Early Detection of Alzheimer’s disease: The good, the bad and the big questions.
You may have seen the recent news articles about the advances in Alzheimer’s disease detection. Researchers are finding new ways to detect if someone has Alzheimer’s disease at the earliest stages. Some researchers wonder if we can detect this disease with a single blood test, or before we even seen the first symptoms.
Let’s start from the beginning
Alzheimer’s disease and other related dementias (Lewy Body, Vascular dementia, and Frontotemporal dementia) have historically been difficult for clinicians to detect. However, advances in neuro-imaging, neuropsychology testing, and our increased understanding of the disease have made it somewhat easier to detect. For a more confident diagnosis, clinicians might wait to see if and how the person with cognitive changes progresses. In other words, does the person continue to get worse? If the answer is yes, the progression likely indicates the disease to be a dementia. It can be difficult to say which form of dementia is likely, but often, if there are cognitive deficits, if it is progressive, and if there are no other causes then it is often called dementia. This may be why we hear, quite often, that a person was diagnosed with dementia in a general sense. Technically dementia is not a diagnosis, but a description of symptoms. Alzheimer’s disease, Dementia with Lewy Bodies, Vascular dementia, Frontotemproal dementia are examples of dementia diagnoses.
For many people, multiple visits to a physician and other types of professionals including neurologists, geriatricians, neuropsychologists, and geriatric psychiatrists are common when dealing with memory loss, unexplained visual/perceptional changes, personality or judgment changes, and the inability handle one’s life as previously accomplished. Before individuals step into the doctor’s office they or their families have an indication that something has changed- whether it be memory loss, behavioral changes, language changes or other cognitive deficits- that provoked them to call the doctor. The first call is often made to the primary physician (PCP). Some PCPs are able to diagnosis a form of dementia in their own clinic with the help of smaller versions of cognitive testing, access to neuro-imaging, and blood work labs. However, it is also common for the PCP to refer to a specialist who can spend more time looking into the symptoms and noted changes by ruling out other causes for the cognitive issues.
The Early Bird Gets the Worm
Early detection. It is a phrase we hear a lot today in our health conscious world. Early detection of breast cancer, have a mammogram starting around age 35. Early detection of cervical cancer, stay on top of your scheduled Pap smear. After age 50 we should begin making plans for regular colonoscopies to detect colon irregularities. Many of these detection screenings are recommended after the age of 50.
Will Alzheimer’s disease and related dementias become a part of this wave? Should you add the dementia screening to your annual plans after you turn 50, maybe even 40? When can we begin to detect different forms of dementia? What do we do once we detect it? There is not a pill we can take or surgery we can administer to eliminate a dementia’s progression, just as the same is true for many cancers.
To many people it is worth going to get your mammogram done because you know that if they find a lump, there is often a treatment plan and likely if found early enough, you can survive and live many more healthy years. This of course is very troubling, but there are tested and proven treatments. These treatments give credit to the early detection, and thus the mammograms.
When is too early to detect, if there is no treatment to stop the progression? When asking to detect a disease that we have no treatment for, where does that lead us? It may be hard now, because there is no cure, but there are good reasons for the early detection push.
What about research?
Research- clinical trials, neuro-imaging studies , non -pharmacological therapies- is a large reason why early detection is so important in the world of Alzheimer’s disease and other dementias. The earlier we can find out that a dementia is present in the brain, the better able we may be to stop it before too much damage has already been done. First, we need to know more about the basics of the disease. What happens in the brain, when and how does the disease start? These are questions researchers have been battling for over 30 years. In order to run clinical trials to find out which medication is most affective, we need more people in clinical trials who have an early diagnosis. In my opinion, this is a very good reason to improve our diagnostic process and push it to the earliest possible time. In other words, one way to look at the push for early detection is as a stepping stone to more research, which will lead us to a more effective treatment.
Take it with a grain of salt
We have to be careful how we interpret what we hear and what we read about. This applies to all subject matters. Alzheimer’s disease related issues take no exception. I am constantly reading the latest in Alzheimer’s disease news. It feels like every day we inch closer toward knowing how to better diagnosis the disease. What concerns me as a reader is when it appears we are making such great strides towards detecting the disease before we even know what causes it, where it comes from, how it moves, how it thinks, etc, etc. How can we know what we are detecting? Does it really matter that we don’t understand the basics of the disease yet? Whatever you read related to Alzheimer’s disease research advances, take time to applaud the hard work of the scientists and the funding of important donors and grantees, but also consider what implications the advances have.
How to get tested?
If you are concerned that you or someone you know is experiencing cognitive changes including memory loss, word finding problems, or behavioral changes it is important to speak with a doctor. A primary physician may be able to run preliminary tests to uncover the cause for your changes, but often a referral to a specialist is needed. If you are interested in an Alzheimer’s Disease Research and Diagnostic Center you can find one of the 30 locations in the country nearest you.
Article edited by Bridget Murtha
Picture by Bottomless Padding Pool