How Alzheimer’s Disease is Diagnosed
Is Alzheimer’s disease the same as dementia?
Dementia is an umbrella term. It means there has been a loss of cognitive function that is severe enough to interfere with daily life. Alzheimer’s disease is the most common cause of dementia in older adults, but it is not the only cause. You can also develop dementia as a result of conditions like stroke, Parkinson’s disease or other disorders that impact the brain.
What are the signs and symptoms of Alzheimer's disease?
Alzheimer’s disease is unique from other types of dementia in that it primarily impacts your brain’s ability to form new memories.
Usually, people have no trouble remembering events that happened a long time ago, but they start to become forgetful of recent events. They may begin to repeat themselves, or not recall a conversation with a family member. They may notice they are misplacing things more frequently. They may begin to have trouble with familiar tasks, like operating the remote or balancing a checkbook. They may get lost while driving. Over time, people can show decreased judgment and may become more impulsive or vulnerable to scams.
Eventually, people can become disoriented – that is, they may lose track of what year it is, or be unable to recognize their surroundings. Their sleep cycle may become disrupted. Often, these cognitive changes are accompanied by mood changes as well. People may begin to seem withdrawn or irritable. Alzheimer’s is a slow-moving disease, and symptoms typically develop over the course of several years. If your symptoms started rapidly, it is more likely something else is going on.
How do I know if I’m at risk of developing Alzheimer's disease?
The greatest known risk factor is age. The older we get, the higher our risk.
The vast majority of people with Alzheimer’s disease are over the age of 65. A family history of Alzheimer’s disease, particularly on your mother’s side, can increase your risk, but it is not a guarantee that you will develop it. We also know that certain lifestyle factors, like smoking or poor cardiovascular health, seem to make our brain tissue more vulnerable to developing Alzheimer’s disease. Even factors like untreated depression can increase our risk.
How is Alzheimer’s disease diagnosed?
Technically, Alzheimer’s disease can only be confirmed at autopsy. When you see your doctor, there is no one test that can diagnose Alzheimer’s with 100% certainty. Instead, Alzheimer’s disease is diagnosed through a series of clinical tests and evaluations.
First, your doctor will need to rule out other conditions that impact the brain. Your doctor will probably order a brain scan, such as an MRI or CT scan, to look for strokes, brain tumors or other problems with brain tissue. In the early stages of Alzheimer’s disease, CT or MRI are often normal. Sometimes, the brain will show mild atrophy or shrinkage. In some instances, they may order a PET scan, which is a more specialized type of neuroimaging. They will probably order blood work to check your vitamin levels. They will ask about other factors that interfere with cognition, such as stress, chronic pain, poor sleep or medication side effects. Finally, they will do a physical and neurological examination.
If other causes have been ruled out, or if your cognitive problems are persisting, the gold standard for determining whether someone has dementia is neuropsychological testing. You will be referred to a neuropsychologist, who will conduct a thorough interview with you and your family, and then conduct a series of in-depth cognitive tests to determine if there are any areas of your thinking that are falling below the normal range for someone your age.
A neuropsychologist will evaluate your attention, memory, language, visual-spatial skills, problem-solving and social-emotional functioning to see if the pattern of those scores is consistent with Alzheimer’s disease. They will also provide you with comprehensive recommendations about what to expect and what you can do about it.
How is Alzheimer's disease treated?
If you or a loved one are ultimately given a diagnosis of Alzheimer’s disease, it can be a very scary moment. But there are a lot of things we can do, and we have a team of people ready to help you through the process.
There is currently no cure for Alzheimer’s disease, although there is always research ongoing. Current medications can temporarily slow the progression, especially in the early stages, but they don’t stop it. Instead, treatment focuses on symptom management so that we can ensure a good quality of life for both persons with Alzheimer’s disease and their caregivers.
In order to slow the decline, it is important to manage the lifestyle risk factors we mentioned earlier, such as diet, exercise, and smoking. A healthy heart makes for a healthy brain, so we want to take good care of any cardiovascular conditions. We want to make sure any stress or anxiety is adequately treated. One important component that is often overlooked is the importance of staying cognitively active. The more you can treat your brain like a muscle by staying active and engaged in your life, the better the outcomes tend to be. There is no one activity that is right for everyone – as long as you are continuing to challenge yourself, you’re on the right track. Maybe that means doing a daily crossword puzzle, joining a book club, taking a cooking class, or learning a new language. Not only do these activities help keep your brain healthy, they also increase your quality of life.
When should I talk to someone about my symptoms?
There are (unfortunately!) a lot of normal changes that occur in our brains with age. We can’t run as fast as we did when we were young, and our brains don’t work quite as fast either. We get a little more forgetful as we age, and we can find ourselves searching for words more often. If we are feeling stressed or aren’t sleeping well or are on a lot of medications, it is normal to feel a little duller from a cognitive standpoint.
But Alzheimer’s disease is NOT a part of normal aging. If your symptoms are starting to interfere with your ability to live your life, it is definitely time to tell your doctor.
Editor's note: This article was originally published on June 21, 2018.