Misdiagnosis of Alzheimer's Disease

A diagnosis of Alzheimer's disease may be delayed or missed because early symptoms develop gradually and are often associated with the normal aging process. In addition, symptoms of Alzheimer's disease can mimic symptoms of a variety of diseases, disorders or conditions. These include TIA, depression, vascular dementia, Creutzfeldt-Jacob disease, bovine spongiform encephalopathy, brain tumor, hydrocephalus, or advanced syphilis or AIDS.

Alzheimer's Disease misdiagnosis: Because AD is so well-known, it is sometimes an over-diagnosed condition. Other causes of dementia or memory loss symptoms may be overlooked. Other possible diagnoses include normal aging (if very mild symptoms), emotional problems (such as grief), fatigue, depression, and certain physical medical conditions such as thyroid disease, brain tumors, multi-infarct disease, or Huntington's disease. In its early stages, a correct diagnosis of AD can also be overlooked itself and misdiagnosed as other conditions such as depression, dementia, simple forgetfulness, or senility.

Alternative diagnoses list for Alzheimer's Disease

For a diagnosis of Alzheimer's Disease, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Alzheimer's Disease:

• Aging - some level of memory and concentration lapse is normal.
• Emotional problems
• Fatigue
• Grief
• Depression - Alzheimer's may be misdiagnosed as depression in its early stages.
• Dementia - and various underlying causes of dementia and causes of dementia symptoms
• Brain conditions
• Head injury
• Subdural hematoma
• Brain tumors
• Brain blood vessel disease
• Chronic hypothermia - may cause confusion or slowing down in elderly living with poor heating.
• Pneumonia - may cause confusion in the elderly.
• Vitamin B deficiency
• Illness
• Vision loss
• Hearing loss
• Alcoholism
• Drug interactions (type of Adverse reaction) - adverse effects of drug combinations can cause similar symptoms.
• Certain medications - some medications affect memory and personality.
• Thyroid problems
• Any other condition that may cause behavioral changes such as:
• High fever
• Lead poisoning
• Mercury poisoning
• Manganese poisoning
• Kidney disease
• Liver disease
• Other causes of dementia symptoms or behavioral changes
• Amnesic disorder
• Other causes of memory loss
• Other causes of dementia
• Pick's disease
• Lewy body disease
• Progressive supranuclear palsy
• Vascular dementia
• Creutzfeldt-Jakob disease
• Thyroid disease
• Vitamin B12 deficiency
• Normal pressure hydrocephalus
• Neurosyphilis
• Frontotemporal dementia
• Idiopathic Parkinson's disease
• Cortico-basal ganglionic degeneration
• Huntington's disease
• HIV infection with CNS involvement
• Cryptococcal infection with CNS involvement
• Hypothyroidism
• Panhypopituitarism
• High -dose glucocorticosteroid therapy
• Vitamin B1 deficiency
• Niacin deficiency
• Thiamine deficiency
• Wilson's disease
• Metachromatic leukodystrophy
• Adrenal leukodystrophy
• Acute cerebral vasculitis
• Metal toxicity (lead and mercury)
• Aniline dyes toxicity
• Uremia
• Liver failure
• Antihypertensive drug intoxication
• Benzodiazepine intoxication
• Atropine intoxication
• Barbiturate intoxication
• Opiate intoxication
• Anticholinergic drug intoxication
• Lithium intoxication
• Bromide intoxication
• Neuroleptic intoxication
• Antipsychotic intoxication
• Normal aging process
• Intracranial tumor
• Multiple sclerosis
• Chronic subdural hematoma (type of Subdural hematoma)
• Multi-infarct dementia
• Progressive subcortical gliosis

As you understand it is very important to make a correct diagnosis for the patient, or the treatment plan would be totally wrong, and may bring more harm that relief. Insist on performing multiple conclusive tests, seek for the second professional opinion, as wrongly diagnosed person might be in a real dangerous situation, since the original problem sources are not treated.

Failure to Diagnose Alzheimer's Disease

Failure to diagnose Alzheimer's Disease may be associated with the following:

• Currently, diagnosis of Alzheimer's is difficult due to the lack of conclusive tests. A diagnosis of true Alzheimer's usually can only be confirmed on autopsy
• Alzheimer's is often undiagnosed in the early stages due to inadequate testing methods. Early diagnosis allows timely treatment which can improve the prognosis

Notes on Hidden Causes of Alzheimer's Disease

The following may be hidden causes of Alzheimer's Disease:

