Alzheimer's Answers: Diagnosing Alzheimer's Disease |
Transcript 5/11/01 Chat Room Disclaimer This Chat Room provides general information that is for educational purposes only and should not be considered as offering medical advice. The information that is made available by this Chat Room should not be used for diagnosing or treating a medical or other health condition. Viewers and participants should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition. ElderCare Online and the hosts MAKE NO WARRANTIES, EXPRESS OR IMPLIED, AS TO THE VALUE, USEFULNESS, COMPLETENESS OR ACCURACY OF ANY OF THE INFORMATION THAT IS MADE AVAILABLE BY THIS CHAT ROOM. >> DebbieKay789 has joined
channel #XC.1993632 RichOBoyleMODERATOR> hello Debbie
Kay and welcome RichOBoyleMODERATOR> we are both
here early [DebbieKay789] Type HERE...yes, I see
- I keep checking in to see if anyone is here yet >> Drscottsmall has joined
channel #XC.1993632 [Drscottsmall] Hello RichOBoyleMODERATOR> Welcome! :) RichOBoyleMODERATOR> Debbie, you
are welcome to ask the first question >> Momasr has joined channel
#XC.1993632 [DebbieKay789] How do you now test
for Alzheimer’s while a person is still living? RichOBoyleMODERATOR> hello momasr
and welcome. RichOBoyleMODERATOR> we have just
gotten started [Drscottsmall] By a physician
performing a good medical history and exam, and usually by ordering some blood tests and
imaging studies to rule out other causes of dementia [DebbieKay789] My Dad has had a
stroke in the left frontal lobe of the brain and has since been diagnosed with
Alzheimer’s Type Dementia - will these tests determine if the dementia is a result of
the stroke or a result of Alzheimer’s? >> anderson8647 has joined
channel #XC.1993632 RichOBoyleMODERATOR> what type of
blood tests are conducted? RichOBoyleMODERATOR> hello
anderson and welcome RichOBoyleMODERATOR> we just got
started so, I will call on each of you in order to ask questions [Drscottsmall] Distinguishing between
'vascular' dementia and Alzheimer's Disease is best accomplished by history and exam... [Drscottsmall] Blood tests: vitamin
levels such as B12, hormone levels such as thyroid RichOBoyleMODERATOR> what
procedures and strategies one would use to distinguish between dementia, delirium and
depression? >> carolspring3 has joined
channel #XC.1993632 [carolspring3] hello RichOBoyleMODERATOR> hello
carolspring and welcome... please hold your question until I call on you [Drscottsmall] Dementia is a slow
process that affects memory, delirium is a fast process that affects attention >> ronphil has joined channel
#XC.1993632 RichOBoyleMODERATOR> hello ronphil
and welcome... please hold your question until I call on you [Momasr] My Dad was diagnosed with AD
at 56 (he's now 60). The more I read about
Picks Disease, the more it seems to fit. How
can you tell the difference? [Drscottsmall] Pick’s disease
affects a different part of the brain compared to AD. Picks disease is more likely to
target the frontal lobes, as such it usually presents with changes in personality and mood
prior to memory per se [Momasr] The doctors said the scans
showed atrophy in the frontal lobe. Also, we thought he was going thru a midlife crisis -
major personality changes. Should we repeat
the scans? [Drscottsmall] I would consider a
different type of scan... a functional scan, such as SPECT or PET >> krazy_kat35 has joined
channel #XC.1993632 RichOBoyleMODERATOR> Dr. Small,
would you please explain/describe these tests RichOBoyleMODERATOR> hello krazy
kat and welcome... please hold your - question until I contact you :) >> weberch has joined channel
#XC.1993632 [Momasr] That was what I was thinking
too. He has little memory loss, but much
speech difficulty and confusion. [Drscottsmall] MRI and CT scan
evaluate the structure of anatomy of the brain. SPECT and PET scans evaluate the function
or activity levels of the brain RichOBoyleMODERATOR> hello weberch
and welcome... please hold your question until I contact you [carolspring3] Thank you, but I'm
just listening and learning. [krazy_kat35] me too RichOBoyleMODERATOR> ok then I
will post an advance question [Momasr] What is the life expectancy
of Picks vs. AD? [Drscottsmall] Tough question.
