September 21 is World Alzheimer's Day 2009

This year's theme, Diagnosing Dementia: See It Sooner, promotes the early detection of Alzheimer's disease. In this issue of Choices, learn about promising research for earlier diagnosis of the disease, which might also indicate whether family members are themselves at risk.

During the earliest stages of Alzheimer's disease, patients and family often wonder: is it really Alzheimer's? Or perhaps just the normal memory changes of aging? Could symptoms be caused by depression, overmedication or some other treatable condition? Even the person's physician may be unsure.

During a patient's lifetime, Alzheimer's disease is most commonly diagnosed through physical and neurological assessments, and tests to rule out other conditions. But at present, the only way to definitively diagnose the disease is after the patient passes away, when an autopsy confirms the presence of brain lesions called amyloid plaques.

At the recent International Conference on Alzheimer's Disease in Vienna, reports were presented on a host of studies on Alzheimer's disease which are underway around the world. Current research offers hope of improved methods of diagnosing—and even predicting—the disease. Here are three promising research areas:

Substances found in spinal fluid can accurately confirm or rule out Alzheimer's. The U.S. National Institute on Aging (NIA) recently reported that scientists are now able to measure the levels of two substances, called tau and beta-amyloid proteins, which signal the presence of the disease. According to Richard J. Hodes, M.D, Director of the Institute, "Research indicates that Alzheimer's pathology causes changes in the brain some 10 to 20 years before any symptoms appear." The new tests detect these changes.

New MRI techniques identify brain changes caused by Alzheimer's disease. Brain scans using imaging methods such as magnetic resonance imaging (MRI) and positron emission tomography (PET) have historically been used largely to rule out other conditions, such as tumors or damage caused by stroke. But new, more sophisticated imaging techniques may help diagnose Alzheimer's during the early stages—even before symptoms are noticeable.

Genetic tests provide information about a person's risk of developing Alzheimer's disease. Though experts still have much to learn about the role of heredity in Alzheimer's, genetic links tied to the two major forms of the disease have been discovered.

Early-onset. Researchers found that certain genetic mutations increase the risk for developing the more rare early-onset form of the disease, which occurs in people ages 30 to 60.

Late-onset. For the more common late-onset Alzheimer's disease, a certain gene (APOE-e4, found on chromosome 19) statistically increases one's risk of developing the condition.

These tests do not predict whether an individual will develop the disease; research is underway to examine how lifestyle and environmental variables interact with genetic factors.

The Advantages of Early Diagnosis

When Alzheimer's disease is suspected, early diagnosis has several advantages for patient and family:

• Other conditions can be ruled out. Depression, thyroid disease, overmedication, delirium and other often treatable conditions are sometimes mistaken for Alzheimer's.
  
  
• Earlier diagnosis will permit faster, targeted treatment of symptoms. Many currently used medications have little effect if not begun early. According to the Alzheimer's Association, "Early detection of Alzheimer's disease and early intervention with improved therapies provides the greatest opportunity to delay or stop additional damage to the brain."
  
  
• Patient and family can begin planning for changes in the person's condition. Appropriate living arrangements and legal preparations allow the patient to have the best possible quality of life as the disease progresses.

For Relatives: To Test or Not to Test?

A note about "direct-to-consumer" tests: Mail order tests for the APOE-e4 gene are currently being marketed, but the Alzheimer's Association cautions, "Home screening tests should not be used as a substitute for thorough examination by a skilled doctor." Testing should only be done as part of genetic counseling, and people who wish to be tested should work with a reputable healthcare provider.

Some genetic tests are already available, and younger family members whose loved one has developed Alzheimer's disease are discussing whether to undergo genetic testing themselves. As with other disorders with a genetic connection, deciding to be tested is an individual choice to be made with the advice of a person's healthcare provider.

For personal reasons, some people prefer not to know whether they are at higher risk. But many others opt for genetic testing as part of planning for the future. Knowing one is at higher risk for Alzheimer's disease can provide motivation to make lifestyle changes right away that promote brain health. These include good nutrition, exercise, avoiding smoking, and taking other steps to reduce the risk of heart disease, diabetes and hypertension, all implicated in hastening the development of Alzheimer's.

Relatives may take heart from the results of a recent study from University of Michigan that demonstrated that most people who learned they were genetically predisposed to Alzheimer's did not suffer from long-term depression or undue anxiety about their chances of developing the disease.

Whatever their choice, people diagnosed with Alzheimer's disease and family members who worry about themselves developing the disease should know that scientists are working hard to unravel the mysteries of Alzheimer's. The goal is to develop better treatment—and eventually a cure—for this devastating disease. When it comes to Alzheimer's disease, knowledge is indeed power.

Read More

The Canada Alzheimer’s Association offers information and updates about the treatment and diagnosis of the disease, including the Safely Home Registry.

Public Health Agency of Canada’s Aging and Seniors features the online brochure "What Should I Know About Alzheimer's?" 

For ongoing information on Alzheimer's research and updates about newer diagnostic tests, visit the website of the U.S. Alzheimer's Disease Education and Referral Center (ADEAR). ADEAR has recently released a new free booklet, Can Alzheimer's Disease Be Prevented?, which includes information about genetic risk factors. Also see the free booklet Alzheimer's Disease: Unraveling the Mystery, which describes some of the new findings.

Just for Fun...

Give Your Brain a Workout! Try your hand at this month’s puzzle, the "Take Care of Your Brain" wordfind, which contains 20 hidden words all having to do with protecting our brain and memory. Click here to download and print your own copy! And if you missed the February 2009 issue of Choices, see how much you know about brain health by taking the "Test Your Brain Health IQ" quiz.