Alzheimer’s Disease – Understanding the Diagnosis

We see a lot of people in our practice who have been told they may have Alzheimer’s disease. or they do have Alzheimer’s disease. You have to step back and see how that diagnosis was made. Sometimes they go to their provider who does a simple memory test called a Mini-Mental State Examination or the St. Louis University Mental Status Examination. The patient receives a couple of basic blood tests and maybe they’re sent for some brain imaging like an MRI or a CAT scan of the brain. The provider looks at these tests, and when the blood tests and the MRI look normal, and the Mini-Mental Status Examination is in the abnormal range, they’re told that they have Alzheimer’s disease. But the reality is that there are much more sophisticated ways of making the diagnosis. Unfortunately, unless we use those sophisticated approaches, you’re going to have a lot of people told they have this condition when in fact they don’t.

So what do we do at Sharlin Health and Neurology?

First of all, you come in and you do your usual office paper work, and you have an appointment with me. We spend a good amount time together taking a detailed history, going through a comprehensive neurological examination, including a more detailed, but still fairly brief, memory test called the Montreal Cognitive Assessment. This is still more or less of a screening tool, but it’s definitely more sensitive to Alzheimer’s disease as a diagnosis than the Mini-Mental Status Examination. We either perform blood work or we review blood work to make sure that all the necessary blood work has been done, and it is necessary to have imaging.

MRI: NeuroQuant Technology

Now, there is brand new software for the MRI that is called NeuroQuant software. The reason this is very interesting and important is that NeuroQuant software actually measures the volume of the region of the brain affected in Alzheimer’s disease. We can compare that brain, the brain volume of our patient to normal brain volume and determine if there’s been significant shrinkage, or what we call atrophy, in that brain region. That gives us much more specific information than a standard MRI without volume measurements. But that’s just the first step. We can use other tools like PET imaging or we routinely perform spinal fluid examinations using what are called biomarkers which are specific to this condition, something called Abeta42 and tau protein. These proteins measured in the spinal fluid can tell us, with a very high degree of certainty, whether the diagnosis is correct or not.