Neurology Conditions

Alzheimer's disease is a gradually progressive illness of the brain. Usually the earliest symptom is short-term memory loss. Often people with early Alzheimer's disease may appear normal to acquaintances. However, loved ones and close friends may notice repetitious questions or comments. People with Alzheimer's disease may also have difficulty recalling appointments or managing checks or bills. With time other areas of thinking become affected. Often this can be seen with new difficulty in planning an outing, solving problems, difficulty with familiar tasks at home or work, confusion with time and/or place, trouble understanding visual information (e.g. reading or road signs), difficulty recalling words, problems keeping up with a conversation, and frequent misplacing things.

As Alzheimer's disease gradually progresses, people have increased difficulty performing their routine tasks at home, work, or in a social settings. These may include difficulty managing finances, putting away dishes, preparing a meal, using a computer, learning a new task for work, and playing a game (e.g. golf, tennis, or cards). With time, other problems can include getting lost, wandering away from their home, seeing things that are not real (i.e. hallucinations), believing things that are not true (i.e. delusions), or behaving inappropriately in a social situation.

The doctor will determine when problems with thinking and/or memory began, whether they progressed, how they impacted the patient, and what other symptoms are also present. Because Alzheimer's disease affects memory, it is vital that the doctor gets information from both the patient and someone who knows the patient well (e.g. a spouse, family member, or close friend). The doctor will examine the patient and often order ancillary medical tests. These may include:

• Neuropsychological testing - Test different parts of someone's thinking and memory. They may also be used to find out whether someone is progressing or not.
• Brain scans - Include CT or MRI's of the brain and look for abnormal shrinkage of the brain, tumors or strokes that may be causing the problems with memory or thinking. More rare, sophisticated tests of brain activity include PET scans.
• Blood work - Include tests for hormone and vitamin deficiencies as well as metabolic abnormalities that could cause problems thinking
• Lumbar puncture (spinal tap)- Tests for proteins in the spinal fluid that baths the brain.

Current treatments for Alzheimer's disease are aimed at improving the memory system of the brain. Cholinesterase inhibitors are the first class of medications that do this. There are several different formulations within this class that all act in the same basic way. The second class of medications is an NMDA-antagonist, called memantine. The two different classes of medications may be used together, but they are not without their side-effects. A physician will help choose the drug or combination of drugs that is most likely to benefit someone.

Memory loss and decline in thinking abilities are serious and anyone experiencing them should be evaluated by a physician. At Emory, we tailor our approach to the individual concerns and problems the patient is experiencing so no two evaluations are exactly alike.

Initial evaluations typically include the following:

• Complete medical history including obtaining information from someone who knows the patient well
• Neurological exam
• Neuropsychological testing (paper and pencil tests of thinking and memory)
• Blood tests
• Brain scans (CT, MRI, or PET)

After our initial evaluation, we provide you with a detailed assessment based on our findings. Many patients want to include their entire family with them during this assessment and we welcome that.

Our team of providers include:

• Physicians with expertise in dementias and Alzheimer's diseases
• Neuropsychologists with expertise in dementias and Alzheimer's disease
• Advanced Practice Nurses who specialize in treatment of dementia
• Social workers with tremendous experience helping those with dementia and Alzheimer's disease
• Neuropsychometric Testers (someone who administers the pencil and paper testing
• Phlebotomists (someone who draws blood)

Watch the following segment from “Your Fantastic Mind,” which focuses on recently discovered preventive measures that help decrease the risk of getting Alzheimer’s disease: