Diagnosing Alzheimer's: An interview with a

Mayo Clinic specialist

To diagnose Alzheimer's disease, doctors rule out several other conditions
and recommend psychological testing. It's tough but worth the effort, says
a Mayo Clinic specialist.
By Mayo Clinic staff

Eric Tangalos, M.D.

In this interview, Eric Tangalos, M.D., a primary care physician and co-director for education at
the Alzheimer's Disease Research Center at Mayo Clinic, Rochester, Minn., explains why older
people with memory problems should have a thorough diagnostic workup. If fears are confirmed,
information and planning can smooth the path for the ensuing years.

How can people recognize the early signs of Alzheimer's?

In the earliest stage of the disease, a diagnosis can be really difficult. What you're looking for is
something that doesn't fit with the individual's former level of function. That's why family
members often notice the symptoms first. The disease affects more than just memory it can
involve language, problem solving or even how we draw a clock.

It's easy to misplace your car in the parking lot. That's happened to all of us. But most of us
eventually find our cars. People with Alzheimer's lose the capacity to adjust and solve the
problem of the lost car. In fact, they might jump to the conclusion that the car has been stolen.

Alzheimer's is a progressive disease that first manifests itself with problems usually related to
memory. Over time, people have more difficulty with tasks. By the end of the disease process,
Alzheimer's is pretty easy to recognize. Our goal is to find out from family as quickly as possible
when something is truly amiss in order to do something about it.

What are the warning signs of Alzheimer's disease?

The Alzheimer's Association's 10 warning signs are:

1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
 4. Disorientation to time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Can magnetic resonance imaging (MRI) or computerized tomography

(CT) scans help in diagnosing Alzheimer's?
There's no biological marker at this time specific enough to prove that someone has the disease.
The brain typically changes with Alzheimer's, and those changes can show up in a variety of
characteristic ways. But that's not enough to make a diagnosis. There's a lot of overlap in what
we consider normal and abnormal, so even if some areas change on CT or MRI, the person may
still function quite well.

In our research, we use brain changes on MRI to help us assess the possibility of Alzheimer's. In
most clinical settings, brain imaging should be used only to rule out such things as hemorrhages,
brain tumors or strokes. However, we are getting closer and closer to defining Alzheimer's with
both laboratory and imaging tests.

What other diseases should be ruled out?

We'd want to check the thyroid, to rule out problems there. And, in many cases, the symptoms
of depression can be mistaken for Alzheimer's and vice versa. We also routinely look for
vitamin B-12 deficiency and always try to make sure that the person is generally healthy and
doesn't have some other serious medical problem that would complicate our diagnosis. A lot of
our older patients have other medical problems that just make things worse like heart
disease, high blood pressure, strokes, diabetes, kidney disease, lung disease or any combination
of these.

What other types of tests are helpful?

A two- to four-hour battery of neuropsychological tests is a routine part of our Alzheimer's
research at Mayo Clinic. We compare skill levels of people who may have Alzheimer's with those
of people at the same age and education level. We know that an 85-year-old is not going to
function as well as a 75-year-old. These tests show us exactly what people can and cannot do
based on comparisons to standard tests of people with the same sex, education and age.

From these studies and knowing what support they have at home, we can tell if the person can
still function independently or if he or she is really on the edge and should be looking for a safer
living environment. Alzheimer's is not an all or nothing phenomenon, so this is why we always
talk about what capacities are preserved and what capabilities may be lost.

What's the benefit of an early diagnosis?

There are both drug and nondrug interventions. Drug therapy isn't a magic bullet, but it can
delay or slow the progress of the disease. Alzheimer's drugs help some people more than others,
but in general, you end up better on the drugs than not on them. With this disease right now,
"better" is just not getting worse.
And an early diagnosis isn't just about starting drug therapy. You can change your home
environment and simplify the world around you. The sooner you move into a structured
environment, the more protected you'll be. The ideal setting is probably one that includes
independent housing, assisted living and nursing services on the same campus. The same
philosophy is at play throughout, so there's less to learn with each move.

What else can be done?

People with Alzheimer's do better when they have a routine to follow. It allows them to refresh
and reinforce their pattern of behavior every day. They get to relearn their habits over and over
and this is good.

When you put them in strange surroundings, they don't do well. That's why they may have
trouble when you bring them to your house for the holidays, or if they have to be hospitalized. A
change in routine is not good for people with Alzheimer's there are just too many problems to
try and solve.

The change in routine is one of the reasons why people with Alzheimer's often have such a swift
downturn after the death of a spouse. The spouse may have been helping to both think for and
protect the person.

What do you hope to see in the future?

I'd like to see people come in earlier for diagnosis. People hide their symptoms, or spouses cover
for them. That's easy to understand because Alzheimer's is such a dreaded disease. But just
because you have a memory problem doesn't mean you can't drive a car. We look for what you
have retained and do our best to keep you as healthy and safe as possible with as little
opportunity to fail.