Diagnosis of Alzheimer’s is often tricky, since it is often mistaken for similar conditions. Standardized criteria for the diagnosis of AD were published in 1984 and are still used today. Doctors will physically and psychologically examine a patient who is suspected to have Alzheimer’s to rule out other mental disorders or causes of dementia. Family members provide more clues toward the diagnosis during interviews with doctors.
The most definitive test to tell if a person is suffering from Alzheimer’s cannot be performed until after the person has died. Nerve tangles, protein plaques, and general brain shrinkage from cell death mark the brain of an Alzheimer’s patient.Medical researchers have also developed a simple, diagnostic eye test that involves no more than administering a certain type of eye drop. Alzheimer's patients are overly sensitive to the drug tropicamide, which is widely used by optometrists for the dilation of pupils. Early studies have shown that dilation observed in Alzheimer’s patients is faster than in healthy people. More study is necessary, however, before this test can be used as an accurate diagnostic.
Treatment takes three forms, one in modifying the biochemical pathway that is associated with the disease and is considered amenable to treatment, another is slowing the progression of the disease and the last form is modifying the behavioral aspects of the disease.
The pathway that is associated with the disease is the acetylcholinesterase pathway and medications that have been developed alter this pathway in some form. There are two drugs that have been approved by the FDA for use in AD: Tacrine (tetrahydroaminoacridine) and Aricept (donepezil). Donepezil is the current drug of choice due to once a day dosing and drug tolerability. These drugs are viewed as palliative treatment, and they may slow down the progression of the disease. It is important to note that no long term studies of the effectiveness of these drugs has been undertaken, but short term use shows measurable, but small, improvements in function. When the drugs are discontinued, the family may notice a marked deterioration in the patient’s condition. Other experimental drugs are available that either aim to slow Alzheimer’s or to treat some individual symptoms.
There are some drugs that have been used to slow the progression of the disease, mostly anti-oxidants: Vitamin E, an anti-oxidant and Ginkgo biloba. There were a number of studies performed that showed that the use of these two medications improved cognitive function slightly.
Modification of behavioral aspects of the disease is an important part of treatment of the disease. There are a number of different behavioral manifestations of the disease that need to be addressed and treated to keep the patients functioning at their highest level. These manifestations are depression, delusions and psychosis, sleep disturbances and wandering. Most antidepressants are effective in the disease and the choice of antidepressant is based upon tolerability and side effects. Delusions and psychoses are treated with neuroleptic drugs. Sleep disturbances are treated with behavior modification such as reducing daytime naps, increased exposure to light, restriction of time in bed and as a last resort sedatives and/or neuroleptic drugs.
There are experimental therapies that are being developed for the treatment of AD – new drugs as well as a new type of therapy called immunotherapy (vaccine development). These treatments raise hopes for new and better treatment and prevention.
While Alzheimer's cannot currently be cured or reversed, among the symptoms that typically develop, none is unique to Alzheimer's disease at its various stages. It is therefore essential for suspicious changes to be thoroughly evaluated before they become inappropriately or negligently labeled Alzheimer's disease. There are ways to alleviate symptoms and suffering and to assist families. Not every person with this illness must necessarily move to a nursing home. Many thousands of patients—especially those in the early stages of the disease—are cared for by their families in the community. Indeed, one of the most important aspects of medical management is family education and family support services. When, or whether, to transfer a patient to a nursing home is a decision to be carefully considered by the family.