Statistical averages have been generated and they stand at around 10 years. It is
important to understand, however, that this may vary from 1-20 years. Every individual is
just that [Momasr] Thank You RichOBoyleMODERATOR> who is the
best specialty of physician to diagnose AD? How does one find a specialist? [Drscottsmall] Dementia specialists
are typically a neurologist or a psychiatrist with sub-specialty in Neurobehavior. The
Alzheimer's Association is a good place to start RichOBoyleMODERATOR> would anyone
like to post their question? [krazy_kat35] Is there any medicine
for a person who has had dementia for several years? [Drscottsmall] I'm not sure, but most
academic centers have at least 1 such specialist. At Columbia we have around 6 such
specialists. [Momasr] The Alzheimer’s
Association has recommended my Dad to see a speech therapist who specialized in AD. Do you think that would be helpful? [DebbieKay789] Is there any evidence
that an AD patient really understands more than we think but they have just lost the
ability to communicate with the right words? [krazy_kat35] Dementia runs in my
family or it seems to and I was wondering how soon should someone be tested and what can
be given for it? [anderson8647] My father passed away
about a year and a half ago. Since then my
mother (age 81) have developed difficulties speaking.
She has had a complete medical, psychological and neurological workup. Her neurologist has diagnosed aphasia and wants to
start her on Aricept [Drscottsmall] There are two
medication that have been approved by the FDA for AD. They are both act by increasing a
neurotransmitter level in the brain. Their commercial names are Aricept and Exelon...
vitamin E can also be considered RichOBoyleMODERATOR> ok lets give
Dr. Small a chance to answer these questions :) Drscottsmall] Speech therapy can help [anderson8647] The speech therapist
was no help. She said she didn't know how to help my mother. [Drscottsmall] There are different
types of Language deficits which are called Aphasias. Some forms of aphasia are
characterized by deficits in producing speech but the person still has normal
comprehension [Drscottsmall] A distinction is made
between Familial AD and Sporadic AD. If a physician thinks that your family has familiar
AD some genetic testing is available RichOBoyleMODERATOR> what does
that genetic testing entail? [Drscottsmall] If aphasia is caused
by AD that Aricept is reasonable to consider [Momasr] What dosage of Vitamin E do
you recommend? RichOBoyleMODERATOR> Can the
doctor diagnose AD and it really be Parkinson';s Disease? (and vice versa) [Drscottsmall] Dosages of vitamin E
used in studies were very high, 2000 IU a day. At these doses vitamins are like
medications, namely, they can cause harmful side effects. I would recommend consulting
with a doctor. RichOBoyleMODERATOR> The
information that is made available by this Chat Room should not be used for diagnosing or
treating a medical or other health condition. Viewers and participants should always
consult a physician or other qualified healthcare provider for the diagnosis or treatment
of any medical or health condition. [anderson8647] That is the question. The doctor has never said she has AD. He said it might be early AD or primary frontal
temporal dementia or primary aphasia. Are
there some other tests he should have done so he could definitely make an AD diagnosis? If so what are they? [Drscottsmall] Parkinson’s
disease can cause cognitive decline and even dementia. A dementia specialist can usually
dissociate AD from PD based on history and exam [krazy_kat35] At what age should
someone go to a doctor to see about getting - tested? [DebbieKay789] I read an article
about using Risperdal with Paxil in that you should not use the 2 together - what are your
thoughts on this? RichOBoyleMODERATOR> OK let's let
Dr. Small catch up :) [Drscottsmall] The diagnosis of
definite AD can only be made by looking at brain tissue under the microscope. During life,
sometimes a functional imaging study (see above) can help [anderson8647] If my mother has
primary aphasia (not AD) in your experience would Aricept still be useful? [Drscottsmall] In principle AD can
present during anytime during an adults life [Drscottsmall] Aricept MIGHT still be
useful [Momasr] Regarding genetics, my
brother and I are concerned about our chances because my Dad is so young. He has 9
siblings and no one else in his family has been diagnosed with dementia. How do we know if
we should get tested? (I am 31, he is 27) [anderson8647] If we pay for these
functional imaging studies and they show a problem in the speech area. Can anything be done at that point? [Drscottsmall] This question should
be addressed to the dementia specialist who diagnosed your father. RichOBoyleMODERATOR> How can you
really tell if someone is also depressed when they have trouble communicating with you
because they also have AD? And then what can you do about it? [Drscottsmall] Good question. There
are two reasons for ordering tests. One is establish a diagnosis with greater certainty. A
second is to allow us to guide treatment. In this question the test will more likely
address the former type of question [Drscottsmall] A dementia specialist
can usually distinguish between cognitive decline and mood decline (depression). [Drscottsmall] Also... keep in mind
that we have very effective treatment for depression available. It should be diagnoses and
treated. RichOBoyleMODERATOR> how does one
get over a person's resistance to go to the doctor? [Drscottsmall] In my experience
patients are reluctant to seek medical attention if there is a sense of futility...