• A family history of Alzheimer's disease and/or Downs syndrome increases the risk of developing Alzheimer's
• Risk factors for Alzheimer's are age, family history of Alzheimer's and a genetic predisposition
• Other risk factors for Alzheimer's are: serious head injury, heart and blood vessel damage due to conditions such as high blood pressure, heart disease, diabetes, high cholesterol and stroke
• Studies also indicate that people who generally maintain a healthy lifestyle into old age are less likely to develop dementia. A healthy lifestyle involves mental and physical exercise, healthy social relationships, avoiding smoking and excessive alcohol consumption
• Other possible risk factors includes chronic inflammatory conditions and a history of clinical depression
• A rare genetic mutation is linked directly to the development of Familial Alzheimer's disease rather than simply being a risk factor
• Down syndrome patients often develop Alzheimer's disease in old age

Notes on Wrong Diagnosis of Alzheimer's Disease

Wrong diagnosis of Alzheimer's Disease may be associated with the following:

• Diagnosis may be difficult when other neurodegenerative disorder co-exist such as Alzheimer's
• Dementia can occur in the later stages of Parkinson's disease in up to a quarter of patients. This makes the condition almost indistinguishable from Alzheimer's and hence a wrong diagnosis can result
• Creutzfeldt-Jakob disease is most commonly misdiagnosed as Alzheimer's disease due to the similarity of symptoms. The misdiagnosis may not be discovered until autopsy. This is a serious concern as the number of people with CJD being diagnosed with Alzheimer's is unknown but may be larger than expected. Common symptoms includes memory loss, behavioral changes and uncoordinated movements
• Experts increasingly believe that a significant number of people suffering from advanced normal pressure hydrocephalus are being misdiagnosed as having Alzheimer's disease. Symptoms such as memory loss and movement problems are common to both disorders. This misdiagnosis is important in the fact that normal pressure hydrocephalus is usually completely treatable. Lack of treatment leads to continuing deterioration
• Because of the difficulty in accurately diagnosing Alzheimer's disease it is important for patients to be continually monitored even after they have been diagnosed with Alzheimer's disease as the progression of symptoms may point to a misdiagnosis or may further confirm and an Alzheimer's diagnosis
• Alzheimer's is frequently misdiagnosed as its main symptom, dementia, is common to a number of disorders, some of which are completely treatable
• Frontotemporal dementia is another dementia disorder which has clinical symptoms so similar to Alzheimer's that even dementia experts may have difficulty distinguishing the two conditions. Alzheimer's drugs can make frontotemporal dementia symptoms worse
• Multi-infarct dementia also has similar symptoms to Alzheimer's and may be misdiagnosed. These symptoms include confusion, memory loss, incontinence and behavioral changes. Often only a brain biopsy is able to distinguish between the two. Diagnosis may be further complicated in patients who have both conditions
• A degenerative brain disease called Huntington's disease may be misdiagnosed as Alzheimer's but a genetic test can conclusively diagnose or eliminate Huntington's disease. Symptoms that may be common to both includes involuntary movements, personality changes, depression, memory loss and reduced ability to make decisions
• Pick's disease may be misdiagnosed as Alzheimer's disease due to the similarity of symptoms - personality changes, confusion, memory loss, and language and movement problems. A diagnosis can only be confirmed by an autopsy.
• Lewy Body Dementia may also be misdiagnosed as Alzheimer's with common symptoms being confusion, language problems, memory loss and eventually movement problems
• Nutritional deficiencies which result in dementia symptoms may be misdiagnosed as Alzheimer's disease. This is particularly disconcerting as nutritional deficiencies are readily treatable. For example thiamine deficiency (Wernicke-Korsakoff syndrome), vitamin B12 and B1 deficiency (due to alcohol abuse, chemotherapy or eating disorders) may cause symptoms such as confusion and memory problems which may be mistaken for Alzheimer's
• Thyroid problems, certain infection and certain drugs may cause dementia symptoms which can lead to a wrong diagnosis of Alzheimer's. Again, this is particularly worrisome as these conditions are readily treatable
• Brain tumors may also produce dementia symptoms which may be wrongly diagnosed as Alzheimer's. A CT or MRI scan can differentiate between the conditions

Complications of Misdiagnosis of Alzheimer's Disease

The following may be complications of misdiagnosis of Alzheimer's Disease:

• Mental impairment that occurs in the elderly is often overlooked as a symptom of Alzheimer's and is simply attributed to the normal processes of aging. This view is often held by health professionals as well as patients. They tend to ignore or dismiss the early symptoms of Alzheimer's
• Depression in older people may be misdiagnosed as Alzheimer's disease due to common symptoms such as memory and thinking problems, personality changes and reduced attentiveness. The risk of misdiagnosis is increased by the fact that often Alzheimer's patients also have depression

Other Notes on Misdiagnosis of Alzheimer's Disease

• An accurate diagnosis of true Alzheimer's is vital as symptoms in Alzheimer patients due to other causes may be reversible
• Due to the range and variation in the possible causes of Alzheimer's-like symptoms, it is important that a full medical history is done on patients in order to avoid a wrong diagnosis

Source: http://www.wrongdiagnosis.com/a/alzheimers_disease/misdiag.htm

Medical History, Physical exams, and Lab Tests in Alzheimer’s Disease Diagnostics

Alzheimer's disease is diagnosed with a medical history and a physical exam. A physical exam is used to help find out if a physical problem may be causing a person's dementia symptoms. It may be possible to correct some of these problems. For example, sometimes a simple hearing or vision problem can cause confusion, social withdrawal, or a change in behavior, such as hostility or unresponsiveness. The person may have an undiagnosed illness or infection that is causing the symptoms.

