Alzheimer's Part 2

Alzheimer's disease, # 2 of 3 blogs on this topic, 2015
This is the second of three blog entries reporting on the annual conference, Meeting of the Minds, sponsored by the Alzheimer's Association and the Mayo Clinic.

Most of the time, in most cases, dementia is a disease of the elderly; Alzheimer's disease is one form of dementia. Research has not yet proven a cause, nor specific prevention. The most common early symptom is progressive memory loss, followed by behavior changes, and physical changes as the disease advances.

While people often joke about memory loss, the humor only mildly covers the underlying dread that “this may be it!” It is a common fear that benign forgetfulness will always lead to dementia. As we age, the brain function slows ever so slightly each year. It is very common, (dare I say 'normal?'), to experience a delay in recalling someone's name from time to time; it is not unusual to misplace something from time to time. A 'normal' brain can recall immediate past activities that may prompt one to remember where that something is located. It is often helpful to mentally retrace one's steps to bring some information back into focus.
There are times, however, when benign forgetfulness begins to interfere with activities of daily living. This may manifest itself as having difficulty with tasks that were once done with ease. It is a common symptom of progressing memory loss when one can no longer keep track of paying the bills; or may not remember how to follow a task that involves a sequence of events, such as cooking. As symptoms of dementia progress, it may be evident in changes involving behavior. Some conversations or actions are no longer consistent from prior habits; it may occasionally involve dressing inappropriately for the season of the year. The individual may not tend to personal hygiene as she once did, because she can no longer remember the steps in the process. Or the opposite may be true, that the person forgets that she just brushed her teeth, and may repeat the process many times.

While research continues to enlighten the medical community about Alzheimer's disease, there is not yet a good comprehensive diagnostic procedure, nor any medications that will prevent or cure the disease. There are medications that may reduce the extent of symptoms, while improved drugs are currently in the research trials process, and not yet available for general use. Each year at this conference, new advances in research bring encouraging information to healthcare providers, families coping with the disease, and the concerned public.

To date, there is still not a direct diagnostic test to detect Alzheimer's disease. But through the process of excluding all other causes for memory loss, the diagnosis can be determined to be Alzheimer's disease with a greater degree of certainty.

The information which follows is taken from the Mayo Clinic website, www.mayoclinic.com/dementia screening, 04/16/2015:

To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely on the following types of tests.

Physical and neurological exam

Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing:

  • Reflexes
  • Muscle tone and strength
  • Ability to get up from a chair and walk across the room
  • Sense of sight and hearing
  • Coordination
  • Balance

Lab tests

Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.

Mental status testing

Your doctor may conduct a brief mental status evaluation to assess your memory and other thinking skills. Short forms of mental status testing can be done in about 10 minutes.

Neuropsychological testing

Your doctor may recommend a more extensive assessment of your thinking and memory. Longer forms of neuropsychological evaluation, which can take several hours to complete, may provide additional details about your mental function compared with others' of a similar age and education level.

This type of testing may be especially helpful if your doctor thinks you may have a very early stage of Alzheimer's disease or another dementia. These tests may also help identify patterns of change associated with different types of dementia and can help doctors estimate your ability to safely manage important activities, such as financial and medical decision-making.

Brain imaging

Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer's.

Brain-imaging technologies include:

·         Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images. MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise.

MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer's disease has occurred.

·         Computerized tomography (CT). For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images (slices) of your brain. It's currently used chiefly to rule out tumors, strokes and head injuries.

·         Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a low-level radioactive tracer. You'll lie on a table while an overhead scanner tracks the tracer's flow through your brain.

The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions. This can show which parts of your brain aren't functioning well. New PET techniques may be able to detect your brain level of plaques and tangles, the two hallmark abnormalities linked to Alzheimer's.

Future diagnostic tests

Researchers are working with doctors to develop new diagnostic tools to help definitively diagnose Alzheimer's. Another important goal is to detect the disease before it causes the symptoms targeted by current diagnostic techniques — at the stage when Alzheimer's may be most treatable as new drugs are discovered. This stage is called preclinical Alzheimer's disease.

New tools under investigation include:

  • Additional approaches to brain imaging
  • More-sensitive tests of mental abilities
  • Measurement of key proteins or protein patterns in blood or spinal fluid (biomarkers

From the information above, from Mayo Clinic, it can also be said that Alzheimer's disease is a worldwide priority in healthcare. It is of global concern because of the cost of care, as well as the affect of other common physical diseases that are compromised in the individual with memory problems. Consider the most common chronic diseases among the elderly: diabetes, congestive heart failure, chronic obstructive pulmonary disease, and chronic kidney disease. When the person with dementia forgets to take appropriate medications, or fails to follow dietary restrictions or finds herself hospitalized for any of these diseases --- the medical staff may not be aware that she has difficulty with memory--- and proper management of these chronic conditions may become compromised.

Development of a screening tool that is reliable and brief is improving diagnosis, in order to support the patient as well as the caregiver. In the majority of cases, it is a family member who becomes the primary caregiver. The caregiver often takes over the responsibility of managing medication, activity, diet, and all other aspects of life for one with dementia; it becomes a prolonged, exhausting care management task. There are becoming available more resources to assist with the care and support of people with dementia and for the families who care for them. Having a reliable test to confirm Alzheimer's disease will assist in obtaining resources and support for families managing the disease. Only recently, Medicare and other health insurance companies have accepted, and approved funding for the “MiniCog” screening test to be done on all those age 65 and older on an annual basis. The MiniCog is actually a short form of the delayed word recall evaluation that has been used in the past; the other component of the MiniCog is a clock face drawing diagnostic test. The MiniCog has an acceptable reliability to rule out, or to provide a basis for further cognitive testing. Usually an individual is referred to a gerontologist, a neuro-psychiatrist, or a geriatric psychologist for further definitive testing.

In the next blog, there will be discussion of lifestyle modifications might be made to improve quality of life for caregivers, families and those with dementia.

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Dorothy Ellerbroek

The professional specialty of parish nursing combines nursing care and health ministry. In broad terms, my goals are to serve this faith community by fostering optimal health of body, mind, and spirit. I must admit that the best thing I do is to listen to others. My work involves visiting those who are homebound or ill; together with that, I may offer health counseling and education, referrals or resources for healthcare needs for all ages. The parish nurse works with volunteers, including the Health Ministry team, to bring programs and services to the congregation. To set up a time to meet with our parish nurse, email Dorothy or call the church office at (612) 927-8849.