Dementia: the Growing Crisis in West Virginia

DIAGNOSIS OF DEMENTIA

As treatments for AD and vascular dementia are different, early determination of the type of dementia from which a patient is suffering is vital. Similar symptoms often make diagnosis difficult, however, unless a patient has experienced recognizable strokes. Brain scans have become available recently that allow doctors to distinguish between vascular dementias and AD. In 2003, researchers at the San Francisco VA Medical Center used magnetic resonance imaging (MRI) along with magnetic resonance spectroscopy to correctly identify 90% of patients who had vascular dementia (68). Vascular dementia, frontotemporal dementia, and dementia with Lewy bodies are all a result of degenerative vascular brain disease.

Researchers are also working on developing neuroimaging methods that can assist in the early detection of AD. MRI scans, computed tomography (CT), single photon emission computed tomography (SPECT), and positron emission tomography (PET) are all being studied as aids in the diagnosis of AD. Neuroimaging techniques are invaluable in researching brain changes that occur in the different stages of AD; however, they represent only one step in diagnosing AD, that of ruling out a vascular cause for a patient’s dementia. As new medications become available for AD, neuroimaging will also allow researchers to determine their efficacy in eliminating plaques and tangles or at least slowing the progression of the disease.

To diagnose AD, doctors usually rely on several evaluations. These include:

■ a patient’s medical history.

■ a mental status evaluation that assesses memory, communication and cognitive skills, and the ability to perform simple math problems.

■ a physical examination to assess the patient’s blood pressure, pulse, and nutritional status and evaluate the nervous system.

■ basic laboratory tests, i.e., blood and urine, to rule out other causes of dementia.

■ a psychiatric examination, also to rule out other causes.

Using these evaluations, doctors can accurately diagnose AD in 90% of cases. A definitive diagnosis comes only with an examination of the brain tissue itself.

Dementia: The Growing Crisis in West Virginia

DIAGNOSIS OF DEMENTIA