1. Alzheimer’s Assessment Assessing the Cognitive-Linguistic effects of Alzheimer’s

2. Introduction  There is no single clinical test to assess for Alzheimer’s Disease.  A comprehensive evaluation is needed to establish the diagnosis. Basically, a series of tests are used to rule out treatable causes of dementia.  Doctors are 90% accurate when assessing patients using the criteria established by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) (see table 1).

3. Step 1 Medical History, Comorbid Diseases:  The first step in assessing for Alzheimer’s is to determine that dementia and not some other form of cognitive impairment or comorbid diseases are responsible. A complete family and medical history is absolutely necessary. Family, friends, and even colleagues are used to supplement patient information.

4. Step 1, cont’d  The following comorbidities should be screened for:  Depression  B12 deficiency  Thyroid functioning  Serologic test for syphilis(only screen for this if the patient has had some specific risk factor or previous infection, or lives in an area of the United States that has a high number of syphilis cases)

5. Steps 2,3, and 4 STEP 2-  Cognitive Screening: (Mini-Mental State Examination or similar tests such as the Blessed Dementia Scale)  STEP 3-  Comprehensive neuropsychological testing (optional) STEP 4— Laboratory tests: computed tomographic scan of the head magnetic resonance imaging of the brain

6. Controversial risk factors and biomarkers to assess for Alzheimer’s Disease  Research still does not substantiate the validity of these two factors:  Apolipoprotein E genetic screening  Check spinal fluid markers especially look at A-beta-42 and tau protein

7. Table 1  I. Probable AD: Core Diagnostic Features  A. Dementia established by clinical examination (including MMSE, BRDRS, and neuropsychological testing)  B. Deficit in at least two areas of cognition  i. Memory (required)  ii. Other area besides memory  C. Deficits characterized by gradual onset and progression, onset after age 40  D. Other systemic disorders or brain disease do not account for the progressive deficits in memory and cognition in and of themselves

8. Table 1, Con;td  II. Possible AD: Core Diagnostic Features   A. Dementia syndrome in the absence of other neurologic, psychiatric, or systemic disorder, OR  B. Presence of a second systemic or brain disorder sufficient to produce dementia, which is not considered to be the primary cause of the dementia

9. Table 1, Cont’d  III. Features that make a diagnosis of Probable or Possible AD unlikely or uncertain  A. Sudden apoplectic onset  B. Focal neurologic findings such as hemiparesis, sensory loss, visual field deficits, and incoordination early in the course of the illness  C. Seizures or gait disturbances at the onset or very early in the course of the illness

10. Table 1, Cont’d  IV. Criteria for diagnosis of Definite Alzheimer’s disease:  A. Clinical criteria for probable Alzheimer’s disease   B. Histopathologic evidence obtained from a biopsy or autopsy

11. References  Clark, David and Jeffrey Cummings. The diagnosis and mangagement of dementia. Middle East Journal of Family Medicine Vol 1 Issue 7 October 2004 1-11.