Alzheimer’s Diagnosis: What should I be looking for? 

Alzheimer’s Diagnosis: Dementia of the Alzheimer’s Type 

An Alzheimer's diagnosis is not easily ascertained. In clinical terminology a diagnosis of Alzheimer's disease is referred to as a diagnosis of dementia of the Alzheimer's type.  The course and clinical features of Alzheimer's disease (dementia of the Alzheimer's type) parallel those for dementia in general.  The early course is difficult because the Alzheimer's individual is usually a very poor informant and the early signs are so subtle that they may be unnoticed even by an individual’s closest associates or family members.  These early signs include impaired memory, difficulty with problem-solving, preoccupation with memories from the past, decreased spontaneity and an ability to respond to an individual's environment with the same speed and accuracy of processing information as previously. They may forget names, misplace things around the house and forget other things that they intend to do.  Sometimes these individuals have an awareness of where their memory is beginning to slip and indicate their concerns to family members.  Family members will frequently be dismissive stating "you're just getting older" and "I do that sometimes myself".  Many times, these dismissive reactions result in the individual becoming depressed which can exacerbate the memory deficit.  Anomia, or difficulty with word finding, can frequently be a problem for these individuals.  Eventually these individuals develop schemes, word associations, and excuses to assist in the retention or cover up their deficits.  Individuals may also utilize other family members as their surrogate memory.  An Alzheimer's diagnosis is dependent on various memory related factors. 

An Alzheimer's diagnosis also becomes more apparent when the individual has an obvious inability to remember newly acquired information, at which time they may try to avoid unfamiliar activities.  Frequently, individuals are seen by clinicians when a problem occurs such as increased confusion, aggression, wandering or some other socially undesirable behavior begins to occur.  Also, frequently at that time, disorders of perception and language may also appear.  An individual often turns to a spouse or other family member to answer questions for them as their surrogate memory.  By this time, the affected individual may have lost insight into their memory loss and maintaining attempts to compensate for their memory loss.  In the later stages of Alzheimer's disease, physical and cognitive effects increase significantly.  Disorders of gait, extremity paresis and paralysis, seizures, peripheral neuropathy, extrapyramidal signs, and urinary incontinence are seen and the individual is often no longer ambulatory.  The wandering that has been seen in the middle stages has usually been replaced by a new, bedridden state.  Myoclonus occasionally occurs, also, mood disturbances remain a distinct possibility throughout the course of the disease among individuals with an Alzheimer's diagnosis.  The disease process may progress at a slow pace for anywhere from 8 to 13 years to the state of complete helplessness. 

Alzheimer's diagnosis and laboratory testing: 

The role of laboratory testing in the determination of an Alzheimer's diagnosis is more related to the exclusion of other causes of dementia, especially those that may be reversible such as mood disorders and medical illnesses that may contribute to the state of confusion.  An Alzheimer's diagnosis is more a diagnosis of exclusion.  Frequently throughout the course of this disorder, laboratory tests are unable to determine anything abnormal.  Some relatively nonspecific changes may occur.  As Alzheimer's disease progresses however computed tomography (CT) and magnetic resonance imaging (MRI) may show atrophy in the cerebral cortex and hydrocephalus ex vacuo. An MRI may show nonspecific alterations in white matter (leukoariosis) and eventually EEG may show some changes. Pneumoencephalography has demonstrated enlarged ventricles and widening of cortical sulci in individuals with Alzheimer's disease, and positron emission tomography (PET) in later stages may show decreased cerebral oxygen and glucose metabolism in the frontal lobes. At the present time, in a work up of an individual to determine an Alzheimer's diagnosis, good family history, physical examination, and laboratory and radiographic tests to rule out other causes of dementia are the most effective tools.

Some information from DSM-IV-TR Mental Disorders Diagnosis, Etiology & Treatment

Additional Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)

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