The diagnosis of Alzheimer’s disease

It is common for cognitive abilities to change slightly with age. However, if dementia is suspected, it is advisable to discuss this with a doctor. Around 50 million people worldwide live with dementia. The most common form is Alzheimer’s disease. It involves the build-up of proteins in the brain that gradually lead to the death of nerve cells. It requires a thorough approach and consideration of various factors to diagnose Alzheimer’s disease. To date, there is no treatment that can cure Alzheimer’s or reverse the brain damage.

How is Alzheimer’s currently diagnosed?

Traditionally, Alzheimer’s disease is only diagnosed at the dementia stage based on a typical clinical syndrome and after ruling out other causes of dementia. However, the diagnosis of dementia is a complex process that requires careful evaluation of cognitive abilities, medical history and other factors. There is no single test method that is used alone to diagnose dementia. It is a combination of different approaches.

The first step in making a diagnosis is often a detailed discussion between the doctor and the patient, and possibly also their relatives. Symptoms and changes in thinking and memory performance are discussed. A precise medical history, including the recording of previous illnesses and medication intake, is crucial.
After the interview, the doctor usually conducts cognitive tests to assess the patient’s thinking skills. These tests may include questions about memory, language, attention and other cognitive abilities. Commonly used tests include the Mini Mental Status Exam(MMSE) and the Clock-Drawing Test (CDT).

As there is currently no test for dementia, other causes of cognitive impairment must be ruled out. Imaging procedures such as magnetic resonance imaging (MRI) or computerised tomography (CT) of the brain can be carried out to identify structural changes in the brain. In this way, brain tumours or strokes, for example, can be ruled out. Blood tests can also be carried out to rule out other causes for the symptoms or to identify underlying diseases such as vitamin deficiencies or thyroid disorders.
The final diagnosis of dementia then requires a comprehensive assessment of all available information.

Note: It is important to note that dementia is a progressive process and that an accurate diagnosis requires careful monitoring of symptoms over an extended period of time.

What is the current state of research?

There are studies (in German) that suggest that it is possible to recognise Alzheimer’s disease at an early stage, i.e. before the symptoms appear. For this purpose, special markers in the blood are used that provide indications of the disease, so-called blood markers. This makes it possible to detect the presence of Alzheimer’s disease in people with only mild symptoms. However, the procedure is not yet used in practice.

Until now, it has also not been useful to diagnose Alzheimer’s in the early stages, as there are no effective therapies or preventative measures. Early detection is particularly helpful from a scientific point of view: if patients at risk can be reliably identified at an early stage, they can be included in studies at an early stage of the disease and thus contribute to exploring future possibilities for therapy and prevention.

However, new research (in German) suggests that an antibody against amyloid could slow the progression of memory problems in the early stages of the disease. In the USA, causal anti-amyloid therapies for the treatment of Alzheimer’s disease were approved for the first time last year. The first amyloid-reducing antibody is also expected to be approved in Europe in the near future. This should make it possible to influence the course of the disease with the help of causal therapies and delay its progression.
These new developments bring new problems for healthcare: it is important that doctors and carers learn more about the early detection of Alzheimer’s and its preliminary stages using special markers. Plans also need to be made to give the new treatments that may soon be available to patients in a timely and correct manner. But in our healthcare system, we don’t have enough knowledge, processes or capacity to handle these tasks.

In view of the advances in the diagnosis and treatment of Alzheimer’s disease, the German Network of Memory Outpatient Clinics (DNG) (in German) was established. The DNG has several goals: It wants to establish clear rules for memory outpatient clinics, organise training for professionals and attract young people to this work. It also wants to work with all those who care for dementia patients – especially GPs and specialists – to develop efficient processes. This should enable patients who could benefit from treatment to be recognised better and more quickly.

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