Diagnosing Alzheimer's and dementia

While many people interchange the terms "Alzheimer's disease" and "dementia," they are not the same.

Not everyone with dementia has Alzheimer's disease, explains Melissa Hunter, PsyD, a licensed clinical psychologist for Sentara Neurology Specialists.

"Dementia isn't a specific disease, but rather an umbrella term that encompasses a decline in thinking skills that impacts a person's ability to manage day-to-day affairs at the same level they could in the past," Hunter explains.

Alzheimer's disease is the most common form of dementia. Researchers have not found a cure for Alzheimer's disease. However, promising new therapies can slow the progression of the disease for some patients. Sentara regularly participates in Alzheimer's clinical trials to continue to advance therapies for the disease.

How does dementia affect the brain?

Dementia begins when changes in some brain regions damage neurons and disrupt the flow of information between brain cells.

For those with Alzheimer’s disease, a tell-tale sign is the formation of plaque in the brain. Plaques are deposits of a protein fragment that builds up in the spaces between nerve cells.

"Tangles" also develop in the brain when someone has Alzheimer's. These are twisted fibers of another protein that build up inside cells. Plaques and tangles disrupt the ability of neurons to relay messages to other neurons.

Dr. Alois Alzheimer discovered these clumps or plaques and tangled figures in the brain in 1906 after someone had died of an unusual mental illness.

Types of dementia

Alzheimer's disease accounts for 60 to 80% of dementia cases. Other forms of dementia include:

• Creutzfeldt-Jakob disease - Caused when a rare protein changes brain cells, leading to a rapid decline in cognitive skills
• Frontotemporal - Occurs when nerve cells in the frontal and temporal lobes of the brain are lost
• Lewy body - Abnormal protein particles accumulate in the brain, forming deposits that cause a form of dementia. Frederick H. Lewy, a neurologist, discovered them while working in Dr. Alzheimer's laboratory.
• Parkinson's disease – People with Parkinson's disease develop Lewy bodies in their brain, which leads to dementia.
• Vascular - Caused by blocked or reduced blood flow to the brain, depriving areas of oxygen and nutrients, such as a stroke.

Other conditions that cause dementia

Dementia caused by Alzheimer's disease and many other conditions cannot be reversed. However, some conditions that cause dementia can be treated and cognitive function improves.

This includes cognitive changes caused by:

• Depression
• Excess use of alcohol
• Medication side effects
• Thyroid problems
• Vitamin deficiencies

Diagnosing Alzheimer's disease

Several tests and screenings play a role in diagnosing Alzheimer's disease. Neurologists will look at medical histories, brain imaging studies, cognitive tests, blood work and their own examinations to determine whether someone has Alzheimer's disease.

Neuropsychologists conduct comprehensive testing that measures memory and learning, language skills, attention/concentration and visuospatial skills.

“In the past, an Alzheimer’s diagnosis was considered a diagnosis of exclusion,” Hunter says. “That meant that we ruled out other conditions that mimic the disease as we evaluated patients.”

In some clinical settings, biomarker testing is now available.

• An amyloid-PET scan measures the build-up of abnormal amyloid protein in the brain, one of the key hallmarks of Alzheimer’s disease.
• Cerebral spinal fluid (CSF) biomarker studies can also help diagnose Alzheimer’s.

Early signs of Alzheimer’s disease

The most common early symptom of Alzheimer's is difficulty remembering newly learned information. Other symptoms include:

• Changes in mood and personality
• Challenges solving problems
• Confusion with time and place
• Difficulty completing familiar tasks
• Misplacing things and not being able to retract steps to find them
• New problems with words in speaking and writing
• Poor judgment
• Trouble understanding images and spatial relationships

Memory clinic at Sentara

Sentara offers a memory clinic model in Norfolk, Va., to assist Alzheimer's patients and their families. The clinic streamlines cognitive screenings, imaging tests and lab work in one appointment.

On the same day, patients will meet with a neurology provider who will use all the information to make a diagnosis and assemble a treatment plan.

Promising new Alzheimer's therapies

Sentara, like other healthcare organizations, participates in clinical trials with the hope of one day finding effective medications to treat the disease.

One exciting development is the Food and Drug Administration's approval of and current use of disease-modifying therapies (DMTs). While these drugs do not improve cognitive function today, they slow the progression of the disease and reduce the amount of cognitive decline over time. The medications, donanemab and lecanemab, are both IV infusions.

Some patients with moderate to severe Alzheimer’s disease can also benefit from symptomatic therapies like donepezil and memantine. Donepezil improves the function of nerve cells in the brain. Memantine reduces the effects of chemicals in the brain that may contribute to the symptoms of Alzheimer's disease. 

Hunter says other lifestyle factors can also slow the progression of Alzheimer's.

"We focus on the quality of life and independence," Hunter says. "Modifiable factors such as improving sleep and combatting depression helps improve cognitive function."

People can also benefit from physical therapy, occupational therapy, speech therapy, a healthy diet and social interaction.

"We also believe strongly in the heart and brain connection," Hunter says. "There's a clear connection between cardiovascular health and brain health."

 

If you have dementia or Alzheimer's concerns, you can connect with a Sentara neurology or neurosurgery specialist at 1-877-310-8713.