Alzheimer's Diagnosis

Getting a clinical diagnosis of Alzheimer's or other forms of dementia can be a very difficult and arduous process as there is no single test or medical method that proves the existence of the disease. 

The process begins with observing the patient’s behavior. Doctors must evaluate the signs to determine if the patient is suffering from other health conditions that could be exacerbating the symptoms, or if they are wholly unrelated.

Physicians— with the help of other specialists such as neurologists, neuropsychologists, geriatricians and geriatric psychiatrists— will then conduct a complete medical assessment that considers all possible underlying causes for changes to cognitive function.

During this time, several tests will be conducted, including:

While physicians can almost always determine if a person has dementia, it may be difficult to pinpoint the exact cause. A brain autopsy is the only definitive way to diagnose dementia.

Anyone who desires confirmation that a clinical diagnosis was accurate should arrange for a brain autopsy to be done soon after the time of death.

If you or someone you love is experiencing a failing memory, communication problems or changes in behaviour that are impeding every day life, it could be time to consult with your physician.

An early and accurate clinical diagnosis of dementia is an important first step to ensure you have access to appropriate treatment, care, family education and plans for the future.

Does Social Interaction impact our brain health?

Researchers have outlined a healthy diet, cardiovascular exercise,  and quality sleep as methods of preventing Alzheimer’s disease. But what about socializing; can social interactions prevent dementia?

The short answer is YES! Staying socially connected helps facilitate and preserves cognitive function. Social interactions are like mental exercises as they require our brains to work and form connections.

In one study, "social interaction" included activities like reading the newspaper, trying new things, having an active approach to life and maintaining an active social life. When I think of socializing, my mind conjures memories of fun nights with friends, or Sunday dinner with the family all gathered around the table.

Being connected to others socially is widely-considered a fundamental human need. Just as every human requires food and water to develop, function and thrive, we require connection and human contact—it is crucial to both well-being and survival.

The importance of social interaction is not to be underestimated. According to Mark Robinson, the chief officer of the non-profit Age UK Barnet, “Loneliness is proven to be worse for health than smoking 15 cigarettes a day,” Robinson said. Extended feelings of loneliness can lead to high blood pressure, heart disease, chronic inflammation and even dementia. It strikes people regardless of age, gender or situation in life.                                                         

Unfortunately, loneliness is a sad reality of modern life with as many as 1 in 4 elderly Canadians reporting feeling lonely. One of the most common causes of loneliness is social isolation, which occurs when an individual has a restricted social network and limited social contact.          

One recent study found that people who have more support in their lives or a stronger social network, as evidenced by their social environment, have a lower chance of developing memory-loss symptoms. Social activities can also help people reduce stress and anxiety, as well as boost mood and keep relationships strong, which is what ultimately leads to lower blood pressure levels. 

If you are unsure where to start, ask yourself “what interests me?”. Be open to new experiences, including joining a group or club. Maintain old friendships and make new ones. Stay social through work, volunteer activities, travel, hobbies, family and friends.

Here are some great tips on how to cultivate social interactions to keep you mentally sharp.                                    

Where did Alzheimer's get its namesake?

I recently attended a talk that opened with a biography of the man who discovered the pathological condition of dementia and diagnosed the disease that bears his name, Alois Alzheimer.

Alzheimer was a German psychiatrist, and began his residency in 1888 at the Hospital for the Mentally Ill and Epileptics in Frankfurt, Germany. He became interested in research on the cortex of the human brain, and continued his education in psychiatry and neuropathology. In 1903, under the tutelage of Emil Kraepelin, Alzheimer created a new laboratory for brain research at the Munich medical school.

Having published many papers on conditions and diseases of the brain, Alzheimer gave a remarkable lecture in 1906 that made him famous, in which he described an 'unusual disease of the cerebral cortex', the first form of dementia, in his patient Auguste Deter.

4726277_orig.jpg

The first Alzheimer’s patient

Auguste Deter, died 9 April 1906

Auguste, a woman in her fifties, demonstrated symptoms not unlike the prevailing markers of dementia: reduced comprehension and memory loss, disorientation, delusions and hallucinations. She died at 55 years-old, and due to her age, she was given a “presenile dementia” diagnosis. However, the post-mortem showed various abnormalities of the brain, including thinner than normal and senile plaque in the cerebral cortex, previously only encountered in elderly people. Alzheimer was able to identify the neurofibrillary tangles in the brain, which had never previously been described.

