Testing to detect early Alzheimer’s disease

Alzheimer’s disease strikes more than five million Americans, two-thirds of whom are women. Yet, one of the major challenges of the disease continues to be early detection.

Developing tests for Alzheimer’s diseases and even dementia is ongoing, but new research has revealed clinical approaches, self-tests, and self-analysis that may help identify cognitive decline before it becomes worse.

“So often most diagnoses occur late in its development when significant damage has already happened,” says Alan Castel, PhD, of the UCLA department of psychology. “While there is no cure for Alzheimer’s disease or dementia, the sooner it can be identified, the sooner available treatments can be used that may slow down its progression.”

Your nose may know

One promising self-diagnosis test may be literally right under your nose. A declining sense of smell may be marker of early stage Alzheimer’s.

Harvard University researchers examined the link between sense of smell, memory performance, and loss of brain cell function in 215 normal, elderly individuals. They used the 40-item University of Pennsylvania Smell Identification Test (UPSIT) along with other cognitive tests. They also measured the size of the entorhinal cortex and hippocampus–two brain regions involved with memory.

They found that those with a weaker ability to identify smells and a decreased memory also had a smaller hippocampus and a thinner entorhinal cortex. The sense of smell-Alzheimer connection appears to be linked to the first cranial nerve, which is often the initial brain area affected in cognitive decline.

Similarly, researchers at the University Florida devised a simple smell test using peanut butter. Participants in the early stages of Alzheimer’s disease had a dramatic difference in detecting the odor between the left and right nostril.

Researchers found that the left nostril was impaired and did not detect the smell until it was an average of 10 centimeters (about four inches) closer to the nose than the right nostril. This was not the case in patients with other kinds of dementia. Instead, these patients had either no differences in odor detection between nostrils, or the right nostril was worse at detecting odor than the left one.

While these tests require further refinement before they can be used definitively, they do suggest that a change in your ability to smell could be a warning sign.

Taking an at-home test

The SAGE test, (self-administered gerocognitive examination), is a short, 22-question test designed to measure memory, reasoning, visual-spatial, and other thinking skills.

Available for free online, it is for patients older than age 50. They can print out and take on their own, or in small groups. A few sample questions include:

* How are a corkscrew and a hammer similar? Write down how they are alike. They both are… what?

* You are buying $1.95 of groceries. How much change would you receive back from a $5 bill?

In a new study published in the journal, Neuropsychiatry and Clinical Neurosciences, researchers tested the SAGE test on 1,047 people age 50 and older, and found that 28 percent of them had cognitive impairment according to the test. (SAGE test makers recommend seeing your physician if you miss six or more questions.)

While the test cannot diagnose Alzheimer’s definitively, it is a good indicator of a patient’s cognitive abilities, according to the researchers. For instance, it may catch lapses in thinking abilities that might not come out in routine questioning or that patients may not notice themselves right away.

Signs you can watch for now

Another means to detect early signs is through self-analysis. You should consult with your doctor if you or a family member notices any of the following:

* Memory loss that disrupts daily life. Everyone forgets a name every now and then, but it could be something more if you constantly ask people to repeat themselves or forget important appointments.

* Difficulty performing familiar tasks. Trouble programming a new cellphone is understandable, but consistent problems in performing routine tasks like driving and making decisions may signal possible cognitive decline.

* Struggling with vocabulary. Routinely forgetting names of common objects and people you know and/or stopping mid-sentence due to losing your train of thought.

When it comes to Alzheimer’s disease and dementia, time is of the essence in terms of treatment. Utilizing these tests and self-reflection may help you identify a potential problem early so you can discuss it with your doctor.

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