Neurology’s Role in Alzheimer’s Disease: DIAGNOSIS
Since we are still unable to completely make an Alzheimer’s diagnosis without an autopsy, we need ways to make the most accurate assessment with the tools currently available. and it’s the job of the Neurologist to appropriately pre-diagnose Alzheimer’s Dementia. Yet, so often the general physician feels compelled to take this on. And most recently, we are seeing dental healthcare workers getting involved in early diagnosis as well. Our best recommendation: talk to the healthcare professional you trust most, and ask them to refer you to a neurologist who is highly adept at not only making the most accurate diagnosis, but what you can do next to slow this disease down. This article discusses the different testing methods that you will likely encounter once you start having questions yourself on changes in your ability to remember, process simple tasks or handle matters that came easy not too long ago.
The Different Types of Testing to Consider
The Montreal Cognitive Assessment Test – MoCA
Quick Testing: The MoCA
This test is a common method for diagnosing Alzheimer’s Disease that tests your ability to do a number of tasks that each of us takes for granted. But as the brain function becomes impaired, ordinary tasks become difficult – and we quickly learn to compensate so as not to have the deficiencies interrupt our daily lives. Still, these are critical functions to successfully caring for ourselves. Which is why the MoCA test is a helpful clue to an astute clinician that signals something is wrong. Low scores can actually signal other underlying brain or psychological issues, which is why this test should not be delivered by a general practitioner, but instead by a specialist who fully understands how the brain works.
Neuropsychological Testing
Your doctor may ask you to undergo more advanced testing to determine the extent and possible origin of your cognitive decline. And in early – mid stage dementia, this form of testing could uncover a medical explanation for the declines. But as these tests are long and very involved, if your loved one’s dementia is advanced, this test will only serve to frustrate him/her with little gain to the patient’s prognosis. So be sure to discuss the pro’s and con’s of this form of testing for Alzheimer’s Dementia with your healthcare professional.
Balance Testing
This is done in the clinic and is based on observation. If a doctor asks you to walk forward and backward a few times, they are looking to determine if you are experiencing symptoms with your gait.
1) Apraxia, is a condition where the cerebral hemisphere is affected, and the signals to perform a directed movement is interrupted, making it hard to fluidly move your legs as you once could. This gate is stiff and clumsy. This diagnosable condition is highly associated with early stage Alzheimer’s Dementia. Very early in the course of apraxic walking in Alzheimer’s Dementia, a cane or a walker can help. It is not uncommon to see a person go from a slow, cautious gait, to a normal walking pattern simply by taking up a cane.
2) Ataxia, on the other hand, is a condition associated with later stage Alzheimer’s when the cerebellum (the balance portion of the brain) becomes affected, and the signals that help you maintain balance is interrupted, which increases a person’s fall risk. An ataxic gait is characterized by imbalance, and abnormal, uncoordinated movements. Typically the individual can stand, but is very unsteady, taking small irregular steps as they struggle with depth perception when it first appears. A Neurologist is very adept at viewing one’s gate and determining what might be going on.
Laboratory Testing
Lab testing can help determine whether you have the proteins associated with Alzheimer’s in your blood and in our spinal fluid, whether you are experiencing one of the hallmark symptoms of this disease (swelling/inflammation), if you are exhibiting issues with balance that often accompany Alzheimer’s or if you have a genetic risk or predisposition for this condition.
PROTEIN ANALYSIS: BETA-AMYLOID TESTING (can be done with blood or CSF): In diagnosing Alzheimer’s Disease, it is now possible to detect Beta-Amyloid proteins in the CSF fluid. This is a very invasive testing method that comes with certain risks. Identifying Amyloid protein in the CSF indicates that there is an active infection in the brain. Whether it’s due to P. Gingivalis or another organism cannot be determined, but it is a new tool that can help rule out infection as well.
INFLAMMATORY TESTING (is done with blood): As Alzheimer’s is a disease of inflammation, it would be wise to check these two markers to see if (and how much) inflammation you may have: 1) CRP – C-reactive protein – this simple test can be done at little expense. It is an inflammation marker that signals to the clinician that somewhere in the body or brain, an inflammatory process is underway. 2) ESR – erythrocyte sedimentation rate – this is another simple test that can be done at little expense. It is also an inflammation marker that signals that somewhere in the body or brain, an inflammatory process is underway. Different from the CRP, this test is more sensitive and real time. Taken together, an elevated CRP and ESR signals there is something causing inflammation that needs to be addressed now.
GENETIC TESTING (is done with blood): APOE 4 / APOE 3 TESTING can determine whether you have the genes that have been linked to Alzheimer’s susceptibility. This test costs $125.00 to perform and is not often covered by insurance.
