Alzheimer’s Disease and Dementia

The good news is that our population is living longer, largely due to a modification of risk factors causing stroke and heart attack, and early cancer screening.  The bad news is that with increasing age comes a markedly increased risk of Alzheimer’s Disease and other dementias.

There have been many failures in trials of disease modifying therapy for Alzheimer’s Disease over the past two decades.  Some large pharmaceutical companies have abandoned Alzheimer’s Disease research because of these failures.  We at Rowe Neurology have been a part of several of these trials, and have seen their disappointing results.

However, even though many of these trials have failed, there are others on the horizon that can possibly lead to real disease modification of this devastating group of diseases.  A new, root-cause approach is needed.  We are excited that we have been selected to be a part of a ground breaking new trial!  We have closed our clinical trial operation and that trial is closed, but I hope you will all keep your eye out for the Lily trial.

Long-term memory loss and the different types of dementia are among the most difficult conditions that anyone, including neurologists, must treat.  But as long as an accurate diagnosis can be made, ruling out mimics, with updated criteria and neuro-psychological evaluation, then quality of life, for the patient and care-giver, can be maintained.

There are many reversible causes of memory loss or cognitive decline, and it’s important to check for each one, which is part of our screening process for research trials. Only in this way can a person maintain as much quality of life for as long as they can.  Whether or not you are interested in being in a clinical trial it is important to have a thorough evaluation to rule out some reversible cause of your memory loss.

What is memory loss?

The memory circuits of the brain for immediate memory are very specific. They lie deep in the brain and involve the hippocampus. Alzheimer’s Disease, as well as Frontotemporal Lobar Degeneration and other dementias causing memory loss, like stroke and inflammation resulting from the remote effects of cancer elsewhere in the body, involve these deep areas of the brain. But these circuits must have the proper “voltage,” or attention input, to function properly. Only when these structures are “awake” and we’re alert (sleep problems play a critical role in this), and the nerve cells in these structures are functioning well, can they help the other areas of the brain lay down more lasting memories. They do this by changing the way networks of nerve cells in the brain fire and signal each other. This is how we remember names, events, faces, and other things we all need to remember.

Alzheimer’s disease, Frontotemporal Lobar degeneration, Multisystem Atrophy, Lewy Body Disease.  All names of what we now believe to be different types of dementia. Destruction of nerve cells and their supporting cells lead to “atrophy,” or shrinkage of the brain.  Where that atrophy occurs will determine what abnormal behaviors are present.

Sometimes, detailed neuropsychological testing has to be done to find defects in our thinking, or what we call cognitive function. Some of these tests are very specific to memory. Others involve personality testing and other functions of the brain. Imaging of the brain with MRI can show areas of atrophy or stroke. PET scans can show areas of amyloid plaque accumulation or tau in Alzheimer’s Disease and other diseases. The circuitry of the brain can be tested to show if any abnormal electrical activity is occurring to disturb memory function. Blood work can be carried out to see whether any electrolyte abnormalities, vitamin deficiencies, or inflammation is occurring. Sometimes spinal fluid testing can be carried out to determine levels of degeneration.

But at the RNI, our primary focus had been on improving the quality of life for every single patient and their caregiver. To do this we have to be as sure as we can be about the correct diagnosis, and we need to make sure other factors, called comorbidities, are not making clinical symptoms worse. Even though Dr. Rowe is no longer seeing patients, you can use the outline here of recommended steps to optimize your quality of life.

If you have memory loss, don’t wait!

The role of the Neuropsychologist in the diagnosis of dementia

Neuropsychological evaluations not only test memory and other cognitive functions, they can suggest how a person can make real life decisions every day, and how much help they need in decision making, driving, and relating to others.
Neuropsychological evaluations involve three factors:

• Testing must be completed in a supportive and positive environment
• One-on-one feedback must be given, and results explained in understandable terms
• A plan for intervention and coping with difficulties must be provided

All this may take a while. The testing part of the evaluation typically takes 3-4 hours to complete. A feedback session is then scheduled, where results are reviewed and suggestions for intervention offered with the patient and, if appropriate, the caregiver.

Why a neuropsychological evaluation might be useful for you or a loved one

• find possible problems with brain functioning
• help to identify other cognitive or mental health issues
• define brain-related strengths and weaknesses
• guide treatment for a person’s personal, educational and/or professional needs
• document possible changes in a person’s functioning over time

What is a neuropsychological evaluation?

A neuropsychological evaluation typically involves assessment of a person’s brain functioning with a group of standardized tests. These functions (e.g. memory, learning) form the necessary building blocks for successful living in an individual’s daily life.

How long will a neuropsychological evaluation last?

Most testing sessions are pretty detailed and can last up to 3 – 4 hours, though sometimes it doesn’t take that long.

What tests are used?

Standardized tests are used to assess the following:

• Attention/concentration
• Memory/learning
• Problem-solving
• Visual-spatial
• Language
• Motor
• Emotional functioning
• Achievement skills