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Josilyn Bulach

English Composition II

Vicki Stalbird

15 November, 2020

Diagnosing Alzheimer’s disease

Alzheimer’s changes not only the lives of the person who has it but the family and friends

around them. My grandfather is named Jim and when Jim was about 80 we started to notice he

was forgetting a lot. My grandma took him to the doctors and they told us he showed early

symptoms of dementia. Not only dementia but Alzheimer’s dementia. It was questioned how did

they know it was Alzheimer’s. There are many sources that claim one can not diagnose

Alzheimer’s before death. Alzheimer’s is diagnosed by using the process of elimination of the

other forms of diagnosed dementia’s.

First to understand how doctors diagnose Alzheimer’s they have to know what it is.

Alzheimer’s is a disease that destroys memory and other mental functions. On page 22 from, A

Pocket Guide to Understand Alzheimer’s Disease and Other Dementias, Section Two, “

Alzheimer’s disease is the most common form of dementia; about two-thirds of people with

dementia have Alzheimer’s disease”. The example is stating that Alzheimer’s is the most

common form of dementia. Out of all the cases of dementia two-thirds are Alzheimer’s cases.

Since this is the most common form doctors can diagnose it easier. Even though there are many

cases of dementia and it is seems difficult to diagnose while alive it is in fact easier due to

commonness.

Another thing doctors need to study to understand how to diagnose Alzheimer’s disease

are the symptoms. It is unclear what causes Alzheimer’s, but scientists now know what happens
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in the brain when it starts. For example on page 24 from, A Pocket Guide to Understand

Alzheimer’s Disease and Other Dementias, Section Two, it is stated that “an abnormal protein

called amyloid is made. Microscopic amounts of this amyloid protein are laid down in the outer

layers of the brain in clumps called plaques” and on page 25 is states; “this is thought to result in

the change of the structure of cells”. Amyloid protein is a protein in the cells. This is how the

brain starts to change when Alzheimer’s sets in. After this starts the brain starts to atrophy in the

memory and cognition parts of the brain. Atrophy is when the brain cells start to die and when

that happens the cells can never grow back so that part of the brain is no longer working. This is

important to doctors, so they can diagnose the problem. Knowing that this is how Alzheimer’s

starts is one of the most important part of diagnosing it. When looking at the brain doctors look

to see how it is changing or the damaged parts. This tells the doctor where the issue is and with

dementia where the atrophy starts tells the doctors what type it is. Doctors know the type of

dementia based on how the brain looks.

Due to the specific symptoms and brain atrophy the doctors can diagnose Alzheimer’s.

Out of the many symptoms the first symptom is told in A Pocket Guide to Understand

Alzheimer’s Disease and Other Dementias, Section Two, “The first symptoms are often minor

memory loss, which can be difficult to tell from normal forgetfulness as a result of getting older;

mild confusion”(Warner 23). This is probably the hardest to notice because as people get older

they become forgetful, so the first symptom can go unnoticed. It could be as simple as someone

not being able to find the right words for a sentence. Many of the dementia’s have subtle first

symptoms therefore the doctors may not know it is Alzheimer’s at first, but tests and brain scans

can show otherwise. Depending on how fast the disease is spreading it may go unnoticed for

years. This is a slow-progressing disease and the patient will eventually need around-the-clock
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care. Nothing seems to be wrong while this is happening because the symptoms are subtle, but

going to the doctor for a check-up can show these symptoms. Doctors can see things that you

may not and then they can perform tests to diagnose.

Brian Atrophy is the easiest place to see which dementia is forming. In the case of

Alzheimer’s memory and cognition is the part of the brain that starts to atrophy first. Cognition

is a mental action or process of acquiring knowledge and understanding through thought,

experiences, and the senses. Doctors can see this and diagnose Alzheimer’s. The atrophy is the

reason people lose their memories first, but people do not typically notice until the cognitive loss

starts because that is more noticeable. Someone may ask how doctors can see the brain change

and in the article, Alzheimer's disease. By: Martone, Robert L., Piotrowski, Nancy A., PhD,

Magill’s Medical Guide (Online Edition), it is stated that “pathological hallmarks are

accompanied by significant neuronal loss and brain atrophy, particularly in areas of the brain

involved in memory and cognition, such as the hippocampus and the temporal and prefrontal

cortex”. It is saying that marks in the brain significant neuronal loss, when the neurons start to

die, and brain atrophy mostly in places that deal with memory. The hippocampus is a small

curved formation in the brain that deals with forming new memories. Doctors take the brain

scans to see if there is something wrong and if this could explain why the memory and cognition

loss if happening. When doctors see the atrophy they look possible things to diagnose why that is

happening. Doctors look at the brain scans to see if the brain is atrophying in the center of the

brain; if the atrophy shows dementia. When they find that the brain shows dementia they then

look to see what kind. They run through the different places that all the dementia’s form and rule

out everything but Alzheimer’s. Doctors can see this and with knowing the symptoms they can

diagnose Alzheimer’s.
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One of the arguments against Alzheimer’s being diagnosed is that there are many forms

of dementia, so doctors cannot diagnose the difference between them while the person is living.

