Is There a Definitive Test Today That Can Diagnose Alzheimer’s Disease? | TLA0041

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody. Welcome back to another new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host, and I have a question for you. Are any of you feeling tired? Totally confused about how Alzheimer's disease is even diagnosed these days. I even get confused sometimes because a lot of people will say, yeah, my mother has been diagnosed with Alzheimer's disease, or my father has been diagnosed with Parkinson's disease. And the word diagnosed is a very common term that we use. And when our doctors tell us that our loved ones have been diagnosed or have Alzheimer's disease, we believe that's an accurate diagnosis. So I want to dispel the confusion and really clarify the diagnostic process for Alzheimer's disease and some of these other brain diseases that cause dementia, because It's vague and it's confusing. So as of this broadcast, I want to tell you, and I've updated the research, I want to give you the most updated information. There still is no single definitive test for diagnosing Alzheimer's disease. Unfortunately, we're just not there yet. Diagnosing Alzheimer's disease typically involves a combination of medical and neurological evaluations. So doctors can test for certain diseases that might mimic or cause the similar symptomology that we see in Alzheimer's disease and some of the other brain diseases that cause dementia. So they can pretty much rule out what it's not. But in terms of a definitive diagnosis, there's only still one way to determine if somebody has Alzheimer's disease, and that is after their passing. If a brain autopsy is performed, the doctors can see if somebody Dr. Lisa Skinner's brain is filled with the plaques and tangles that cause Alzheimer's disease. So this is the process that a doctor will take you through to make his best educated and professional determination as to whether or not somebody is possibly suffering from Alzheimer's disease. And the other thing, there's so many other complicated factors that go into the mix that I'm going to cover with you in just a minute. But I've mentioned this before, people live with what we call mixed dementia. So they can have Alzheimer's disease and another brain disease that causes dementia happening simultaneously in their brains. I'll use Parkinson's disease as the second example. You can have Alzheimer's and Parkinson's, happening at the same time. And guess what? There's no definitive test yet for Parkinson's disease either. And that's what really makes these diseases so, so complicated and difficult, is, um, that through process of elimination, doctors can, yes, eliminate— it's not this, it's not this, it's not this. And I'll go into a couple of examples in a little bit, but to actually have a definitive test like we have for cancer and some of the other medical conditions we all— we suffer from. As of right now, there is nothing that will definitively tell us if somebody truly has Alzheimer's disease or even Parkinson's disease and some of the other diseases that attack our brains. That fall under the category of dementia-related diseases. So the doctor will take your medical history, including your symptoms and your neurological function, your overall health, your medications. Those are very important to know what medications you're taking. They will perform physical and neurological exams. They will probably administer a couple of mental status and cognitive tests that they use routinely to test your cognitive function. They'll get blood tests to see if there's an underlying disease or medical condition happening that might be contributing to the symptoms that you're presenting with. They do. We do have brain imaging tests, but the tests that we have available right now can indicate possibly that something's going on in the brain, but there's still nothing that definitively shows up. So while all these tests and evaluations can strongly indicate The presence of Alzheimer's disease, a definitive diagnosis can only be made with certainty through a brain autopsy after death. And I think this is really important to understand. However, advances in brain imaging and biomarker research are finally leading to the development of more accurate and reliable diagnostic tests for Alzheimer's disease And research in this area continues. So I want to share with you a true, couple true stories. Those of you, and I'm dating myself, who remember Kris Kristofferson, that very dynamic and handsome musician and actor who played with Barbra Streisand in A Star Is Born, and he was one of the Highwaymen with Johnny Cash. Kris Kristofferson was a perfect— is a perfect example of not being able to definitively diagnose Alzheimer's disease. He was showing a variety of symptoms that resembled and mimicked Alzheimer's disease. Many, many, many symptoms. He was put through a battery of tests and the doctors that he was working with finally concluded that he truly had Alzheimer's disease, and he was treated for 3 years for Alzheimer's