It was Emil Kraepelin’s suggestion that the newly discovered disease be given the name “Alzheimer’s disease”, after its founder.

Today, the methods for diagnosing Alzheimer's disease is still typically based on the same investigative methods used in 1906. This is remarkable compared with the development of investigative methods for other diseases, and it speaks volumes about the quality of Alzheimer's discovery.

Potential Precursor to Alzheimer's

As people age, they may experience a waning in their cognitive abilities, including memory and thinking skills. However, if the changes are greater than the cognitive changes associated with normal aging, then there may be more at play.

Mild Cognitive Impairment or (MCI) is a descriptive syndrome rather than a specific condition or disease where an individual experiences mild but measurable changes in memory, language, thinking or judgement noticeable to the person affected and to family and friends.  

Typically, changes in cognition are not significant enough to interfere with daily life =, but do increase the risk of developing Alzheimer's or another dementia.  For the majority of people who have MCI, memory is the cognitive ability most affected.

However, not everyone diagnosed with MCI goes on to develop Alzheimer’s, rather some people remain stable and others may even show an improvement in cognitive abilities over time.

Approximately 15 to 20 per cent of people age 65 or older have MCI.
— Alzheimer's Association

Mild cognitive impairment is a categorized as a clinical diagnosis. A medical professional determines the presence or absence of MCI by evaluating a person’s cognitive and behavioural changes, and using professional judgement about the possible causes and severity of the symptoms. 

People diagnosed with MCI have different patterns of symptoms with many possible underlying causes, often leading to many unanswered questions. It is important to seek out information, education and support in order to help live with this condition effectively.

Whether MCI, dementia or Alzheimer's, try to focus on and nurturing current abilities without worrying about what might happen in the future.

Blood Test Breakthrough

Until now, the only way to measure plaques in the brain, a hallmark of Alzheimer's disease, has been through expensive and invasive testing methods that are generally only available in a research setting.

However, Doctor Koichi Tanaka has developed a minimally invasive, cost-effective blood test measuring for a specific peptide to detect if a person is at the earliest stages of Alzheimer's disease. 

The test has shown to have a greater than 90 per cent accuracy at predicting people at risk of Alzheimer’s, raising hopes of earlier and more precise interventions in the treatment of the devastating condition.

It was developed as part of a 30 year journey and its success proven by Australian scientists at the Florey Institute and Japanese researchers at the National Centre for Geriatrics and Gerontology (NCGG).

To assess the accuracy of the approach, researchers compared samples indicating plaques taken at NCGG against patient samples with plaques from the Australian Imaging, Biomarker and Lifestyle Study.

This test will help detect if people are on the pathway to Alzheimer’s or if they are symptomatic, it can suggest that there are other causes - it may even suggest how quickly someone could deteriorate.

To learn more about this potentially revolutionary discovery, read the study published in Nature in its entirety.

Young Carers Awareness Day 2018

Today marks Young Carers Awareness Day. The aim of the day is to identify and raise awareness of the 700,000 young carers across the UK. 

A young carer is someone aged 18 or under who helps look after a relative who has a condition, such as a disability, illness, mental health condition, or a drug or alcohol problem. Most young carers look after one of their parents or care for a brother or sister.
— NHS UK

The 2018 campaign, presented by Carers Trust-a major charity for, with and about carers-highlights a section of carers that I was unfamiliar with, Infant young carers.

The number of infant young carers, aged 5-7, is rising at an alarming rate (83% increase since 2001). There are around 10,000 young carers between the ages of five and seven providing unpaid care, according to the most recent Census.

More needs to be done to support them and their families. Carers Trust hope that by raising awareness, it will help get the support it so desperately needs.

Help spread the word about this cause by using #youngcarers!

 

#ilivewithdementia

In last week's post entitled, Showing Vulnerability to Build AwarenessI talked about a new Alzheimer Society of Canada awareness campaign I am featured in. 

I wanted to revisit the topic and discuss how powerful I think this campaign is. I read all of the stories included on the website and found them both inspiring and disheartening, simultaneously.

I did discover some very interesting patterns interwoven throughout the stories, including:

  • the level of care and understanding differed based on geographical location;
  • stigma still exists and it is primarily based on a lack of education;
  • the diagnosis and the disease itself greatly impact caregivers and families, which is still not being addressed in the way it could and should be; and 
  • the person suffering from dementia is still a person and deserves to be treated with dignity and respect.

These people were brave enough to talk about how they live with dementia on a daily basis. I  strongly encourage anyone living with this disease to discuss their situation as it is in itself unique. 

