from Reuters.com

In July of this year, Reuters reported that new tests assessing brain changes and body chemistry are showing promise at diagnosing Alzheimer’s disease in its earliest stages. Studies presented at an Alzheimer’s Association meeting in Vienna, Austria included:

1. Irish researchers found scans measuring brain volume and a combination of memory tests accurately identified nearly 95 percent of people who had progressed from mild cognitive impairment to early Alzheimer’s disease.  Michael Ewers of Trinity College Dublin and colleagues studied 345 participants in the ADNI study with mild cognitive impairment, a precursor to Alzheimer’s. They looked at an array of tests and found three memory tests plus MRI measurements of brain volume in the left hippo campus — a region closely linked to memory — were most predictive of disease progression.
2. U.S. researchers found that a type of brain scan that measures glucose combined with low scores on memory tests was a strong predictor of disease progression. Susan Landau of the University of California, Berkeley used data on 85 patients and found positron emission tomography scans that measure glucose in the brain and poor memory recall were strong predictors. People who did poorly on these measures were 15 times more likely to progress to Alzheimer’s within two years.
3. A team at Duke University in North Carolina led by Dr. Allen Roses found that a gene called TOMM40 raises Alzheimer’s risk. The gene predicted the age of Alzheimer’s development within a five- to seven-year window in people over 60. It is closely linked to another Alzheimer’s gene called APOE4. Both APOE4 and TOMM40  account for an estimated 85-90 percent of the genetic effect according to Roses.

As was mentioned in Part 1, there’s progress, but we still have a long ways to go to find an effective test. But even if we were to have a conclusive test, doctors still have very few effective treatments for Alzheimer’s disease. And still, as it has been for a long time, only an autopsy will reveal definitively whether or not a person truly has Alzheimer’s disease.

Brain Tour from Alzheimer's Association (click image)

Just what is Alzheimer’s disease (AD)? Everyone seems to agree that it is the most common form of dementia accounting for at least half of all dementia cases. (See previous post on discussion of dementia). There is also agreement that in advanced Alzheimer’s disease, a person cannot function intellectually and socially. According to the Mayo Clinic, “Alzheimer’s disease is not a part of normal aging, but the risk of the disorder increases with age. About 5 percent of people between the ages of 65 and 74 have Alzheimer’s disease, while nearly half the people over the age of 85 have Alzheimer’s.”

What is happening in the brain that is causing a person not to be able to function intellectually and socially? Take the “Brain Tour” on the left and notice the shrinkage of the brain as well as the tangles. Just looking at those pictures explains the confusion, doesn’t it?

According to the Mayo Clinic, there are currently three major areas that doctors depend on to make a diagnosis:

1. Lab tests
2. Neuropsychological testing (extensive assessment of thinking and memory skills)
3. Brain scans
   • Magnetic resonance imaging (MRI)
   • Computerized tomography (CT)
   • Positron emission tomography (PET)

Although memory assessments should always be conducted by a medical practitioner, here are two quick paper and pencil tests. The first was published by Times Online (UK) called the “Five Minute Alzheimer’s Test.” The second one is on the Web site of a well-known Alzheimer’s drug, but it states, “This screening tool cannot be used to tell if your loved one has a medical problem, only whether he or she should be tested.” It was adapted from Galvin JE, et al. The AD8, a brief informant interview to detect dementia. Neurology 2005:65:559-564.

Once again, do not draw any conclusions from these memory tests. As discussed by Carrie Hill, Ph.D. in “What you Need to Know about Screenings for Memory Problems,” she states:

1. A memory screening should not be used to make a diagnosis
2. A memory screening does not replace a diagnostic workup
3. Memory screenings should only be performed by qualified professionals
4. Memory screenings should be confidential and provide follow-up resources
5. Memory screenings can be used to establish a baseline
6. Opinions differ on the value of memory screenings. Here she talks about the different views of the two leading non-profit Alzheimer’s organizations — Alzheimer’s Foundation of America and Alzheimer’s Association.

In our next blog post next week, we will look at the most recent diagnosis tools. In the meantime, have you done your Sudoku for today?