Diagnosing Alzheimer’s Disease
Dr. Gregory T. Golden, chief of research and development at the VA Medical Center in Coatsville, Pennsylvania, is part of the hospital’s Dementia Outpatient Clinic Leadership Team. Dr. Golden first learned about Nymox during a Society for Neuroscience meeting. The VA hospital had a large population of mostly late-stage Alzheimer’s patients, and the outpatient clinic was trying to attract veterans in the early stages of Alzheimer’s disease who were just beginning to have memory difficulties.
Q: Have you used the AD7C test in your programs?
A: Yes. We have used it in selective patients when we weren’t really sure what was going on, especially patients who would come in with memory complaints that didn’t seem to be progressing. On at least two occasions, we have had patients whose repeat urine tests did not change in terms of the neural thread protein level; it stayed in the normal range. The result prompted us to look for something other than Alzheimer’s in these patients.
Q: Was the test helpful in ruling out Alzheimer’s as the cause of the memory deficit?
A: Yes, it can be beneficial in that sense, too. Its benefit will become more apparent in the very near future as more effective, relevant therapies become available for treating Alzheimer’s disease. There are also other tests that need to be done in conjunction with this. None of these tests are 100 percent; you can’t rely on one test. You have to do the examination.
Q: What other tests and exams do physicians use to verify the diagnosis of Alzheimer’s?
A: A neurologist will look for all other possible causes of dementia, including potentially reversible ones like vitamin deficiencies, especially B vitamins; heavy metals in the blood; any kind of disease that might affect your thyroid gland, liver, kidneys. Depression in an elderly patient, for example, can also mask as dementia. Sometimes treating the depression lifts the symptoms that look like dementia.
You also have to worry about vascular dementia–multi-infarct dementia, where patients are having many small strokes in their brain.
There are lab tests. And if someone suspects an illness such as Creutzfeldt-Jakob disease, an EEG might be ordered.
Sometimes a workup will include some form of imaging technique–a CAT scan or a MRI–to rule out the possibility of a structural problem in the brain–a tumor, meningitis, or infection–that could be causing the symptoms.
Q: What about mental status tests?
A: The mainstays that we use for mental status testing include the clock-drawing test. In this test, you ask the patient to draw the face of the clock and then to draw the figures on a clock. The results can be scored depending on how well they do. After that, you actually ask them to draw the hands of the clock so that the clock reads a particular time, such as 10 minutes after 11:00, which can be scored. The test seems to be a very accurate way of tracking the progress of the dementia.
The mini-mental status test is a series of questions, such as: do you know where you are, what is the name of this hospital, do you know what season it is, what month it is, what year it is? And name three unrelated objects–such as a pen, ball, and shoe–which you then ask the patient to repeat three times. You will then go back in a few minutes after asking the patient to count backwards and ask the patient to name those three items again. You end up with a score between one and 30, 30 being perfectly normal–the lower the score, the more abnormal the test results are. This exam will include other tasks like figure construction, such as asking them to perform certain movements with their hands–taking a piece of paper, folding it in half, and placing it on the floor. You then see if he or she can follow those movements. There are series of tests like this that can be given in about 10 minutes.
Mini-mental state test scores can be used to screen for memory deficits.
You also look for speech difficulties either in the comprehension or production of speech. One would note agnosia–ignoring objects in your visual field, even though you can see them–and apraxia, an inability to do previously known, learned motor movements. Not that the AD patient can’t do the movements, but he can’t chain them together to respond–brush his teeth, button his shirt, or things like that.
Q: Is early detection of Alzheimer’s disease important?
A: There are many reasons why one would want to know. I would want to know because I would want to be involved with the planning and what is going to happen to me when I get to the point where I can’t make decisions for myself. It allows the patient to be involved in making plans for his or her life in terms of the progression of the disease.
An early diagnosis would also be important because it could help patients avoid other problems, such as motor vehicle accidents, by getting the patient to stop driving sooner.
If we are going to have a major impact on this disease, we have to have an early diagnosis. The National Institute on Aging estimates that if we could delay the onset of symptoms of Alzheimer’s disease by five years, we could cut the number of cases in this country by 50 percent. If you delay onset by ten years, it would cut the number of cases by 75 percent within a generation.
Q: Would yon recommend this test to other physicians and their patients?
A: I think that it is useful as an adjunct to the examination. I have looked at the science behind neural thread protein, and you can’t argue with the science. The people that did this research are very good scientists.
Q: They are working on drugs based on the spheron theory.
A: That is another thing about the company. They are not afraid to go against the mainline and do something really innovative. The evidence for the spheron is really intriguing. I have read the articles that they have published, and it is really incredible. They have 20 different characteristics that correlate very highly between these spherons and the amyloid deposit. When you think about it, this is the only disease that you see amyloid in the brain that deposits in a spherical lesion.
They were also the first ones to say that this amyloid is important, because it is inside the neurons. For years, people thought the amyloid was just gumming up the connections between the brain cells and neurons. At the last Alzheimer’s international conference, people were revising the beta amyloid hypothesis to say: It is not so much that the amyloid plaque is outside in the extracellular space; it is the processing and trafficking of the amyloid inside the neuron that is important. No one until very recently has ever really been able to identify beta amyloid in the neuron itself. Nymox is saying it’s there; it’s been there all the time in the form of spherons. As spherons mature, they will eventually transform into the amyloid plaques. I think that this is an intriguing idea.
Q: How long does it take to get the urine test results?
A: I get them very quickly, usually between 24 to 48 hours. They are going to release another test that will make the assay even quicker, so you will get even more immediate results.
You Be the Judge
by Jose Schorr
Three friends were hunting on the open range in California. While one climbed a hill, two others remained below. A quail suddenly flew along the hillside. Both of the hunters below the bird aimed uphill and banged away. But of all their barrage of birdshot pellets, only one hit anything–the third hunter’s right eye. The injured hunter sued both of his companions. He pointed out that, beyond a doubt, one of them fired the shot that hit him.
The contention of the defendant hunters simmered down to arguing, “You were hit in the eye by only one pellet. Obviously it was fired by only one of us. So the other is not responsible. As you are unable to prove which one fired the shot, to fix damages on either of us might be penalizing us unfairly. Thus you fail to make a case.”
If you were the judge, how would you solve the dilemma of the trigger-happy hunting party?
The court ruled that both defendants were responsible. “It has been held that where a group of persons are on a hunting party … and two of them are negligent in firing in the direction of a third person who is injured thereby,” the court said, “both of those so firing are liable for the injury suffered by the third party, although the negligence of only one could have caused the injury…. To hold otherwise would be to exonerate both from liability, although each was negligent and the injury resulted from such negligence.”
Based on a 1948 decision by the Supreme Court of California.
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