Archive for the ‘diagnosis’ Category

Dye to Diagnose Alzheimers

Nov 14th, 11 / 1 Comment








Normally when it comes to diagnosing Alzheimers disease, it’s a question of ruling out a variety of other similar symptoms. My grandmother might very well have been suffering from depression for several years (she visited my grandfather every day and he was in a vegetative coma from strokes – enough to depress anybody) before the Alzheimer’s hit.

However, there is a new treatment entering the final stages of clinical approval that involves injecting dye (a chemical called Flutemetamol) into the body (through the arm – not the head) :-) and then scanning the head with a PET scan.

The dye locks onto the plaque causing Alzheimer’s and shows up as a red glow on the scan.

Diagnosis is pretty much a given when you can see concentrations of the plaque in forebrain areas. One issue as I understand it right now is the level of Alheimer’s and the level of “glow” is being studied to determine when the disease really hits. In other words, you may have a “glow” from the dye but not be exhibiting any symptoms. Will you then develop symptoms?

The expectation fron GE Healthcare is that if the trials continue to be successful, a commercial startup can be expected some time in 2012.

diagnosis

Alzheimers Treatment Research

Nov 7th, 11 / 0 Comments








The Journal of the Alzheimer’s Association has just published a study evaluating the behavior of 686 patients after they were diagnosed with Alzheimers and put on medications to slow down the effects of the disease.

Every patient in this Alzheimer’s treatment research was tested to begin and then tested twice a year to chart the progress of the disease. Researchers were trying to determine how fast the onset of the disease was and the effects of standard of care over a 4 year period.

Over 90% of patients used standard medications over the 4 years but each lost an average of 2.4 points per year on the Mini-Mental Status Examination and gained 4.5 points on the ADAS-cog tests. In other words, they lost the healthy memory points and gained the illness points.

7.4% of patients died during the 4 years whlie 13.4% were institutionalized.

But 17% did not experience a “major event” defined as functional disability or neuropsychiatric symptoms. In other words, 17% of those diagnosed and treated did not deteriorate significantly over the 4 years of the study.

This was considered surprising (it sure as heck surprised me) and treatment teams are going to have to take another look at the deterioration rates and prognosis for patients diagnosed with this disease.

The one thing that wasn’t clear from the journal was if there were any behaviors the 17% did that they other groups did not. In other words, could exercise, music, stimulation or ?? be a factor here? In my mind (and for my peace of mind) :-) I’d surely like to know about this aspect of Alzheimer’s treatment research

diagnosis, lifestyle, medications, research, symptoms

Eye Test for Alzheimers

Jun 7th, 10 / 0 Comments

The quick version of this Alzheimers test is that it’s research.

But given that individuals with Down’s Disease (virtually all) get Alzheimers then looking at their characteristics may help researchers with new treatments.

Turns out the amyloid protein associated with Alzheimers is also found in the eyes of Down’s disease patients.

It is therefore possible according to lead researcher Dr. Lee Goldstein of Boston University School of Medicine that a test could be devised to measure the level of protein in eyes and correlate it to the existence of the protein in the brain. (note that now, the only test is post-mortem dissection/evaluation).







diagnosis

Early Signs of Alzheimers

May 5th, 10 / 0 Comments








Some of the early signs of Alzheimers include the following points.

Please understand that some of these behaviors are quite normal in limited quantity. But, if you’re like me, you’re always wondering is this normal or is this a problem.This might give you a sense of being able to tell the difference.

Memory Loss

We all know this one as one of the primary stages of Alzheimer’s but we all forget names and appointments on occasion (don’t forget the better half’s birthday or anniversary – if you’re a guy – tattoo that one on the insides of your eyelids).

The difference is that the symptom of Alzheimer’s means we’re forgetting things we just learned. Not things we’ve known for some time.And the person is unable to remember that data because it’s simply lost.