disease. And then one of his doctors got the idea to test him for Lyme disease. And guess what? Turns out the man had Lyme disease. So they stopped treating him for Alzheimer's disease and started treating him for Lyme disease. Urinary tract infections can mimic the same exact signs that we see with people living with dementia. So one of, one of the brain diseases that causes the symptomology that we see that those brain diseases like Alzheimer's cause The difference is if you have a urinary tract infection, and if you don't know this, both men and women get urinary tract infections. The symptoms come on quite, quite suddenly. And that's not the case with Alzheimer's disease or with some of these other brain diseases. It's a very slowly progressing disease. When I worked in a building years and years ago, I had a woman— I was the community care counselor, and I was responsible for admitting new residents and doing all the assessments. And I had a woman come into my office one day, and she said, Lisa, you have to help me, you have to help me. My mother just all of a sudden has developed dementia, and I need to to get her into your memory care unit. And I said, it came on that suddenly? And she said, yes, just like out of nowhere. She's confused. She doesn't know who she is. She doesn't know where she is. She barely remembers her name, let alone what she had for breakfast. And of course, that was a huge red flag for me because I've been working with families and dementia and people suffering from it for 30 years now, and I— you just don't see it come on that quickly. So I said to her, before you conclude that your mom has Alzheimer's disease or a related dementia, I would strongly suggest that you take her to the doctor and have her tested for a urinary tract infection, because we know— I said, I see this all the time. That urinary tract infections can bring on the same and similar symptoms, but they come on very suddenly. She says, "Well, I just had her at the doctor. They didn't offer to test her for a urinary tract infection." I said, "Well, I think that we need to eliminate that first." So long story short, she takes her mom back to the doctor. She insists on a urinary tract— a urinary infection test. And sure enough, she has a urinary tract infection. She'd had it for a while. It went septic. It was in her blood. And once it gets into your blood system, then you start seeing very similar symptoms to Alzheimer's disease and related dementia. Fortunately, those symptoms can be reversed with a urinary tract infection. So once you get on an antibiotic, The antibiotic can kill the bacteria that's causing the urinary tract infection, but once it gets into your blood, it's going to take weeks for it all to clear out. So even when— if they complete their regimen of antibiotics, it will take several more weeks before you see those symptoms subside completely and go away. Parkinson's disease is another very interesting brain disease. I mentioned there is no definitive test for it, which there is not. Again, another process of elimination. But one thing that makes Parkinson's disease so unusual versus Alzheimer's disease is Parkinson's disease can be accompanied by dementia once it starts damaging the brain. But people live with Parkinson's disease without the dementia component to it, like Michael J. Fox. He's been living with Parkinson's disease for over 30 years, but his brain has not been affected by the Parkinson's disease. And then we have, you know, probably half the other people who develop Parkinson's disease, and they get the dementia with it. So you see the confusion. Probably the strongest hallmark of Parkinson's disease are hallucinations. So people hear things that aren't there. They see things that aren't there. This is very, very common in Parkinson's disease, but it's also very common with Alzheimer's disease. And again, throwing that extra layer of complication into the mix, a person seriously can have both of them happening at exactly the same time, which just, you know, makes the whole situation that much more difficult to manage and to understand and to deal with. A lot of people aren't aware of this, so I want to make sure you understand that. There is a fairly new— it's not brand spanking new, but it's one of the newer imaging tests that are available. It's called the PET scan, and it's— PET is short for positron emission tomography. And they actually can be used to detect the presence of beta amyloid plaques. And tau tangles in the brain, which are, by the way, the hallmarks of Alzheimer's disease. But there are several reasons why PET scans are not universally used as a primary tool for diagnosing Alzheimer's disease in routine clinical practices right now. And the reasons why are the cost. A PET scan, especially those using specialized tracers to detect the beta amyloid or tau, can be extremely expensive and cost prohibitive. So the high cost as a result may limit access to these scans for some patients, and they may not be covered by all insurance plans. Plans. PET imaging facilities with the capability