Alzheimer's Answers: Diagnosing Alzheimer's Disease

Transcript 5/11/01
Alzheimer’s Answers: Diagnosing Alzheimer’s Disease: Tests, Procedures and Issues
With Dr. Scott Small, Taub Institute at Columbia University

Chat Room Disclaimer

This Chat Room provides general information that is for educational purposes only and should not be considered as offering medical advice. The information that is made available by this Chat Room should not be used for diagnosing or treating a medical or other health condition. Viewers and participants should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition. ElderCare Online and the hosts MAKE NO WARRANTIES, EXPRESS OR IMPLIED, AS TO THE VALUE, USEFULNESS, COMPLETENESS OR ACCURACY OF ANY OF THE INFORMATION THAT IS MADE AVAILABLE BY THIS CHAT ROOM.

>> DebbieKay789 has joined channel #XC.1993632

RichOBoyleMODERATOR> hello Debbie Kay and welcome

RichOBoyleMODERATOR> we are both here early

[DebbieKay789] Type HERE...yes, I see - I keep checking in to see if anyone is here yet

>> Drscottsmall has joined channel #XC.1993632

[Drscottsmall] Hello

RichOBoyleMODERATOR> Welcome! :)

RichOBoyleMODERATOR> Debbie, you are welcome to ask the first question

>> Momasr has joined channel #XC.1993632

[DebbieKay789] How do you now test for Alzheimer’s while a person is still living?

RichOBoyleMODERATOR> hello momasr and welcome.

RichOBoyleMODERATOR> we have just gotten started

[Drscottsmall] By a physician performing a good medical history and exam, and usually by ordering some blood tests and imaging studies to rule out other causes of dementia

[DebbieKay789] My Dad has had a stroke in the left frontal lobe of the brain and has since been diagnosed with Alzheimer’s Type Dementia - will these tests determine if the dementia is a result of the stroke or a result of Alzheimer’s?

>> anderson8647 has joined channel #XC.1993632

RichOBoyleMODERATOR> what type of blood tests are conducted?

RichOBoyleMODERATOR> hello anderson and welcome

RichOBoyleMODERATOR> we just got started so, I will call on each of you in order to ask questions

[Drscottsmall] Distinguishing between 'vascular' dementia and Alzheimer's Disease is best accomplished by history and exam...

[Drscottsmall] Blood tests: vitamin levels such as B12, hormone levels such as thyroid

RichOBoyleMODERATOR> what procedures and strategies one would use to distinguish between dementia, delirium and depression?

>> carolspring3 has joined channel #XC.1993632

[carolspring3] hello

RichOBoyleMODERATOR> hello carolspring and welcome... please hold your question until I call on you

[Drscottsmall] Dementia is a slow process that affects memory, delirium is a fast process that affects attention

>> ronphil has joined channel #XC.1993632

RichOBoyleMODERATOR> hello ronphil and welcome... please hold your question until I call on you

[Momasr] My Dad was diagnosed with AD at 56 (he's now 60).  The more I read about Picks Disease, the more it seems to fit.  How can you tell the difference?

[Drscottsmall] Pick’s disease affects a different part of the brain compared to AD. Picks disease is more likely to target the frontal lobes, as such it usually presents with changes in personality and mood prior to memory per se

[Momasr] The doctors said the scans showed atrophy in the frontal lobe. Also, we thought he was going thru a midlife crisis - major personality changes.  Should we repeat the scans?

[Drscottsmall] I would consider a different type of scan... a functional scan, such as SPECT or PET

>> krazy_kat35 has joined channel #XC.1993632

RichOBoyleMODERATOR> Dr. Small, would you please explain/describe these tests

RichOBoyleMODERATOR> hello krazy kat and welcome... please hold your

- question until I contact you :)

>> weberch has joined channel #XC.1993632

[Momasr] That was what I was thinking too.  He has little memory loss, but much speech difficulty and confusion.

[Drscottsmall] MRI and CT scan evaluate the structure of anatomy of the brain. SPECT and PET scans evaluate the function or activity levels of the brain

RichOBoyleMODERATOR> hello weberch and welcome... please hold your question until I contact you

[carolspring3] Thank you, but I'm just listening and learning.

