The detection of probable Alzheimer’s disease typically involves the collection and piecing together of information and test data, like a puzzle, until a clear picture emerges. One of the most effective strategies for piecing together a puzzle is teamwork; a multidisciplinary approach, in collaboration with patients and their families, is essential to diagnosis.
What are some of the puzzle pieces that healthcare providers use in the diagnosis of Alzheimer’s disease or other causes of memory loss? Neuroimaging, like brain MRIs; CT scans; or PET scans can be used to identify whether the brain is showing signs of a degenerative condition. Laboratory studies (bloodwork) typically examine vitamin levels, thyroid function, metabolic function, or presence of infection, which are important to rule out as possible causes of cognitive decline. Physicians sometimes order lumbar puncture for analysis of CSF (cerebrospinal fluid; where biomarkers like levels of amyloid beta and tau are informative) or genetic testing (like the presence of double APOE-e4 genotype), although they typically order only the the tests that are necessary and/or likely to improve the accuracy of a diagnosis.
Neuropsychological evaluations are immensely helpful in the detection of Alzheimer’s disease or other forms of dementia, and are detailed in a previous blog post. Neuropsychologists use cognitive and psychological testing to measure attention, executive functions, memory, mood, and other factors in order to determine whether a person’s cognitive decline is consistent with any neurological conditions. They also review medical records and typically have access to all of the puzzle pieces already collected at the time of their evaluation.
Neuropsychologists also assemble puzzle pieces through collaboration with patients and their families. In order to understand what has changed about a person who may have Alzheimer’s disease, we must first appreciate their history. We gather this history through a comprehensive and detailed discussion, or interview, with the experts: patients themselves, and their families.
Detection of Alzheimer’s disease as early as possible is important for optimal treatment and management. The sooner we identify it, the sooner we (as patients, families, loved ones, healthcare providers, and community service organizations) can start to mobilize. Some medications slow the progression of the disease and some can only be prescribed in early stages. And the sooner we identify the likelihood of progression into dementia, the longer we have to plan for the future, with thoughtful consideration of a person’s values and preferences.
If you are concerned about memory loss, talk to your primary care doctor. They may initiate the process of testing, or they may refer you to a specialist, like a neurologist or a neuropsychologist. Sometimes it seems like one doctor’s appointment inevitably leads to a few more, and that’s a good thing! Puzzles come together more quickly when we work together.
To learn more about the diagnosis of Alzheimer's disease and its importance, visit the National Institute on Aging and The Alzheimer's Association and its guide on navigating treatment options.
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