Personal medical history

The physician will need the following:

- A detailed description of changes in mental abilities, personality, mood, and behavior, including when and how the changes began and how they have affected the individual's ability to function. Letters, checkbooks, household lists, or other materials that illustrate changes in cognition may also be helpful.
- Information about physical complaints or symptoms, such as loss of coordination, sudden vision problems, or weakness.
- A complete medical history, including injuries and recent illnesses.
- A list of medications the patient is taking, including nonprescription drugs and herbal supplements.
- Information about the medical problems of family members, especially relatives with a similar illness.
- This may seem like a lot of information, but the person's history provides the foundation for the doctor's diagnostic workup. It enables the physician to construct a list of possible diagnoses that will guide the medical evaluation that follows.

Physical examination

Disorders as diverse as heart failure, liver disease, kidney failure, thyroid disorders, and respiratory diseases can cause dementia-like changes. What's more, elderly people don't always have typical symptoms of an illness. The sensation of pain is often dulled in the older person, for example, and it's not unusual for confusion, rather than chest pain, to be the main symptom of a heart attack.

Therefore, the physician will evaluate the cardiovascular system, lungs, and other organs for any signs of abnormalities. Because sensory losses can add significantly to a person's cognitive difficulties, the doctor will also test the individual's vision and hearing. The physician will also pay close attention to the nervous system, because neurologic abnormalities may signal a brain disorder other than Alzheimer's disease.

Muscle tone and strength, coordination, reflexes, senses, eye movement, and the pupils' reaction to light can tell the physician about the health of specific areas of the brain. For example, unequal reflexes or weakness on one side of the body suggests localized brain damage (perhaps from stroke or tumor), while tremors or other involuntary movements may indicate a degenerative disorder such as Parkinson's disease. These types of abnormalities are not usually features of early Alzheimer's disease.

Summarizing, the following tests should be included in the physician’s examination:

- Vital signs (temperature, blood pressure, pulse)
- Height and weight
- Skin
- Head, eyes, ears, nose
- Throat/neck
- Chest, including lungs and heart
- Breasts
- Abdomen
- Bones and muscles
- Nerves
- Rectal/genital area

Lab tests

A small number of people with dementia have a condition that proper treatment can reverse (unlike Alzheimer's disease). Lab tests may be done to rule out other possible causes of a person's symptoms, such as levels of certain minerals or chemicals in the blood that are too high or too low, liver disease, abnormal thyroid levels, or nutritional problems, such as folate or vitamin B12 deficiencies. Treatment for these conditions may slow or reverse mental decline.

Blood tests often done to check for these conditions include:

- Complete blood count (CBC), which shows the kinds and number of cells in your blood to help your doctor evaluate your symptoms.
- Liver function tests (AST, ALT, alkaline phosphatase, bilirubin), which detect liver damage or disease.
- Folate (folic acid) test, which detects the level of the B vitamin folic acid either inplasma (the liquid part of blood) or in the red blood cells. Folic acid is needed for the production of both red and white blood cells.
- Vitamin B12 concentration, which detects the level of vitamin B12 in your blood. Vitamin B12 is needed to produce red blood cells and to maintain a healthy nervous system.
- Electrolyte and blood glucose levels (sodium, potassium, creatinine, glucose,calcium), which are needed to keep the body's balance of fluids at the proper level and to maintain normal functions, such as heart rhythm, muscle contraction, and brain function.
- Thyroid function tests. Abnormal thyroid hormone levels are a common cause of forgetfulness, confusion, lethargy, and other symptoms of dementia in older people. Medicine can easily improve symptoms if a thyroid problem is present.
- Human immunodeficiency virus (HIV) infection test, if the person has risk factors for HIV or the medical history suggests it. Untreated HIV can cause symptoms such as personality changes or problems concentrating.


Sources and Additional Information:
http://www.webmd.com/alzheimers/tc/alzheimers-disease-exams-and-tests
http://alzheimers.about.com/od/diagnosisofalzheimers/a/diagnosis.htm
http://www.aarp.org/health/conditions/articles/harvard__a-guide-to-alzheimer-s-disease_7.html
http://www.cchs.net/health/health-info/docs/2300/2346.asp?index=9176