Alzheimer's And Dementia: Diagnosis
Alzheimer's And Dementia: Diagnosis
Gus Alva (Medical Director, ATP Clinical Research) gives expert video advice on: What do I do if I think a loved one has Alzheimer's disease?; How is Alzheimer's disease diagnosed?; Who can diagnose Alzheimer's disease or dementia? and more...
What should I do if I think I have Alzheimer's disease?
If one thinks that one is developing Alzheimer's disease, seeking out medical attion in a prompt fashion would probably be the best way to go. Again, just alieving any anxiety in the individual that might not have it makes sense, but if in fact that person has the illness, initiaing treatment is a great idea. And although we do not have a cure for this disease state just yet, I feel hopeful that we will in the near future. We do have medications that can slow down the progressive decline associated with the illness. Why do we want to do that? Well the answer is, if we're able to maintain the functional status of the individual affected by this illness, that's great news. We can maintain someone's dignity, that's great news. And early prompt attention will often times beget that.
What do I do if I think a loved one has Alzheimer's disease?
At the very first suspicion of Alzheimer's disease, I think that seeking out a medical professional would make the most sense. There are three emergent situations now with the patients: delirium, depression, and dementia. Each one could be deathly for the individual, not necessarily over the same time frame, but in essence, if there is a suspicion that this is Alzheimer's disease, it's better to find out sooner than later. It turns out that the earlier we do something about this problem, the better the potential outcome for that individual who may have Alzheimer's.
How is Alzheimer's disease diagnosed?
The Alzheimer's disease diagnosis is made based on a clinical diagnosis. The doctor will usually analyze the individual to make sure that it isn't something reversible. However, since we are dealing with a memory impairment problem, it is of great importance to carry out the most specific and sensitive tests out there right now. In screening Alzheimer's disease patients, the MCI Screen is a very useful tool for detecting whether somebody has a memory problem or not. It differentiates normal individuals from Alzheimer's disease impaired individuals.
Who can diagnose Alzheimer's disease or dementia?
Not just psychiatrists but other doctors can diagnose Alzheimer's disease. Classically, neurologists, psychiatrists, gerontologists or geriatricians were the individuals that would come in close contact with individuals with Alzheimer's disease. However, since this is an illness that's growing at such a rapid pace, internists and family practitioners also have been asked to help out with this. And this is an illness that can be readily diagnosed in an office-based setting. So again, when we suspect Alzheimer's disease, our diagnostic accuracy is very high. Most people, or most well-trained clinicians, doctors, can actually diagnose this condition and do something about it.
What is an "MCI Screen"?
The MCI screen is a diagnostic tool that can help in detecting somebody that has a cognitive impairment versus a normal individual. It's a test that was developed by a company called MC Care and there's a website in which most clinicians could actually look up the specific tool. It basically helps in identifying short-term memory problems in individuals, and again, it has great sensitivity and specificity. There are other tests that are also used as well. The MMSE, although widely used, is very crude because depending on the individual's age or educational backdrop, people would score very differently. And then there are also other things like Clock Drawing, the Mini Cog, the AD-8, the Slums, etc. There's a whole slew of different tests to help figure out whether somebody has a memory problem or not; unfortunately none of them is 100% specific.
How does an MCI Screen work?
The MCI Screen is a tool that is used utilizing one's computer. Basically the individual that's interviewing the subject that's being tested sits across from the individual and asks them specific questions directly out of their computer. It takes approximately 10 minutes to do, and it basically utilizes immediate and delayed recall features that came out of the CERAD study or the CERAD test. In addition, there's triad z-score based on animal model or animal naming that is utilized that helps give the test the solid specificity and sensitivity that it has.
What is the "MMSE"?
The MMSE is a test that was devised by Marhall Folstein sometime back to look at individuals with metabolic encephalopathies. It's been adopted by most third party payers or clinicians because it's a relatively easy scale to use. It's 3 points. The higher you score, the better you're doing. The lower you score, the worse you're doing, and it's typically the tool that we use to stage individuals: mild (above 20), moderate (10 to 20), and severe (less than 10).
What is the "Clock Drawing Test" (CDT)?
Clock drawing is pretty simple. You basically ask the individual to draw a clock, to have it have all the numbers, and then subsequently to draw the clock hands specifically specifying a time that you want them to point at. Now in essences, it's a useful tool because regardless of the individual's education, or their language -- their native tongue -- most anybody would be able to draw a clock. Distortions on any portion of the clock drawing would be indicative of some type of a cognitive problem.
What is the 'Mini-Cog test'?
The "Mini-Cog" is a tool that helps blend in portions of the MMSE with clock-drawing. It basically asks the individual to remember three words and so you have a situation whereby you can test immediate recall. You distract them by having them draw a clock and then subsequently you check for delayed recall by asking them about the three words that you asked them to remember initially.
What is the "AD8 test"?
The AD8 test is a simple variation of asking functional questions about the individual's abilities and in essence, depending on whether somebody is having a problem or not, a combination of several affirmative scores would be indicative of a likelihood of a dementing process.
What is the "SLUMS examination"?
The SLUMS is a tool that would help along the lines of identifying functional deficits in association with memory problems in somebody who would be suspect of having Alzheimer's disease. SLUMS is basically a simple check-off type of a list that looks at how the individual is doing overall. Pretty easy to use, very straightforward.