Page 137 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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When Did Ronald Reagan's Alzheimer's Begin?

During a deposition in 1990, President Ronald Reagan could not recall the name of the chairman of
the Joint Chiefs of Staff. We now know that he went on to develop Alzheimer's disease. Did he
already have the disease at that time, or perhaps even earlier? While we will never know the answer
definitively, his experience illustrates how Alzheimer's disease often starts. In Reagan's case it began
with forgetting names, a common symptom of age-related memory loss. This is classic for
Alzheimer's disease: in its very early phases, it is nearly impossible to distinguish it from memory
loss solely due to the aging process, but over time, other symptoms develop. (Recall the case of
Frieda Kohlberg, the seventy-four-year-old Holocaust survivor with a genius-level IQ whose only
neuropsychological abnormality was a subtle deficit in recent memory; this was the first sign of
Alzheimer's disease.) But with all the new technology now at our disposal, isnt there a better, more
accurate way to make an early diagnosis of Alzheimer's disease?

Making an Early Diagnosis

The short answer is that no diagnostic test has been consistently proven to be better than a
comprehensive neurological and psychiatric evaluation with careful history taking (increased age,
low education are known risk factors), supplemented by a neuropsychological test battery, in making
the diagnosis of Alzheimer's disease. The long answer is that there are many promising tests, each of
which may have some clinical utility.

Early Diagnostic Tests for Alzheimer's Disease

1. After neurological and psychiatric evaluation, neuropsychological testing is essential.
2. Reduced ability to discriminate among smells (odors).
3. Hippocampal and parahippocampal atrophy on MRI scan.
4. Temporoparietal blood flow and metabolism deficits on SPECT or PET.
5. Decreased A-Beta protein amyloid and increased tau protein levels in the cerebrospinal fluid.
6. Presence of apolipoprotein E e4 genotype.

I will cover each of these in more detail.