Familiar Tasks

I don’t know about you but I do wander into a room and ask myself, ‘Why did I come down here?’ This is normal.You’re focussing on several items at the same time and you decide to do something but on the way there your brain is processing other information as well. You “forget” why you went into the room and then a few minutes later – you remember and feel pretty stupid about it.This is normal.

What isn’t normal is when you’re focussing on the task at hand and forget the steps involved in doing them.You forget how to dial a telephone or play a game.Those are things to worry about.

Language Problems

I write for a living and I wish I had a quarter for every time I’ve sat and stared the word processor saying: I know that word – where is it? I can’t remember the darn thing.This is normal.

What isn’t normal is when you forget a simple word or substitute an unusual word (or one that doesn’t quite make sense) into a written or spoken sentence so that sentence doesn’t quite make sense.Sometimes substituting phrases for the word in question (that describe the word) is also used so you wind up with extremely convoluted sentence structure.Mind you, if you’ve been doing this all your life (as a friend of mine has) then you shouldn’t worry.

Forgetting Time

It’s not uncommon for normal folks to be driving along and forget where we’re going.Or forget one stop in the sequence of shopping stops.It’s also not uncommon for normal folks to lose track of time in the day.

One of the early signs of Alzheimers though is getting lost in your neighborhood and not being able to find your way home. Patients forget their normal routes and how to return home.Getting lost is hard on both the individual and the family because it signals a serious level of problem. At the beginning of the disease, there are compensations a person can take – such as calling a cab – but as Alzheimer’s progresses, this kind of coping skill disappears as well.

Judgment Calls

This is a tough one to pin down.We all make decisions that, in hindsight, we wouldn’t do again. And we’ll keep on doing this because we’re human.

So this makes it a really tough call about an early sign of Alzheimers because there’s a line that gets crossed and it’s a hard one to identify.

Small decisions don’t make a lot of sense in individual circumstances.It’s not the big decisions that count here, it’s all the little ones – like wearing inappropriate clothes for the weather, cleaning out the house and giving things to strangers.

I had to remove the valuable jewelry from my mom’s cabinet when she started giving things away to other people out of the family.We did it by suggesting the grandchildren would like these pieces now rather than after she was dead.Mom liked that suggestion – I took the jewelry and she never missed or mentioned it all again.







diagnosis, symptoms

Signs of Alzheimers

May 5th, 10 / 0 Comments








When it comes to more distinct signs of Alzheimers Disease, the following scale may be of assistance.

Health care folks use this sliding scale in their decision making (it’s called the Global Deterioration Scale or Reisberg Scale.

This scale divides the progression into seven alzheimers stages.

Stage One

There is no cognitive decline – the patient has normal function and nobody knows the disease is working.

Stage Two

Very mild cognitive decline. The difficulty is understanding the severity of this sign of Alzheimers, deciding if it’s “normal” or whether it is Alzheimer’s.

Typical symptoms would include: memory lapses, forgetting familiar names and locations, normally found objects. Generally, the patient notices these things but othere do not. The difficulty is that it is a sliding scale. We all lose stuff – where’s the deciding line between normal and Alzheimers. At this point however, the patient is likely getting concerned.

Stage Three

This is where the family begins to see some cognitive decline and clear signs of Alzheimers. In some individuals, the disease can be diagnosed (but not in all patients at this early stage)

You’ll see mild forgetfulness, difficulty learning new things but still possible to do so, difficulty concentrating or a lowered attention span, some difficulty with geography and a tendency to get temporarily lost.

This Alzheimers stage produces the first communication difficulties with finding the right word and misplacing valuables. Problem solving tends to become more difficult and if working, this may become noticeable faster. Friends, co-workers and family know there is an issue now.

Stage Four

We enter the world of moderate cognitive decline and the ability to diagnose the early stage of Alzheimer’s Disease.

