Test Procedures for Dementia

Suzanne is joined by Dr. Paul Winner, the Senior Director of the Premiere Research Institute and Attending Neurologist at Palm Beach Neurology in West Palm Beach, Florida. When family members see that mom may be fine, but maybe Dad starts to have some memory issues. How do you start the process of having the conversation to get them tested? Dr. Winner says, “I think you want to let people know that we have very good diagnostic methods today. We can actually determine what it is. It could be something simple. So you need to go to a center, essentially a memory disorder center. If you really have a problem, something that's essentially now affecting the family, that's no longer, “I'm worried if I have a little bit of an issue with my memory,” then you have to go to a memory disorder center. They need to get to a place that can do 1) a very, very good history and 2) a very good physical exam, and they're looking at domains of how the brain works. A good history can determine how long it's been that there's been memory issues. What was the initial problem? Was it a short term memory issue, was it an immediate memory issue, was it a behavior issue? Was it a movement problem? What is it? Because there's all different kinds of dementias, or maybe it's something else. A medication got changed a year ago and that's when this all started. So there are some simpler problems. There's thyroid conditions in the family and their medicine got changed. There's a lot of different variables. So a very good history, a very good physical exam. You need to do laboratory studies, basic laboratory studies, to make sure there is not a problem with thyroid. There isn't a B12 deficiency. There isn't an autoimmune or infectious process. This is not expensive and not hard to do. What happens next? Dr. Winner explains, “Next is a nerve behavioral test. You need proper testing on what is going on with the brain. Is the aspect that's wrong? Is it memory? Is an executive function? Is it processing speed? All the different aspects, attention problems, is there a non-functional area or multiple areas? This gives you a clue right away of what you're dealing with. Then you need a picture of the brain. You need to make sure there's not another explanation, or maybe there's a mix, there could be two dementias. Sometimes a brain tumor caused this. Sometimes it's a meningioma with edema, and we can treat that, and they're all better pretty quickly. “Then let's say we go through that and it's suggestive of Alzheimer's dementia. Well, you can make a clinical diagnosis, but you're not going to be right a lot of the time. You need to go to the next level. The next level is bio markers. We have serum bio markers, but essentially the gold study we should do is to use a PET scan, an amyloid PET scan, and/or add to that a tau pet scan. Two proteins are involved in Alzheimer's, amyloid and tau, so we can tell whether they're present. If you do not have significant amyloid deposits in the brain, you do not have Alzheimer's disease, period. But that test is expensive. It's $5, $6, $7,000, and it's not covered by insurance right now. “Why is it so important to do this? We need to know the diagnosis. We must get it correct, because certain medicines are being developed for Alzheimer's. Others are being developed for general dementias, others for Parkinson's. Others may work at all of these different dementias. We need to know what the person has, so we can select the right medicine as we move forward.” Learn more about the Athira Pharma Alzheimer's LIFT-AD research study, Interested in learning more? Contact Premiere Research Institute at (561) 296-3838, contact Dr Winner at (561) 851-9400 or learn more about him here. This podcast is courtesy of Athira Pharma.See omnystudio.com/listener for privacy information.