Fast Five Quiz: Early Diagnosis and Management of AD
Alzheimer's disease is the most common form of dementia. It is an incurable neurodegenerative disorder marked by a long preclinical period of progressive cognitive and behavioral impairment that significantly interferes with social and occupational functioning. Approximately 55 million adults worldwide have been affected by Alzheimer's disease. Early diagnosis and management of Alzheimer's disease allow patients to maintain higher cognitive levels and functional ability.
How much do you know about the early diagnosis and management of Alzheimer's disease? Test your knowledge with this quick quiz.
Current clinical practice guidelines from the Alzheimer's Association state that, in order to render a diagnosis of MCI owing to Alzheimer's disease, the patient's cognition upon assessment must be outside the normal range of function for their age and educational background but not sufficiently impaired to constitute dementia.
Cognitive decline can be documented by history from the patient, which is ideally corroborated by someone who closely observes the patient on a regular basis or upon observation by the clinician, per the same guidelines.
The Alzheimer's Association guidelines also note that impairment can involve one or more cognitive domains. The clinician determines whether memory is prominently impaired or whether the impairments in other cognitive domains predominate, such as spatial or language impairment. Typically, memory is the most common domain involved among patients who subsequently progress to Alzheimer's dementia.
There is generally mild functional impairment for complex tasks, but basic activities of daily living should be preserved, and the person should not meet criteria for MCI.
Learn more about the presentation for Alzheimer's disease.
Depression is a significant consideration in the early diagnosis of Alzheimer's disease. Further, it has been shown to be a sign of early Alzheimer's disease. The clinical manifestations of depression overlap with those of Alzheimer's disease. The term pseudodementia refers to the appearance of cognitive dysfunction owing to depression.
Depression in patients with Alzheimer's disease appears to differ from depression in elderly patients without cognitive impairment. Depression in Alzheimer's disease more often features motivational disturbances (eg, fatigue, psychomotor slowing, and apathy), whereas depression in patients without cognitive impairment tends to feature mood symptoms (eg, depressed mood, anxiety, suicidality, and sleep and appetite disturbances).
Hypoglycemia, hearing impairment, and alcohol or drug abuse have been linked to cognitive decline and increased risk of dementia. However, they are generally not regarded as signs of Alzheimer's disease nor are they significant diagnostic considerations.
Learn more about diagnostic considerations in Alzheimer's disease.
Patients with MCI are at higher risk of developing Alzheimer's disease and other dementias than patients who do not have MCI. Vitamin D deficiency has been shown to greatly increase the risk for cognitive impairment in older adults. Patients with severe vitamin D deficiency have been shown to have more than double the risk of developing MCI than patients who were not vitamin D deficient. Similarly, a narrative review of cross-sectional and longitudinal studies focused on neuroimaging changes in patients with vitamin D found a consistent association between vitamin D deficiency and cognitive impairment. Further, vitamin D deficiency leads to network disruption centered in the right hippocampus in patients with MCI.
Moderate alcohol consumption, bilingualism, and hearing aid use are all considered part of the protective and lifestyle factors that have been associated with lower incidence rates of MCI.
Learn more about the workup for Alzheimer's disease.
ChEIs are used in an attempt to prevent or delay the deterioration of cognition in patients with Alzheimer's disease. Available ChEIs have shown modest benefit on measures of cognitive function and activities of daily living. Patients taking ChEIs have shown slower declines on cognitive and functional measures than patients on placebo and might also alleviate the noncognitive manifestations of Alzheimer's disease, such as agitation, wandering, and socially inappropriate behavior. However, they do not address the underlying cause of the degeneration of cholinergic neurons, which continues during the disease.
Antidepressants have an important role in the treatment of mood disorders in patients with Alzheimer's disease; however, data regarding their effect on delaying cognitive deterioration are inconsistent and they are not typically used for that function.
Neuroleptic agents, also known as antipsychotics, can reduce confusion, delusions, hallucinations, and psychomotor agitation in patients and were sometimes used to treat secondary symptoms of Alzheimer's disease, such as agitation. In 2005, the US Food and Drug Administration added a black box warning on the use of atypical neuroleptics in the treatment of secondary symptoms of Alzheimer's disease because of increased risk for death or stroke. Further, they are not typically used to delay cognitive deterioration; the combination with antidepressants is also not typically used in this setting.
Learn more about the treatment of Alzheimer's disease.
ChEIs and mental exercises are used in disease as an attempt to prevent or delay the deterioration of cognition in patients with Alzheimer's disease.
Many experts believe that mentally challenging activities, such as doing puzzles and brainteasers, as an adjunct to pharmacotherapy might reduce the risk of developing Alzheimer's disease in patients with MCI. Clinical trials are under way to determine the effect these cognitive activities have on Alzheimer's disease progression.
Behavioral interventions are often combined with the more widely used pharmacologic interventions rather than used alone. Their effectiveness ranges from modest and temporary to excellent and prolonged and varies greatly from patient to patient.
Brain inflammation has been suggested as a key factor in the pathogenesis of dementia and is considered a cardinal feature of Alzheimer's disease. Both docosahexaenoic acid and eicosapentaenoic acid can enhance the nerve growth factor level. However, they are not established treatments in this setting.
There are no special dietary considerations for Alzheimer's disease.
Learn more about approach considerations for Alzheimer's disease.
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