[krazy_kat35] me too

RichOBoyleMODERATOR> ok then I will post an advance question

[Momasr] What is the life expectancy of Picks vs. AD?

[Drscottsmall] Tough question. Statistical averages have been generated and they stand at around 10 years. It is important to understand, however, that this may vary from 1-20 years. Every individual is just that

[Momasr] Thank You

RichOBoyleMODERATOR> who is the best specialty of physician to diagnose AD? How does one find a specialist?

[Drscottsmall] Dementia specialists are typically a neurologist or a psychiatrist with sub-specialty in Neurobehavior. The Alzheimer's Association is a good place to start

RichOBoyleMODERATOR> would anyone like to post their question?

[krazy_kat35] Is there any medicine for a person who has had dementia for several years?

[Drscottsmall] I'm not sure, but most academic centers have at least 1 such specialist. At Columbia we have around 6 such specialists.

[Momasr] The Alzheimer’s Association has recommended my Dad to see a speech therapist who specialized in AD.  Do you think that would be helpful?

[DebbieKay789] Is there any evidence that an AD patient really understands more than we think but they have just lost the ability to communicate with the right words?

[krazy_kat35] Dementia runs in my family or it seems to and I was wondering how soon should someone be tested and what can be given for it?

[anderson8647] My father passed away about a year and a half ago.  Since then my mother (age 81) have developed difficulties speaking.   She has had a complete medical, psychological and neurological workup.  Her neurologist has diagnosed aphasia and wants to start her on Aricept

[Drscottsmall] There are two medication that have been approved by the FDA for AD. They are both act by increasing a neurotransmitter level in the brain. Their commercial names are Aricept and Exelon... vitamin E can also be considered

RichOBoyleMODERATOR> ok lets give Dr. Small a chance to answer these questions :)

Drscottsmall] Speech therapy can help

[anderson8647] The speech therapist was no help. She said she didn't know how to help my mother.

[Drscottsmall] There are different types of Language deficits which are called Aphasias. Some forms of aphasia are characterized by deficits in producing speech but the person still has normal comprehension

[Drscottsmall] A distinction is made between Familial AD and Sporadic AD. If a physician thinks that your family has familiar AD some genetic testing is available

RichOBoyleMODERATOR> what does that genetic testing entail?

[Drscottsmall] If aphasia is caused by AD that Aricept is reasonable to consider

[Momasr] What dosage of Vitamin E do you recommend?

RichOBoyleMODERATOR> Can the doctor diagnose AD and it really be Parkinson';s Disease? (and vice versa)

[Drscottsmall] Dosages of vitamin E used in studies were very high, 2000 IU a day. At these doses vitamins are like medications, namely, they can cause harmful side effects. I would recommend consulting with a doctor.

RichOBoyleMODERATOR> The information that is made available by this Chat Room should not be used for diagnosing or treating a medical or other health condition. Viewers and participants should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition.

[anderson8647] That is the question.  The doctor has never said she has AD.  He said it might be early AD or primary frontal temporal dementia or primary aphasia.  Are there some other tests he should have done so he could definitely make an AD diagnosis?  If so what are they?

[Drscottsmall] Parkinson’s disease can cause cognitive decline and even dementia. A dementia specialist can usually dissociate AD from PD based on history and exam

[krazy_kat35] At what age should someone go to a doctor to see about getting

- tested?

[DebbieKay789] I read an article about using Risperdal with Paxil in that you should not use the 2 together - what are your thoughts on this?

RichOBoyleMODERATOR> OK let's let Dr. Small catch up :)

[Drscottsmall] The diagnosis of definite AD can only be made by looking at brain tissue under the microscope. During life, sometimes a functional imaging study (see above) can help

[anderson8647] If my mother has primary aphasia (not AD) in your experience would Aricept still be useful?

[Drscottsmall] In principle AD can present during anytime during an adults life

[Drscottsmall] Aricept MIGHT still be useful

[Momasr] Regarding genetics, my brother and I are concerned about our chances because my Dad is so young. He has 9 siblings and no one else in his family has been diagnosed with dementia. How do we know if we should get tested? (I am 31, he is 27)

[anderson8647] If we pay for these functional imaging studies and they show a problem in the speech area.  Can anything be done at that point?

