The diagnosis of Alzheimer's disease is made clinically - meaning that the doctor obtains a history and performs a thorough exam which then suggests the presence of Dementia. There are general guidelines to help healthcare providers make a diagnosis of Alzheimer's disease that include a complete history and physical exam and use of certain laboratory biomarkers in some cases. The problem with Alzheimer's disease is that when the disorder is diagnosed late, most treatments are futile. Researchers believe that the earlier the disorder can be diagnosed, the better the prognosis with the available treatment. Hence the need to develop imaging techniques that can identify patients at risk for the disorder or will develop the disorder within the next ten years.
Doctors often order imaging tests like a CT scan or MRI of the brain not to make the diagnosis of Dementia but to ensure that there is no other possible cause for the disorder (eg a stroke, vitamin B12 deficiency, cancer or thyroid disease). These imaging tests are also useful in ruling out other potentially reversible causes of cognitive decline such as normal pressure hydrocephalus or a subdural hematoma in patients with Alzheimer's disease.
Even though clinical research using MRI has shown that there is a decrease in size of certain brain structures associated with memory (hippocampus), the MRI is not a routine test in the diagnosis of Alzheimer's disease. Not only is the imaging test not readily available, it is also prohibitively expensive to use indiscriminately.
Several genes associated with early onset Alzheimer's disease have also been identified in the past 2 decades. However, genetic testing is only done in symptomatic individuals with early onset Alzheimer's disease and those who have a family history of the disorder. All individuals who are about to undergo genetic testing are usually offered proper counselling on the predictive value of the test. More important, the counselling is continued after the test in order to understand the implications of the results.
Another new method for detecting early signs of Alzheimer's disease using amyloid PET scan has been developed by some Swedish researchers. In this test a special chemical which binds to a special protein in the brain, B-amyloid is administered to the patient and its transition in the brain is mapped with PET scan imaging. The test is sensitive and can identify patients with early stage Alzheimer's disease or those who will develop the disorder in the near future.
However, the reason why this Swedish study is of importance is that in many previous clinical trials the treatments failed because the drug treatment was started too late in the course. With this new test it may be possible to identify suitable candidates at an early stage of Alzheimer's disease and offer treatment on time. This may also increase the chance that the drugs may work and prevent worsening of cognition and memory. On the other hand, experts in aging indicate that this test should not be used for routine screening for Dementia.
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