namely, if someone is concerned about dementia they might feel that seeing a doctor will
have no benefit. A number of things should be emphasized: First, there are causes of
dementia that we can potentially treat. Second, even AD is now becoming an entity that we
can treat. Hopefully, in the near future we will have even better medications RichOBoyleMODERATOR> how long does
it take to do the "standard workup" for dementia? I have heard that it can be up
to two days of tests? [anderson8647] what tests would you
perform to determine if my mother's aphasia is due to AD? [Drscottsmall] A doctor’s exam
usually takes 1-2 hours. Blood tests take a few minutes to draw and few days to come back.
Imaging studies take around 1 hour. Neuropsychological testing can take a few hours. RichOBoyleMODERATOR> so the
complete workup can take the better part of a day? [Drscottsmall] The diagnosis of AD
typically requires that someone has deficits in multiple cognitive domains. Language is
one. I would try to determine whether you mother had deficits in other cognitive domains,
such as memory, abstract reasoning, or spatial ability. A neuropsychological test might
help [Drscottsmall] Yes RichOBoyleMODERATOR> what are the
"cognitive domains?" [anderson8647] She had
neuropsychological testing and it was normal, in fact she was better than some people much
younger than her RichOBoyleMODERATOR> are there any
additional questions before we finish up? Now is your chance ! [Drscottsmall] Our higher mental
faculties are called cognition. Cognition is subdivided, somewhat arbitrarily, into
different domains… the common domains are memory, language, abstract reasoning,
visuospatial ability, etc. [anderson8647] What are the side
effects of Aricecpt? Would it be appropriate
for someone who is taking heart medications to control rhythm? Drscottsmall] Yes. The list is long.
I would recommend consulting individual doctors RichOBoyleMODERATOR> I will post
the final question: RichOBoyleMODERATOR> please tell
us about the brain donation program at Taub... how can families help researchers to
unravel the mysteries of AD? [Drscottsmall] As I mentioned
earlier, the only way to be certain of the diagnosis of AD and other related disorders is
by looking at the brain under the microscope. For this reason brain donation is very
crucial part of our attempts to understand the mechanisms of AD. If anyone has questions
about the Brain Donation Program at Columbia, please contact 212 305-9086 and ask for
Arlene [anderson8647] Dr. Small, Thank you
for your time and help!! RichOBoyleMODERATOR> Dr. Small
thank you for your time and efforts, this has been very informative [DebbieKay789] Thank you RichOBoyleMODERATOR> and thank you
to all of our participanbts [Drscottsmall] You're welcome Chat Room Disclaimer This Chat Room provides general information that is for educational purposes only and should not be considered as offering medical advice. The information that is made available by this Chat Room should not be used for diagnosing or treating a medical or other health condition. Viewers and participants should always consult a physician or other qualified healthcare provider for the diagnosis or treatment of any medical or health condition. ElderCare Online and the hosts MAKE NO WARRANTIES, EXPRESS OR IMPLIED, AS TO THE VALUE, USEFULNESS, COMPLETENESS OR ACCURACY OF ANY OF THE INFORMATION THAT IS MADE AVAILABLE BY THIS CHAT ROOM. ----END--- © 2001 Prism Innovations, Inc. All Rights Reserved. |