[Drscottsmall] This question should be addressed to the dementia specialist who diagnosed your father.

RichOBoyleMODERATOR> How can you really tell if someone is also depressed when they have trouble communicating with you because they also have AD? And then what can you do about it?

[Drscottsmall] Good question. There are two reasons for ordering tests. One is establish a diagnosis with greater certainty. A second is to allow us to guide treatment. In this question the test will more likely address the former type of question

[Drscottsmall] A dementia specialist can usually distinguish between cognitive decline and mood decline (depression).

[Drscottsmall] Also... keep in mind that we have very effective treatment for depression available. It should be diagnoses and treated.

RichOBoyleMODERATOR> how does one get over a person's resistance to go to the doctor?

[Drscottsmall] In my experience patients are reluctant to seek medical attention if there is a sense of futility... namely, if someone is concerned about dementia they might feel that seeing a doctor will have no benefit. A number of things should be emphasized: First, there are causes of dementia that we can potentially treat. Second, even AD is now becoming an entity that we can treat. Hopefully, in the near future we will have even better medications

RichOBoyleMODERATOR> how long does it take to do the "standard workup" for dementia? I have heard that it can be up to two days of tests?

[anderson8647] what tests would you perform to determine if my mother's aphasia is due to AD?

[Drscottsmall] A doctor’s exam usually takes 1-2 hours. Blood tests take a few minutes to draw and few days to come back. Imaging studies take around 1 hour. Neuropsychological testing can take a few hours.

RichOBoyleMODERATOR> so the complete workup can take the better part of a day?

[Drscottsmall] The diagnosis of AD typically requires that someone has deficits in multiple cognitive domains. Language is one. I would try to determine whether you mother had deficits in other cognitive domains, such as memory, abstract reasoning, or spatial ability. A neuropsychological test might help

[Drscottsmall] Yes

RichOBoyleMODERATOR> what are the "cognitive domains?"

[anderson8647] She had neuropsychological testing and it was normal, in fact she was better than some people much younger than her

RichOBoyleMODERATOR> are there any additional questions before we finish up? Now is your chance !

[Drscottsmall] Our higher mental faculties are called cognition. Cognition is subdivided, somewhat arbitrarily, into different domains… the common domains are memory, language, abstract reasoning, visuospatial ability, etc.

[anderson8647] What are the side effects of Aricecpt?  Would it be appropriate for someone who is taking heart medications to control rhythm?

Drscottsmall] Yes. The list is long. I would recommend consulting individual doctors

RichOBoyleMODERATOR> I will post the final question:

RichOBoyleMODERATOR> please tell us about the brain donation program at Taub... how can families help researchers to unravel the mysteries of AD?

[Drscottsmall] As I mentioned earlier, the only way to be certain of the diagnosis of AD and other related disorders is by looking at the brain under the microscope. For this reason brain donation is very crucial part of our attempts to understand the mechanisms of AD. If anyone has questions about the Brain Donation Program at Columbia, please contact 212 305-9086 and ask for Arlene

[anderson8647] Dr. Small, Thank you for your time and help!!

RichOBoyleMODERATOR> Dr. Small thank you for your time and efforts, this has been very informative

[DebbieKay789] Thank you

RichOBoyleMODERATOR> and thank you to all of our participanbts

[Drscottsmall] You're welcome

Chat Room Disclaimer

This Chat Room provides general information that is for educational purposes only and should not be considered as offering medical advice. The information that is made available by this Chat Room should not be used for diagnosing or treating a medical or other health condition. Viewers and participants should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition. ElderCare Online and the hosts MAKE NO WARRANTIES, EXPRESS OR IMPLIED, AS TO THE VALUE, USEFULNESS, COMPLETENESS OR ACCURACY OF ANY OF THE INFORMATION THAT IS MADE AVAILABLE BY THIS CHAT ROOM.

----END---

 

2001 Prism Innovations, Inc. All Rights Reserved.