Diagnosis of Alzheimer’s disease is normally done through a combination of efforts by multiple teams at Wright-Patterson’s medical center.
“Neuropsychological testing is really important as part of diagnosis, and for most the standard of practice is to also have some positive imaging for making a solid diagnosis,” Banning said.
Working as part of an overall diagnostic team, Banning pointed out that sometimes a referral will come to his office from Family Practice, and that he also works closely with the Neurology department.
“They’ll send up a referral, saying, ‘This person seems to be having memory problems.’ They may or may not have imaging [brain MRI, CT scan, PET scan, etc.] yet when they come up for neuropsychology testing.”
“However, sometimes the imaging is negative or the images don’t clearly indicate if there is anything going on, but neuropsychology testing is very sensitive to changes in the brain. Sometimes you can pick up on the subtleties of a person starting to have some difficulties,” Banning said.
In some cases, it’s the family that notices symptoms and sometimes it’s the person experiencing them who notices.
“They come in, do some imaging, they’re not too sure about it, and then they can come up and see us. If they don’t yet have a diagnosis, then at least we have good baseline data so that if anything comes along, we can compare them not to some population, but to themselves and say, ‘This is what you looked like a year ago,’ and we can track disease progression pretty well,” Banning said.
A primary symptom of the onset of Alzheimer’s is the memory problem that people typically have, he added.
“We want to parse that out between: ‘Is this normal decline? Unfortunately for all of us, our memory is not going to be what it was when we were in our 20s. We experience some cognitive problems as we get older, but Alzheimer’s is a different process, and there’s this hallmark symptom of memory loss,” Banning said.
People will start to notice if they’re not forming new memories, known as Anterograde memories.
“We can ask you, ‘Where did you go to high school?’ We’ll get a reply such as, ‘I went to such and such high school and I dated so and so,’ and they’ll give us the whole story, but if we ask them what did they had for dinner yesterday, they’ll say, ‘I have no idea.’”
Family members sometimes work with their loved ones suffering from dementia by creating things like helpful hints to help with short-term memory loss.
“I had a patient who played kind of a game with their spouse where they name things, for instance saying, ‘Well, we had something green for dinner yesterday,’ but even with hints, they couldn’t get it. For most people, as we get older, with a couple hints, we can usually get the information.”
Another symptom that can be noted early on in the disease’s progression is finding things such as language problems, specifically in speech production, finding the names of things, referred to as ‘confrontation naming.’
“So, when you show them a carrot and say, ‘What’s this called?’ and they say ‘It’s on the tip of my tongue and I know what it is and I recognize it, I can tell you about it, but I can’t think of the word – ‘carrot.’ They just can’t get there,” Banning said.
Part of it is the disease progression and how it affects the part of the brain called the hippocampus first as it kind of shrinks a little, he explained. The hippocampus is critical for learning and memory.
“Sometimes you can see that on imaging early on and notice that the hippocampus is smaller. It deals with memory and then the progression goes from your temporal lobe area and starts to spread up to the frontal lobe. The frontal lobe is where you find your executive functioning, your mental flexibility, your decision making.”
Banning cited an example of where someone once said, “You know, I’ve worked on cars for 25 years and I went out to change the oil the other day and I just got confused and couldn’t remember how to do it.”
“Or maybe they’re the one that always did the bills and the checkbook, and they’re like “I can’t really seem to figure this out today,” so they’re starting to have a couple of these lapses that are above and beyond the typical ‘I misplaced my keys’ or ‘I can’t remember that particular grandchild’s name’ kind of thing, but it’s now becoming things you would expect them to remember.”
Early diagnosis is key for a lot of reasons, according to Banning.
“Medications might slow the progression for some people, but it’s not going to grow new brain cells,” Banning said. “So, if you wait too long to get a diagnosis before the person is getting lost in the neighborhood and they’re really impaired, those medications aren’t going to do a lot for that person. If you can get the meds earlier and they do work for them, they may slow the progress and if they’re not too bad off, it may extend how they’re going to do for a while, but you have to weigh that out with your doctor.”
As November is National Alzheimer’s Disease Awareness Month and if you have a loved one who seems to be struggling with more than a basic case of forgetfulness, it might be a good time to schedule an appointment at the Wright-Patterson Medical Center for an evaluation.
Although Alzheimer’s has been known to be irreversible and fatal, medical professionals maintain hope that by advancing research and treatment options, these outcomes can be changed to allow for a brighter future for those battling the disease, Banning said.
For more information visit the Alzheimer's Association website, www.alz.org. If you suspect you or a family member are in need of a neuropsychological evaluation, contact your primary care provider for a referral.