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Diagnosis

Diagnosis

Diagnosis of Alzheimer’s Disease

He often used to forget his way back home. I had noticed a change in his behavior too. Not recollecting my sisters name easily, not able to remember my phone number. This was very unusual,” narrates Mr. Keith’s wife. Mr. Keith, now 73 years old, worked as a chief editor for a local newspaper for 34 years. His wife noticed his symptoms at a very early stage. He is now diagnosed to have cognitive impairment. The neurologists suspect he is suffering from AD.

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If you are concerned about unusually forgetting things or suffering memory problems, it is advisable that you talk to your Healthcare Provider (HCP). Your HCP may suggest you to take memory-screening test that can help detect problems. You may also need to undergo a complete physical examination, some laboratory and brain imaging studies.

Medical History

Your HCP may ask you several questions about your overall health, past illnesses and symptoms that you, or those near you have noticed. You must mention about the difficulties about forgetting things, performing daily activities, speech problems, if any.

Physical Examination

Your HCP may conduct a physical examination and also check your neurological health by testing your ability to get up and walk properly, balance, co-ordination, hear and see things.

Laboratory Tests

There are no specific tests that can confirm the diagnosis of AD. However, blood tests and urine tests may rule out other causes of memory loss.

Brain Imaging Studies

Brain imaging studies or scans is used to identify visible abnormalities, such as trauma or tumors that may cause memory problems. You may need to undergo brain scans, such as computed tomography (CT) or magnetic resonance imaging (MRI) to distinguish AD from other possible causes.

If the HCP suspects that you are suffering from AD, you may be advised to see a specialist, who can understand the details of your condition.

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The specialists include:

Geriatricians

Geriatricians are physicians who have expertise in care for old people. They understand the changes in the aging body and can detect the symptoms accurately.

Geriatric Psychiatrists

Geriatric psychiatrists specialize in evaluating the mental health problems in old people.

Neurologists

Neurologists specialize in abnormalities of the brain and central nervous system. They can evaluate and review the results of brain scan.

Neuropsychologists

Neuropsychologists are healthcare professionals who can conduct tests of memory and thinking.

 

What Does the New Research Say?

Researchers have identified some novel biomarkers that may identify the risk of developing AD

  • According to the researchers at Washington University School of Medicine report, buildup of amyloid plaques (hyperlink) and the protein tau in the brain can identify people who are likely to develop cognitive problems.
  • Some other researchers also found that certain blood-based protein biomarkers such as cortisol, pancreatic polypeptide, insulinlike growth factor binding protein 2, β(2) microglobulin are increased in individuals with AD.
  • Recently, a novel gene/protein–ALZAS(Alzheimer Associated Protein) has been identified that may become a useful "non-invasive" diagnostic marker via a simple blood test.
  • The scientists believe that in the future reliable biomarkers for AD would be confirmed.

 

What Does Diagnostic and Statistical Manual Of Mental Disorders (DSM-5)Say?

The DSM-5 (A manual used by clinicians and researchers to diagnose and classify mental disorders) categorizes AD as Neurocogntitive Disorder (NCD). This term was introduced in the revised version of DSM-5 released in May 2013. This change was implemented to avoid the stigma associated with the term “dementia,” which in Latin means “without mind.” However, it may still be considered as an alternate term due to its familiarity among clinicians and patients. Another major and most distinct change in the DSM-5 is introduction of categories – mild and major NCD. These terms are applicable to all the neurocognitive disorders, such as AD, Parkinson’s disease, HIV infection, Lewy body disease, and vascular disease. This means that AD can be classified as major or mild disease, depending upon the symptoms.

Mild NCD due to AD, which was earlier known as Mild Cognitive Impairment, is the most bothersome symptom faced by majority of elderly population. Although their symptoms do not fit into the diagnostic criteria for a major NCD, it is clearly disturbing. People suffering from mild NCD can live independently; however, they may have to struggle with some of their daily activities and explaining this problem to their health care provider. The pathological changes that lead to AD begin much before the symptoms are actually seen. Therefore, combination of symptoms of mild NCD and presence of specific biomarkers significantly increase the likelihoodthat mild NCD may progress to AD (major NCD). Therefore, DSM-5 has included the term mild NCD so that those people who have chances of progressing to AD, be diagnosed much earlier.

Diagnostic Criteria for Major NCD Due to AD

  • Evidence of substantial decline in neurocognitive performance
  • Cognitive impairment that interferes with daily activities making a person less independent
  • Cognitive impairment need not specifically occur in context of delirium (severe confusion and disorientation)
  • Cognitive impairment that is not attributable to another mental disorder (e.g., major depressive disorder, schizophrenia).

Diagnostic Criteria for Mild NCD Due to AD

  • Evidence of modest decline in neurocognitive performance
  • Cognitive impairment that does not interfere with daily activities and therefore the person may not be completely dependent on others
  • Cognitive impairment need not specifically occur in context of delirium (severe confusion and disorientation)
  • Cognitive impairment that is not attributable to another mental disorder (e.g., major depressive disorder, schizophrenia).

 

Last Reviewed on: August 02, 2014

Reviewed By: Dr. Akshya Vasudev, MBBS, MD, MRCPsych, PG Cert Med Edu

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