Alzheimer’s disease

Diagnosis

Healthcare providers employ various procedures when assessing whether a patient experiencing memory problems has Alzheimer’s disease. This is crucial due to the diverse array of diseases, particularly neurological disorders, that can lead to dementia and exhibit symptoms similar to those of Alzheimer’s. By utilizing a range of diagnostic approaches, healthcare professionals aim to accurately differentiate Alzheimer’s disease from other conditions and establish an appropriate diagnosis.

Understanding the symptoms is crucial to making an accurate diagnosis of Alzheimer’s disease. It can be helpful to get feedback on their symptoms and how they affect their everyday life from a close family member or friend. Memory and cognitive tests can also be used to identify Alzheimer’s.

When plaques and tangles were discovered in the brain under a microscope, Alzheimer’s disease was previously only definitively identified after death. Alzheimer’s disease during life can now be identified with greater confidence by healthcare providers and researchers. The presence of plaques and tangles can be determined by biomarkers. Testing for amyloid and tau proteins in the fluid components of blood and cerebral spinal fluid is one example of a biomarker.

The following tests would probably be used to identify Alzheimer’s disease:

• Physical and neurological examination: A physical examination will be done by a healthcare provider. Testing may be part of a neurological examination by checking the reflexes, muscle tone and strength, the ability of the patient to get up from the chair and walk, senses such as sight and hearing, coordination, and balance.
• Imaging test: Typically, images of the brain are utilized to identify observable changes associated with diseases other than Alzheimer’s disease that may produce comparable symptoms, such as strokes, trauma, or tumors. Although they are mostly utilized in large hospitals or in clinical trials, new imaging techniques may assist identify particular brain alterations brought on by Alzheimer’s.
  • Magnetic resonance imaging (MRI). A powerful magnetic field and radio waves are used in MRI to provide detailed pictures of the brain. MRI scans not only rule out other illnesses, but they may also reveal shrinkage of particular brain regions linked to Alzheimer’s disease. In general, an MRI is preferred to a CT scan when assessing dementia.
  • Computerized tomography (CT): Cross-sectional images of the brain are created using the specialist X-ray technology known as a CT scan. To rule out tumors, strokes, and head injuries, it is typically applied.
  • Positron emission tomography (PET): Images of the illness process can be captured by PET scan. A low-level radioactive tracer is injected into the blood during a PET scan to reveal a specific aspect of the brain. PET imaging could consist of:
    • Fluorodeoxyglucose (FDG) PET imaging: demonstrate the parts of the brain where nutrients are not properly metabolized. Differentiating between Alzheimer’s disease and other forms of dementia can be made easier by looking for patterns in the regions with poor metabolism.
    • Amyloid PET imaging: The amount of amyloid deposits in the brain can be determined using this method. This test is primarily used in research, however it might be applied in cases where a person exhibits very early or unusual onset dementia symptoms.
    • Tau PET imaging: This is usually used in research settings and assesses the brain’s tangles.
• Blood test: Blood testing can help rule out other possible reasons of forgetfulness and confusion, like a thyroid condition or low vitamin levels. Beta-amyloid and tau protein concentrations can also be determined by blood testing, however access to these procedures may be restricted.
• Mental status and neuropsychological test: To evaluate memory and other thinking abilities, the healthcare provider may administer a quick mental status test to the patient. Longer versions of this type of test may offer more information about mental function that can be compared to that of individuals of a comparable age and educational level. These tests may help in making a diagnosis and act as a basis for further symptom monitoring.
• In specific situations, alternative tests may be employed to assess the levels of amyloid and tau proteins in the cerebrospinal fluid. These tests may be recommended when symptoms rapidly worsen or when dementia occurs at an atypical younger age.
• Future diagnostic tests: Tests that can evaluate biological indicators of conditions processes in the brain are being developed by researchers. These diagnostics, which include blood tests, could increase the precision of a diagnosis. They might also make it possible to identify the illness before any symptoms appear. There is a blood test to check beta-amyloid levels.

