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
Showing posts with label medical history. Show all posts
Showing posts with label medical history. Show all posts
Friday, December 11, 2009
Wednesday, September 16, 2009
Early Testing for Alzheimer's Disease
One of the most important aspects of dealing with Alzheimer’s is early detection. Early diagnosis of Alzheimer’s has many advantages to the victim and their families, allowing for opportunities to deal with the physical, mental and emotional effects of Alzheimer’s disease. With Alzheimer’s, knowledge is power. Knowing and recognizing the symptoms of Alzheimer’s is the most effective way to deal with experiences of memory loss, behavioral shifts, confusion and other symptoms when they happen. When Alzheimer symptoms become identifiable, they are less frightening for family and friends. Once accepting of Alzheimer’s, early diagnosis allows patients and family to build the best medical team for their case, and also makes available current and experimental drugs and treatments for Alzheimer’s disease.
Alzheimer's disease is diagnosed after other conditions are ruled out. If you are suffering from a decline in mental abilities (dementia), your doctor will attempt to find out if another treatable condition may be causing those symptoms.
- It is very important to rule out delirium as a possible cause of symptoms, especially if the symptoms came on suddenly rather than gradually. Delirium may require emergency medical attention.
- Symptoms of confusion and memory loss can sometimes be caused by depression. Depression is very common among older adults, but it is sometimes difficult to recognize. It may be successfully managed with medicine and counseling.
Upon appearance of symptoms of Alzheimer’s, one must find a doctor that the patient and family feel comfortable with. While there are no specialists in Alzheimer’s, The American Alzheimer Association can help with finding doctors who are knowledgeable and comfortable with the Alzheimer’s disease. These doctors might also refer patients to neurologist, psychiatrists or psychologists who specialize in mental function and can quickly detect and diagnose Alzheimer’s.
There is no single test that proves someone has Alzheimer’s. Rather, the medical workup for Alzheimer’s is designed to evaluate overall health conditions and identify mental problems.
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.
Estimates show that a regular physician can diagnose Alzheimer’s with 90 percent accuracy, and even if they can only divulge it as dementia, a brain specialist can certainly identify Alzheimer’s. Be prepared to tell your doctor when Alzheimer’s symptoms started, how often and how severe they are, as this will help determine the stage of Alzheimer development. Interviews with family members are standard when diagnosing Alzheimer’s disease and medical history of relatives will be thoroughly examined.
Also, complete physicals and diagnostic tests are very common in order to identify if other disorders are causing Alzheimer symptoms. Brain imaging has also revolutionized the way doctors can look at and map the brain. Typical Alzheimer’s work-ups involve magnetic resonance imaging (MRI) and sometimes computed tomography (CT). Also, positron emission tomography (PET) and function MRI maybe employed in order to reveal how brain cells in various regions are working through their use of sugar or oxygen.
- Magnetic resonance imaging (MRI). An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into the tube-shaped MRI machine, which makes loud banging noises during scans. The entire procedure can take an hour or more. MRIs are painless, but some people feel claustrophobic in the machine.
- Computerized tomography (CT). For a CT scan, you 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, or slices, of your brain. The test is painless and takes about 20 minutes.
- Positron emission tomography (PET). During a PET scan, you'll be injected with a low-level radioactive material, which binds to chemicals that travel to the brain. You lie on a table while an overhead scanner tracks the radioactive material. This helps show which parts of your brain aren't functioning properly. The test is painless and can be particularly useful in distinguishing between different types of dementia.
Note that some 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.
When assessing mental function and Alzheimer’s risk, often doctors will recommend the mini-mental state exam (MMSE) which tests the patients’ range of everyday mental skills. Sample questions include but are not limited to:
- Remember and repeat a few minutes later the names of three common objects.
- State the year, season, day of the week and date
- Count backward from 100 by 7s or spell “world” backwards
The maximum MMSE score is 30 points. A score of 20 - 24 suggests mild dementia, 13 - 20 suggests moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer’s disease declines about 2 - 4 points each year.
Another Alzheimer’s test used is the “mini-cog” which includes two tasks: 1) remembering and a few minutes later repeating the names of three common objects, and (2) drawing a face of a clock showing all 12 numbers in the right places and a time specified by the examiner. Both tests are good indicators of mental capacity and can reveal symptoms that might overlap with dementia and Alzheimer’s disease.
Sources and Additional Information:
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