The only way to start addressing stigma is by getting the word out there and discussing dementia in a meaningful way. I want to know how you live with dementia.

Let's build a network of people living with dementia and their caregivers to educate the public. Ours is a compelling and cautionary tale; one that’s only just beginning for an entire generation.
 

Showing Vulnerability to Build Awareness

January 8th was the official launch of the Alzheimer Society of Canada's January Alzheimer Awareness campaign, I live with dementia. This is especially exciting because I have the honour of being featured in it!

This amazing feat all started when I reached out to the Alzheimer Society of Canada to become a media spokesperson in June 2017. The Communications Director of the Society, Roseanne Meandro, has worked with me since to help me get my story out there.

In September, Ramp Communications contacted me to do a photoshoot for the campaign. It just so happened that the photoshoot landed on my birthday, so I felt very special. David Tam, the Creative Director from Pear Tree Photography managed to get the shot used for the campaign right off the bat.

I continued to work with David Brouitt, the Creative Director of Ramp Ad, to refine my story, which was set to be featured as part of the campaign.

For the remainder of 2017, the campaign was under embargo, so we couldn't talk about it publicly. 

But now the word is out there and I am so thrilled to get a chance to share! My hope is, and has been since I decided to become a public advocate for this cause, that by allowing myself to be vulnerable, it will resonate with people.   

I want to personally thank all of the people who made this campaign possible, and  I encourage you to start a discussion about dementia using the #ilivewithdementia

Read my story. 

Sundowning: Late-Day Confusion for People with Dementia

Over the holidays, my brother and I tried to visit our mother on a daily basis.  My brother mentioned that he preferred to visit in the morning, because her behaviour changes significantly after the sun goes down.

This neurological phenomenon is known as Sundowning or Sundown Syndrome, which I witnessed firsthand while working at an assisted living facility.

Sundowning is an ailment of Alzheimer's Disease and other forms of dementia, and is most prevalent in the elderly, that causes symptoms of confusion after "sundown."

Dementia sufferers purport periods of extreme anxiety, increased confusion, delusions or paranoia during mid-afternoon to early evening, although specific behavioural changes are unique to the individual.

Interestingly, the specific causes of sundowning is considered somewhat of a medical mystery and has not been empirically proven to date. There are several theories on the exact cause, but some evidence suggests that disruption to the circadian rhythm can directly impact sundowning behaviours. 

Some doctors believe it’s an accumulation of the sensory stimulation from the day which begins to overwhelm and cause stress, while others speculate that Sundown Syndrome is caused by hormonal imbalances that occur at night. 

According to the Alzheimer Society of Canada, it is thought that sundowning can be a problem for as many as 66% of people with Alzheimer’s disease or other dementias.

These changes in behaviour can be very difficult and frustrating for caregivers. The good news is that there are several ways of coping with the confusion and irritability 

Here are some tips to help come with caring for your loved one after sunset. 

Christmas with Dementia

With only seven days left until Christmas, I am finalizing my plans to go and visit my family in Edmonton, Alberta, for the holidays. 

My brother and I used to have an annual tradition where we would take my mum out of the continuing care home for an overnight visit on Christmas Eve and wake up on Christmas Day to open presents as a family. I really cherished this tradition as it was one of the only times a year my mum willingly came out of the home.

Each year was stressful; for my mother, myself and the rest of the family, but the last few years became too much to bear. We decided to alter our tradition to bring brunch to the home and eat together as a family.

It is important to be adaptable with this disease as each day is different. Even if you have plans for how to pass the time, be it baking or sharing in conversation, the best you can do is to involve the person in a way that's not stressful, so that they feel included and needed.

A question to ask is how can the person with dementia contribute to this celebration? Remember, they’re doing the best they can and they still love you as much as they always have.

A few things that I have learned over the last 10 years of caring for my mum during the holiday season is:

  • Be patient to allow person with dementia to open presents without feeling rushed. Offer help if need be, but don’t try to hurry them along. 
  • Noise can be difficult to cope with for the person with dementia.  Remind friends and relatives  to keep the noise down, or try to keep one room in the house a quiet zone, where TV, music and noisy games (or people) aren’t allowed. 
  • Tell loved one if visitors are stopping by to minimize stress. Also, explain to visitors that they may see a difference in their behaviour or demeanour.
  • Don't about making Christmas perfect. Try to keep it real, and if things go wrong, keep your cool and maintain perspective. 

Here are some additional tips for supporting people with Dementia at Christmas.