to perform scans for the beta amyloid or tau are not as widespread as facilities offering other types of imaging, such as the MRI scans or the CAT scans, the CT scans. This limited availability can restrict widespread use of PET scans for Alzheimer's diagnosis. While PET scans can detect the presence of beta amyloid plaques or tau tangles, here's another complication. The interpretation of these findings in the context of diagnosing Alzheimer's disease is not always straightforward. And this is because the presence of these biomarkers, the plaques and the tangles, does not always correlate perfectly with the presence or severity of cognitive impairment. Some individuals may have significant beta amyloid or tau pathology. In other words, their brains are filled with these plaques and tangles, but they don't show the symptoms of the disease. While others may have dementia symptoms, without significant levels of these biomarkers. Another problem with PET scans and why they're using it primarily in clinical trials right now is availability, cost, the cost perspective of it, and the fact that insurance companies just aren't routinely covering it now. So again, it puts limitations on this as a resource for helping diagnose Alzheimer's disease. It is, it's, it's, it's not an accurate diagnosis, as I just mentioned. So the PET scans are typically performed at specialized imaging centers or hospitals that are equipped with PET scanners, but they're not all equipped with them. Not every special imaging center or hospital even has a PET scan. These facilities have the necessary equipment and trained personnel to conduct PET scans and interpret the results. So if you do have, um, a prescription or a referral for a PET scan, then make sure you're being referred to a place that has a specialist trained to conduct them and to interpret them. PET scans Can be helpful in supporting the diagnosis of Alzheimer's disease, especially when used in conjunction with other clinical assessments and when interpreted alongside a patient's clinical symptoms and other diagnostic information. They can contribute to the overall assessment of Alzheimer's disease. But Once again, nothing certain, nothing definitive. So the other thing I want to share with you, and I ran across these years and years ago, and this is one of the reasons why I personally have been aware how complicated and difficult the diagnostic process is for Alzheimer's disease. And this, I want to tell you about something that I came across, I don't know, 20 years ago called the Nun Study. It was a longitudinal research project that began in 1986, and it involved the study of a group of Catholic nuns in the United States. The study was led by Dr. David Snowden, a neuroscientist at the University of Minnesota and then later at the University of Kentucky. The Nun Study aimed to investigate the relationship between early life factors, cognitive function, and the development of Alzheimer's disease and other age-related conditions. The reason why he chose nuns for the study is because they all had a very, very similar lifestyle. So he felt he wasn't going to have to factor out a variety of different lifestyle factors that played into the study. They all lived together, they all worked together, they were all the same age group. And what he did was, for everybody who agreed to participate in his study, he asked them that after their passing, would they agree to having their brains autopsied after their death? And every one of them agreed. And that's what made this study so fascinating and contradictive. And this is what I found fascinating. So what they did was they filled out detailed health and lifestyle data. And they detailed information about their early lives, their educational backgrounds, their cognitive function, and their health histories. This rich dataset allowed researchers to explore the potential influences of early life factors on cognitive aging and Alzheimer's disease risk. Then, of course, they all agreed to donate their brains for autopsies and neuropathological examination. So here are the insights on what the study found and why it was so, uh, important. The Nun Study contributed to our understanding of cognitive reserve which refers to the brain's ability to maintain normal cognitive function in the presence of neuropathological changes. The study provided evidence that some individuals with significant neuropathological changes in the brain did not exhibit the clinical symptoms of Alzheimer's disease during their lifetimes. Suggesting that factors such as education and cognitive stimulation may contribute to cognitive reserve. I'll explain what that is in just a second. Overall, the Nun Study provided valuable insights into the complex interplay of biological, lifestyle, and environmental factors in cognitive aging and the development of Alzheimer's disease. The findings from the study have contributed to our understanding of dementia risk factors and the potential protective effects of certain early life experiences and cognitive engagement. So what does