementia

  • 1Ashford and St Peters Hospitals NHS Trust, Chertsey KT16 0PZ, UK
  • As Brunet rightly says, the diagnosis belongs to the patient.1 That is precisely the problem in dementia, when the patient often has little insight and does not notice symptoms. The drive for GPs to increase diagnosis rates is admirable, but there are many unknowns and potential dangers.

    Diagnosis in people with language barriers, no collateral history, chronic mental illness, epilepsy, hearing and

    Who Else May A Person With Dementia See

    A person with suspected dementia may come into contact with a range of health and social care professionals. Consultants usually operate within specialist teams, including nurses, psychologists, occupational therapists and social workers. Nurses who work with people with dementia, and those caring for them, include: community mental health nurses , who work in the community, providing treatment, care and support for people with mental health problems and dementia district or community nurses, who provide care and advice for people living at home and practice nurses, who work with doctors in GP practices.

    Clinical psychologists, who often work with consultants in memory clinics, assess memory and learning abilities. Occupational therapists can advise people on ways of maintaining their independence including carrying out adaptations and using special equipment. Social workers may be involved in assessing someones need for care services and home care workers may be brought in to help with personal and other care. Physiotherapists may be asked to advise on exercise for people, particularly in the early stages of dementia. Dieticians may be asked to provide guidance on nutrition, poor appetite, weight loss or weight gain.

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    How Does Alzheimer’s Disease Affect The Brain

    Scientists continue to unravel the complex brain changes involved in Alzheimers disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimers, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimers as well.

    The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimers, damage is widespread and brain tissue has shrunk significantly.


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