Though Alzheimer’s disease is not curable, meaning there is no definitive treatment for the disease, diagnosing the disease at an early stage is important to ease the living of the patient as well as the caretakers. More often, it is the caretakers of the patient with Alzheimer’s disease most stressed out because of the problems occurring secondary to the disease.

How can diagnosing the Alzheimer’s disease help?

It is not helpful because the diagnosis of the disease would not change the management of the patient. But it would help gain an understanding of the reasons behind the behavior of the patient. At an early stage of the disease, the diagnosis would also enable the physician to start the medications to control the progress of the disease. These medications are only helpful during the initial stages of the disease, so an early diagnosis is very important.

How is Alzheimer’s disease diagnosed?

History: The evaluation of the patient would start with a detailed history. A young individual would recognize the symptoms and might be concerned. In case of an elderly, the family might be concerned of the patient. The recent behavior, the symptoms manifested, any unusual or uncommon patterns of behavior should be noted down. The date of onset of the symptoms or atleast the time duration of the present symptoms should be noted. Also, the mental status of the patient, the life style including the stress levels should be asked for. Any family history of the disease should be considered as well.

Cognitive tests: since dementia is the important symptom of the disease, a cognitive test to assess the level of forgetfulness is important. A mini mental status exam is conducted which might show lack of attention, affected problem solving, memory loss etc.

Investigations: Magnetic resonance imaging (MRI) and positron emission tomography (PET) scan could be conducted and may show brain changes, which may be considered as diagnostic.

A microscopic evaluation of the brain tissue is the only confirmatory test of Alzheimer’s disease. Since this is not possible, the physician has to depend on the history of the illness, the cognitive tests as well as the brain scans to make a diagnosis.

The initial presentation of the disease is by forgetfulness. The person tends to forget recent events, names of people who are associated with him/ her, numbers etc. Most of the time, this is attributed to age related changes ( if the person is an elderly) or stress if it happens in a younger person. Measures are advised to avoid stress so as to see whether there is a relief of the symptoms. In Alzheimer’s disease, there would never be a remission of the symptoms, but the memory loss only worsens. The initial stage of the disease is termed as predementia.

Once there is onset of the disease, the signs and symptoms only worsen. The patient becomes generally withdrawn, often irritable or aggressive, agitated when he can’t remember things, may not be able to find the location of his own house, starts wandering off, seems lost, may seem not able to remember words or phrases when speaking, writing abilities also might be impaired. There are often instances where elderly people are found wandered off a long distance from their homes, and then cannot remember anything related to their families (names, phone numbers etc). This level of the Alzheimer’s disease is called early dementia. The patient is still able to remember the incidents related to his childhood, may recognize people from early life, might be able to undertake activities of daily living under supervision and lead a life at home.

The disease then progresses to a stage where the patient might not recognize his own family, may not be able to speak or write properly, gets agitated or irritable more often, the distant memories which was retained till this stage also seems lost, control of body movements like urinary or fecal continence might be lost, may not be able to maintain the activities of daily living. This is moderate dementia.

The end stage of Alzheimer’s disease is advanced dementia when the patient is very terminal with all the bodily functions gone. Feeding has to be done by another person, other activities of daily living are also done by another person, and the patient is often bedridden and deteriorated. At this stage, infections or other diseases often set in and death results mostly because of the secondary illnesses.

Though a patient with predementia or early dementia may stay at home and requires only supervision, the patient with moderate or advanced dementia needs constant professional care. At the initial stage, measures like keeping a tag with the details of the patient and contact numbers of the family may be helpful. At advanced stage, relatives might consider transfer to a home care facility where skilled care is available.