Typical signs of Alzheimers at this stage include the loss of memory of the patient’s personal history, an increasing inability to handle complex tasks such as finances or travel arrangements. Multi-stage tasks become increasingly difficult. Patients tend to have a decreased knowledge of current events. There will be a deterioration in complex mathematical abilities (such as backward counting in multiples or multiplying numbers together – things that require some thinking in symbols)

Stage Five

This is moderate to mid-stage Alzheimers disease and here the person starts to require help with day-to-day tasks.

Typical symptoms would include major gaps in memories, forgetting often-used telephone numbers or the names of close friends (or even family). A loss of awareness or remembering recent events in their lives is now very evident.

Stage Six

Moderately to Severe (mid-stage) Alzheimers and the signs of Alzheimers are becoming more severe.

Symptoms would include starting to forget the name of the primary caregiver of close family members (often temporarily). Recent events are forgotten fairly quickly (within a few minutes).

Some assistance may be needed with daily living and help get dressed or bathed may be in order. Greater difficulty counting or with any math processing is evident.

At this stage we start to see some very evident emotional changes such as anxiety or confusion. There may be agitation, anxiety, hostility or the exact reverse. This often comes a a great surprise to the family – to see a formerly loved, happy person become anxious and hostile.

There may be obsessive or repetitive behavior of simple activities and sleep problems will be reported. Incontinence rears its head.

Stage Seven

When it comes to a sign of Alzheimers, this coincides with severe or late-stages.

Symptoms include: increasingly severe cognitive decline and most complex thinking activities are lost. Vocabulary continues to shrink and disappears at this stage. The ability to walk independently and sit without support disappears. Assistance is needed with all activities of personal hygiene and the patient is usually incontinent.

Summary

These are the “typical” symptoms and progression. There is no one-size fits all here – each individual will be different and the movement between stages isn’t clear nor is it consistent. These signs of Alzheimers should be treated as guldeposts rather than a distinct road-map.

You do your best.







diagnosis, symptoms

Alzheimers Symptoms

May 5th, 10 / 0 Comments








Alzheimers symptoms generally fall into several areas but it is first important to understand that *everyone has occasional memory problems*

At least I do.

So it’s a fairly normal part of being alive to “forget” something (like birthdays but hopefully not anniversaries). And forgetting something doesn’t mean you have Alzheimer’s.

I look at it as being in the moment. And the length of that moment simply shortens as the diseease progresses. So while healthy folks have very long moments – years in fact – those with Alzheimer’s or early Alzheimers symptoms have progressively shorter moments till they become measured in minutes or seconds.

Here are some of the Alzheimer’s symptoms.


Increasing the number of times you forget something and the persistence of this.

So you tend to forget recent things, you forget more of them and this doesn’t get better with time. Note that sometimes medications can cause symptoms of forgetfullness or
confusion. I routinely forget the names of people I’ve met but the Alzheimer’s patient forgets names of people they’ve known well. This progresses until even family members can’t be recognized.

Abstract thinking becomes more difficult.

For example, if you’ve always had trouble balancing the checkbook, then you don’t have Alzheimer’s. But if you start having trouble and can’t seem to get it right over time – then this is an example of abstract thinking degrading. Numbers are one thing that seems to be a target and obvious symptom for many folks. The ability to deal with things that contain numbers is abstract thinking.

Ever have trouble finding the right word.

As a writer, this is a feature of my everyday life but when it starts becoming worse, then it’s a symptom. The use of language degrades and eventually even writing or reading become difficult.

Disorientation in time and date.

This has been one of the marked Alzheimers symptoms in my family and it progressively gets worse as the disease progresses. Knowing what date or even day of the week it is disappears.

There’s a loss of the ability to plan or make judgements about situations.

So it is entirely possible to plan to make dinner but forget to take the burning pot off the burner. Or to think you’ve eaten dinner when you haven’t.

Again, this starts with small things and progresses.

Burning pots and the associated fire risks are often one of the signals that families use to obtain care for their loved one. A friend told me she hadn’t known how bad the problem was with her mother until she found multiple sets of old pots/pans cardboard packing boxes in the basement.