this mean? Again, what the study concluded after the autopsies were performed was that some of these nuns were found to have— their brains were completely engulfed in plaques and tangles. And by all means, they should have been, by the times of their death, they should have been in the advanced stages of Alzheimer's disease and showing advanced symptoms of Alzheimer's disease. They showed no symptoms of Alzheimer's disease. There are other nuns who, upon their autopsies, showed little, very little to no plaques and tangles in their brains, the hallmark of Alzheimer's disease, but they were symptomatic in their lifetime. So they went through the progressive brain changes that happen with Alzheimer's disease from mild to moderate to severe. So that's a conundrum right there, a quandary that nobody can really answer, and have pretty much drawn the attention to other factors that attribute to our risk of developing the symptoms of Alzheimer's disease. There was another study done after the Nun Study at a retirement center in a retirement community in Florida. Same thing, they gathered, I don't know, over 100 residents that were in their 90s, took very detailed and lengthy health histories, medication histories on these people, and then studied them as they aged, and they all agreed to donate their brains for an autopsy. And guess what? They found the same results as they did with the nuns. Some of the people who had passed away showed plaques and tangles in the brain that showed no symptoms in their, uh, while they were alive in their lifetime, and vice versa, just like the nun study. So this is part of the reason why there's stronger evidence now that it's just not set in stone, a conclusion that if your brain contains plaques and tangles, you definitely have Alzheimer's disease. You do have Alzheimer's disease, but you might not be showing any symptoms of Alzheimer's disease, and vice versa, which is just complicates our whole situation even more. So what is cognitive reserve? It is known that one of the risk factors that could increase a person's risk of developing Alzheimer's disease at a, a later stage in their life is their level of education. And one of the things that we know is the higher our level of education, all the way up to, you know, a JD or PhD, will not prevent us from developing Alzheimer's disease. I have seen many, many, many very intelligent people, scientists and doctors and lawyers, who live with Alzheimer's disease. But the higher level of education you have, the lower your risk will be of developing it. And the reason why is because the more you use your brain at a younger age and higher level of education, you build up what is called a cognitive reserve. And what that does is refers to the brain's ability to maintain normal cognitive function despite the presence of those plaques and tangles. In other, in other words, brain pathology such as that associated with neurodegenerative diseases like Alzheimer's. The concept of cognitive reserve suggests that individuals with higher cognitive reserve may be better able to withstand the effects of brain changes before exhibiting noticeable cognitive decline and/or the symptoms of dementia. Cognitive reserve is thought to be influenced by a combination of genetic, developmental, occupational complexity, intellectual and social engagement, bilingualism— in other words, speaking more than one language— um, and it is believed to be a form of neuroplasticity, which reflects the brain's ability to adapt, reorganize, and function effectively despite underlying neuropathology. So if you weren't confused before, I'm sorry if you're feeling even more confused now. These diseases are just so complicated and there's always something being additional being thrown into the mix to keep us confused, to confuse us more. You know, the scientific community is feverishly out there working to try to find treatments, cures, causes, of how, what we can do, and lifestyle choices that we can make to lower our risk of developing Alzheimer's disease. We know that the projections are by the year 2050, the number of people living with Alzheimer's disease is projected to triple by then. That's only 20 1 year away off. So the more we know, the better off we're going to be. This information is really all based on evidence-based scientific studies. So we know that most of this, they have found direct correlations to Alzheimer's disease. So that's the show this evening. I hope this has been really helpful. And I hope that this really has clarified some of the questions that a lot of you have as to whether or not there is, as of right now, a definitive diagnosis to determine if any of us are suffering from Alzheimer's disease. So I'll be back next week with another new episode of The Truth Lies in Alzheimer's Show. Again, I'm Lisa Skinner, your host. I appreciate you being here so much, and I look forward to seeing you again next week. Thanks so much for being here.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. You're not alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.