In this, the third of our series of breakthrough tests for Alzheimer’s disease, scientists at the University of California San Diego (UCSD), have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). This study promises to improve diagnosis and monitoring of Alzheimer’s disease (AD).

The techniques were applied to the dataset of the multi-institution Alzhiemer’s Disease Neuroimaging Initiative (ADNI). What the scientists at UCSD were able to demonstrate was that the sub-regional brain volume measurements outperform available measures for tracking the severity of AD, including widely used cognitive testing and measures of global brain-volume loss.

According to insciences.org, the new research shows that changes in the brain’s memory regions, in particular a region of the entorhinal cortex, offer sensitive measures of the early stages of the disease. According to Anders M. Dale, PhD, professor of neurosciences and radiology at the UC San Diego School of Medicine, who led the study, “Loss of volume in the hippocampus is a consistent finding when using MRI, and is a reliable predictor of cognitive decline. However, we have now developed and validated imaging biomarkers to not only track brain atrophy, but distinguish the early stages of Alzheimer’s disease from changes related to normal aging.”

The study’s co-author, James Brewer, MD, PhD, a neurologist and assistant professor in the Departments of Radiology and Neurosciences at UCSD adds that, “The technique is extremely powerful, because it allows a researcher to examine exactly how much brain-volume loss has occurred in each region of the brain, including cortical regions, where we know the bad proteins of Alzheimer’s disease build up.”

If a picture is worth a thousand words, here are serial MRI brain scans, taken six months apart, that show progression from mild cognitive impairment to Alzheimer’s disease with significant atrophy (blue) and ventricle enlargement (orange/red).

For more information, see “Analyzing Structural Brain Changes in Alzheimer’s Disease” at insciences.org.

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?