While genetic testing is not typically recommended for most patients undergoing assessment for Alzheimer’s disease, individuals with a family history of the condition may consider it as an option. Prior to undergoing genetic testing, it is advisable to engage in a discussion with a genetic counselor. This allows for a comprehensive evaluation of the potential benefits and risks associated with the test, aiding in making an informed decision.

Treatment

While a definitive cure for Alzheimer’s disease remains elusive, there are medications available that can temporarily slow down the progression of dementia symptoms. These medications aim to prevent the worsening of cognitive decline. Additionally, behavioral symptoms associated with Alzheimer’s can be managed and improved through the use of medications and other treatment approaches.

It may be feasible to retain everyday functioning for a while by starting Alzheimer’s treatment as soon as possible. Current treatments, however, cannot halt or reverse AD.

Treatment is extremely customized because AD has different effects on each individual. The most effective course of treatment for Alzheimer’s is determined by the healthcare provider in consultation with the patient and their caregiver.

• Medications: With memory issues and other cognitive abnormalities, medications for Alzheimer’s disease can be helpful. Currently, two types of medications are used to treat symptoms:
  • Cholinesterase inhibitors: Cell-to-cell communication is increased as a result of these medications. The drugs protect a chemical messenger that depletes in the brain by AD. These are frequently the first medications used, and the majority of patients report slight symptom relief.

Cholinesterase inhibitors may help with behavioral problems including depression or agitation. The medications can be administered orally or through a skin patch. Donepezil, galantamine, and rivastigmine transdermal patch are examples of cholinesterase inhibitors that are frequently prescribed.

These medications’ most common side effects are diarrhea, nausea, appetite loss, and sleep difficulties. An irregular heartbeat can be a significant adverse effect in persons with specific heart conditions.

• • Memantine: This medication delays the progression of moderate to severe Alzheimer’s disease symptoms by acting on a different brain cell communication network. It can occasionally be used with a cholinesterase inhibitor. Among the somewhat infrequent side effects include confusion and dizziness.
  • Additional medicine: The Food and Drug Administration (FDA) authorized aducanumab in June 2021 for the management of a few Alzheimer’s disease cases. The medication was tested on persons with early-stage Alzheimer’s disease, including those who had the illness-related mild cognitive impairment. The brain’s amyloid deposits are lessened with the help of the medication.

For those with mild Alzheimer’s disease and mild cognitive impairment brought on by Alzheimer’s disease, lecanemab, another Alzheimer’s drug, has showed potential. The medication was given FDA approval in 2023. According to a phase 3 clinical trial, the drug significantly reduced the rate of cognitive loss in individuals with early Alzheimer’s disease (27%). Lecanemab functions by inhibiting the aggregation of amyloid plaques in the brain. The greatest trial to date examined whether removing amyloid plaque clusters from the brain could delay the onset of the condition.

To help manage the behavioral symptoms of Alzheimer’s disease, other medications, such as antidepressants, may occasionally be used.

Establishing a secure and encouraging surrounding

Adapting a treatment plan to a patient’s needs who has Alzheimer’s disease is an essential component. Reduce memory-intensive tasks and establish and improve routines. These actions can greatly simplify life.

In order to maintain a person’s sense of well-being and functional capacity, consider the following:

• To prevent losing valuables, keep the keys, wallets, phones, and other items in the same location at home.
• Store medications in a safe place. Use a daily to-do list to remember the dosages.
• Set up automatic payments and deposits for the finances.
• Have the Alzheimer’s patient carry a mobile phone equipped with location tracking. Set up the phone with important phone numbers.
• Whenever possible, make sure that regular appointments take place on the same day and at the same time.
• Keep track of daily schedules using a calendar or whiteboard. Make it a habit to cross off things when completed.
• Take away extra furniture, messes, and area rugs.
• Install strong handrails in restrooms and on staircases.
• Ensure that the shoes is cozy and offers sufficient traction.
• Limit the use of mirrors. Mirror reflections might be frightening or perplexing for those with Alzheimer’s.
• Check to see if the Alzheimer’s patient is wearing a medical alert bracelet or carrying identification.
• Arrange pictures and sentimental items around the house.