Memory Loss Equals Alzheimers?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Alzheimer's Disease- Why So Hard to Diagnose?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Alzheimer's Biomarkers- What ARE They?

In yesterday's post about the new Alzheimer Disease (AD) guidelines, I talked about how Alzheimer's biomarkers represent hope for future early diagnosis and treatment of AD. But what the heck ARE biomarkers? Today I will clarify...

Biomarkers - short for biological markers-are any naturally occurring substances in the body that reliably predict or indicate a disease. Cholesterol, for example, can be considered a biomarker for heart disease. We know when cholesterol levels are very high, it is likely that plaques of cholesterol could be building up in the heart arteries, making it more likely that that person could have a heart attack. In the case of Alzheimer's disease, the pathological changes in the brain involve the buildup of certain types of protein around the nerve cells in the brain, as well as degeneration and breakdown of other nerve cells. The combination of these two problems makes it hard for the brain to function correctly, as messages can't be passed effectively from one part of the brain to another.

Biomarkers for AD include beta-amyloid protein (that builds up in plaques) and tau protein, which is part of "neurofibrillary tangles"- clusters of protein that block nerve conduction. Right now, these proteins must be measured in spinal fluid, which means the patient must have a spinal tap (aka. lumbar puncture) which involves a needle in your back near your spinal cord. The hope is that measuring levels of these proteins in blood or urine may also prove to be accurate predictors of AD, so the more invasive procedure is not needed.

Not all of today's biomarkers require spinal fluid. Genetic testing for APOE-e4, as well as other genes that increase risk for AD, can be done by a simple blood test. Additionally, imaging of the brain using MRI and PET scans can provide valuable information as well.

Unfortunately, the diagnosis of Alzheimer's disease is not black and white, even with use of biomarkers and the new guidelines. I'll delve more into the challenges of diagnosis tomorrow.

BOTTOM LINE: Biomarkers for Alzheimer's include blood tests, spinal fluid tests and brain imaging, and these procedures are primarily restricted to research settings in 2011.

Celiac Disease: Do I Have It?

This week I am talking about celiac disease, a very common problem that affects 1 in 133 Americans. With non-specific symptoms such as fatigue and abdominal bloating, how can it be diagnosed? As is often the case, it is not as clear cut as you might think.

The first caveat is that you must EAT wheat (gluten) for the whole month before you are tested to get the most accurate evaluation. Blood tests are performed that check your antibodies, including the most sensitive test (meaning it will miss the fewest cases, but may have some false positives) anti-tTG (anti-tissue transglutaminase antibody.)

The doctor must also test your IgA levels (immunoglobulin A) because if you are not making adequate IgA, you could test negative for celiac disease even though you have it. Additional blood tests include anti-endomysial antibody (EMA-IgA) and anti-deaminated gliadin peptide (DGP – IgA and IgG).

Ultimately, the diagnosis will need to be confirmed not only with a blood test, but with a small bowel biopsy which is done through endoscopy. The biopsy will look directly at the lining of the gut and determine what level of damage exists.

Alternatively, you can choose to follow a strict gluten-free diet, and if your symptoms resolve, it is likely you have celiac disease (or at least gluten-intolerance.) This is obviously less specific and accurate, but is certainly a good starting place.

BOTTOM LINE: If you are concerned you may have celiac disease, talk with your doctor about getting a simple blood test to help determine if you should go gluten-free.