Cooking or other sequential tasks become harder to do as one part of the sequence is forgotten.

If you see a sequence changing, then you might want to pay attention. In my grandfather’s case, he always went to work on the same streetcar, same route, same
time but one day he forgot where the streetcar stopped. That was his last day of work.

Mood swings or personality changes might occur.

Stubborness, distrust, anger or the opposite – complete goodwill towards all mankind might emerge. One friend’s mother, who was quite the harridan while we were growing up became all light, love and good cheer as the disease progressed.

Restlessness or increased anxiety and inappropriate behavior might occur.

Most Frightening Thing

One of the most frightening things is that individuals with this disease know it is happening to them.

And they hide it, keeping the problems to themselves for as long as possible.

Even family doctors are not told. So when we do finally recognize some of the extreme behaviors, we also recognize the smaller signs that had been present for some time. My mother developed excellent coping skills and her actiing ability was such that not even close friends knew she had no idea who they were during their conversations.

These are the basic early Alzheimers symptoms in plain language and I hope they help you understand a bit better.

As with all things, a little bit of these things may be normal but it’s the pattern of them that add up to the diagnosis.

Bottom line

One of the first questions I asked our family physician was how long this was going to last – how long did my formerly extremely-bright mother have to live with this problem – her own version of hell?

The answer was a little surprising. Once Alzheimers symptoms are confirmed and the diagnosis is made, the average lifespan is 8 years.

The first three years are the best in terms of performance but survival and problems increase dramatically after that.

So the pattern of Alzheimers symptoms we saw are simply getting worse month by month.







diagnosis, symptoms

Alzheimers Disease Stages

Feb 15th, 10 / 0 Comments







The progression of Alzheimer’s Disease stages is fairly well known but the movement between the stages (figuring out which one a patient is in) and the speed of movement is quite an individual matter. There is no one-size fits all in this progression or length of time in each stage.

Some Things to Consider

The symptoms, the order in which they appear and the severity of those symptoms will be different for each patient (as will the effect on their lives and that of their family’s)

Stages overlap so there is no clear progression between stages. And there is often a plateau – where relatively rapid decline is followed by a longer period of seemingly lack of change.

The movement from stage to stage (because of the overlapping) can be quite subtle just as the initial diagnosis may have been difficult, so too is clearly defining the individual stages.

We’re looking at a (rough) estimate of 7-10 years for the disease to progress (although there are variations out of the average).

From a family point of view, the patient is losing ability but all care providers emphasize it is important for the family to support the patient by focussing attention on the abilities the patient is left with rather than emphasizing what has been lost.

The Stages

Early Stage

Mild impairment including (but not limited to) forgetfulness, problems expressing themselves, changes in mood or behavior. At this early stage, the patient requires minimal care and assistance. They likely have some sense of what’s happening and can discuss the problem and help with directing care plans.

Middle Stage

This second of Alzheimers disease stages is where serious decline begins, memory declines and other cognitive abilities continue to deteriorate. At this stage, the person may still retain the knowledge of the problem but clearly requires help in daily living.

Later Stages

The disease progresses, the patient loses knowledge of their memory loss, increasing amounts of care are required for daily living, generally a 24/7 level of care is required to handle an increasing level of tasks the patient can no longer accomplish. Some physical symptoms begin e.g. incontinence and communication abilities deteriorate. The patient loses a sense of location, getting lost easily.

End of Life

At this stage, the person increasingly stops functioning in the world and nursing care is increasingly required for feeding and personal care. The person stops walking and continues to physically decline. The focus on care at this point is quality of life and comfort.

There is a Global Deterioration Scale that you may find useful because it tends to pinpoint in greater accuracy this deterioration and can be used for discussions with physicians.

But the above are the main Alzheimers disease stages that are commonly used by support people to discuss the patient’s needs.







diagnosis