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Alzheimers Autoimmune Diagnosis
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Abnormal Brain Tissue Findings
1. Plaques and Tangles
Microscopic brain tissue changes have been described in Alzheimer's disease since Alois Alzheimer first reported them in 1906. The two principal changes are senile or neuritic plaques (chemical deposits consisting of degenerating nerve cells combined with a form of protein called beta amyloid) and neurofibrillary tangles (malformations within nerve cells).
The plaques found in the brains of people with Alzheimer's disease appear to be made, in part, from protein molecules--amyloid precursor protein (APP)--that normally are essential components of the brain. Plaques are made when an enzyme snips APP apart at a specific place and then leaves the fragments--beta amyloid--in brain tissue where they come together in abnormal deposits. It has not as yet been definitely determined how neurofibrillary tangles are formed.
2. Brain Scans
Magnetic-resonance imaging (MRI), probes the brain by examining the interaction of the magnetic properties of atoms with an external magnetic field. MRI provides both structural and chemical information and distinguishes moving blood from static brain tissue (Taylor, 1990).
Clinical Features of Alzheimer's Disease
The "clinical" features of Alzheimer's disease, as opposed to the "tissue" changes, are threefold:
1. Dementia--significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning;
2. Insidious onset of symptoms--subtly progressive and irreversible course with documented deterioration over time;
3. Exclusion of all other specific causes of dementia by history, physical examination, laboratory tests, psychometric, and other studies.
Diagnosis by Exclusion
Based on these criteria, the clinical diagnosis of Alzheimer's disease has been referred to as "a diagnosis by exclusion," and one that can only be made in the face of clinical deterioration over time. There is no specific clinical test or finding that is unique to Alzheimer's disease.
Meanwhile, Alzheimer's disease is the most overdiagnosed and misdiagnosed disorder of mental functioning in older adults. Part of the problem, already alluded to, is that many other disorders show symptoms that resemble those of Alzheimer's disease. The crucial difference, though, is that many of these disorders--unlike Alzheimer's disease--may be stopped, reversed, or cured with appropriate treatment. But first they must be identified and not dismissed as Alzheimer's disease or senility.
Conditions that affect the brain and result in intellectual, behavioral, and psychological dysfunction are referred to as "organic mental disorders." These disorders represent a broad grouping of diseases and include Alzheimer's disease. Organic mental disorders that can cause clinical problems like those of Alzheimer's disease, but which might be reversible or controlled with proper diagnosis and treatment, include the following:
- Side Effects of Medications: Unusual reactions to medications, too much or too little of prescribed medications, combinations of medications which, when taken together, cause adverse side effects.
- Substance Abuse: Abuse of legal and/or illegal drugs, alcohol abuse.
- Metabolic Disorders: Thyroid problems, nutritional deficiencies, anemias, etc.
- Circulatory Disorders: Heart problems, strokes, etc.
- Neurological Disorders: Normal-pressure hydrocephalus, multiple sclerosis, etc.
- Infections: Especially viral or fungal infections of the brain.
- Trauma: Injuries to the head.
- Toxic Factors: Carbon monoxide, methyl alcohol, etc.
- Tumors: Any type within the skull--whether originating or metastasizing there.
In addition to organic mental disorders resulting from these diverse causes, other forms of mental dysfunction or mental health problems can also be confused with Alzheimer's disease. For example, severe forms of depression can cause problems with memory and concentration that initially may be indistinguishable from early symptoms of Alzheimer's disease. Sometimes these conditions, referred to as "pseudodementia," can be reversed. Other psychiatric problems can similarly masquerade as Alzheimer's disease, and, like depression, respond to treatment.
. If a person in his thirties misplaces keys or a wallet, forgets the name of a neighbor, or calls one sibling by another's name, nobody gives it a second thought. But the same normal forgetfulness for people in their seventies may raise unjustifiable concern. On the other hand, serious memory difficulties should not be dismissed as an unavoidable part of normal aging.
The Importance of a Comprehensive Clinical Evaluation
Because of the many other disorders that can be confused with Alzheimer's disease, a comprehensive clinical evaluation is essential to arrive at a correct diagnosis of symptoms that look like those of Alzheimer's disease. Such an assessment should include at least three major components--(1) a thorough general medical workup, (2) a neurological examination, and (3) a psychiatric evaluation that may include psychological or psychometric testing. The family physician can be consulted about the best way to get the necessary examinations.Is there any treatment?
IVIG is the best treatment.