That is not completely true because there are four that are the most common. Alzheimer’s,

Vascular, Lewy Body, and Frontal Temporal dementia. This is the reason the symptom and brain

scans are so important. The doctors can see which dementia it could possibly be. Each of the

dementia’s may have similar symptoms, such as memory and cognition loss, but when and where

this occurs are the important factors. Doctors look at where the brain is atrophying, age, and the

different symptoms to diagnose the form of dementia.

It is stated in that Alzheimer’s is the most common form of dementia, but Vascular is the

second most common dementia and it is either on its own or it is mixed with Alzheimer’s. It is

stated that “Vascular dementia refers to dementia that occurs because the blood supply to the

brain is not as good as it should be or the blood supply to a part of the brain has been interrupted

by a stroke or hemorrhage”(Warner 30) This type of dementia can be caused by a stroke or a

hemorrhage; which is no blood flow to the brain. When there is no blood in the brain oxygen

does not get to the nerves of the brain and they start to die. This is different because Alzheimer’s

it is not caused by a lack of blood flow it is genetic. Doctors can easily rule Vascular dementia

out because it is not caused by the same thing and the parts of the brain that are damaged can be

different. Also, the symptoms may be different depending on where the lack of blood flow was

in the brain. Doctors and see when someone has a stroke or a hemorrhage, so that is how they

know when dementia is Vascular or not.

Another form is Lewy Body dementia and it is different from both Alzheimer‘s and

Vascular dementia. This is the third most common form of dementia. It is mostly in men rather

than women. This form of dementia is much like Parkinson’s disease. The symptoms, in the
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beginning, are stated on page 34 of A Pocket Guide to Understanding Alzheimer's Disease and

Other  Dementias, Second Edition, “shaking, especially in the hands, stiffness and reduced

mobility). They also experience hallucinations, often seeing things that are not there (such as

people or animals). These hallucinations are often vivid and detailed but rarely scary.” Lewy

Body might be hard to diagnose because it is similar to Parkinson’s. Although it is not like

Alzheimer’s, so this is not hard to rule out when diagnosed with Alzheimer’s. Doctors can see

the difference between the two and rule Lewy Body out as a possible diagnosis.

The fourth form of is Frontotemporal dementia. This is the fourth most common type of

dementia. This from tents to be in younger people and is often confused with early-onset

Alzheimer’s. Early-onset Alzheimer’s appears in people before the age of 65. Doctors can

typically diagnose early on-set because frontotemporal and Alzheimer’s are the only two who for

in younger people.. In the journal; Neurodegenerative Patterns of Cognitive Clusters of Early-

Onset  Alzheimer's Disease Subjects: Evidence for Disease Heterogeneity, it is stated “with onset

before 65 occur in approximately 6% of cases”. 6% is not a high number so this makes it easy for

doctors to diagnose early-onset Alzheimer’s. Although Frontotemporal dementia forms in

younger people too. The main place in the brain that is affected for frontotemporal dementia is

the temporal lobe and that is shown on the brain scans. Alzheimer’s disease is primely in the

frontal lobe and therefore the doctors can clearly see if the diagnosis is Alzheimer’s or

Frontotemporal dementia.
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This picture is from the article “The Scope of Dementia: Variants, Symptoms, Stages, and

Causes”. This picture shows the different lobes in the brain and what they are responsible for.

The picture also shows the common symptoms if one of the lobes gets damaged. This does not

show the affect od Alzheimer’s on it but it does show what the symptoms are if that part of the

brain gets damaged.

Some people may say that sense Alzheimer’s disease cannot be definitively determined

until after death that there is no possible way that people can be diagnosed with Alzheimer’s.

This is true to an extent, doctors cannot be 100% certain until after the person has died and a

brain biopsy can but done. Whereas according to the National Institute of Aging brain scans such

as MRI, CT, and PET are used to rule out the other dementia’s so Alzheimer’s can be diagnosed.

MRI stands for magnetic resonance imaging, CT stands for computed tomography, and PET

stands for positron emission tomography these are machines that are used to scan the body, in

this case the brain, to see if there is something wrong inside. Knowing the difference in the
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symptoms and where the brain is affected doctors can tell what kind of dementia it is. The best

way for doctors to see what kind of dementia is forming is by what is causing it or where in the

brain it is forming. It is shown that vascular is caused by oxygen deprivation, Lewy Body has

Parkinson’s symptoms, Frontotemporal is in the temporal lobe, and Alzheimer’s is in the frontal

lobe. Knowing these facts is how doctors diagnose Alzheimer’s. Doctors eliminate the other

dementia’s until they have Alzheimer’s and then they continue to check-up to make sure they are

correct. It may seem like it is impossible to diagnose Alzheimer’s before death, but doctors are

successfully do it.

This is from the article “What is the Hippocampus?” This picture shows what the PET

scan looks like. The bright yellow and red spots are active brain function and the blue and black
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spots are spots of the brain that is unactive; not working. The right side is the PET scan with

Alzheimer’s it shows that there significantly less brain function.

Alzheimer’s cannot be diagnosed definitively until after death, but doctors can still

diagnose it. The four most common types of dementia fairly similar but at the same time

different. The symptoms, age when it occurs, and where in the brain it occurs all are different.

Doctors take apart the case and look at everything separately then bring it back together to get an

overall diagnosis. My grandfather would forget his way around town and eventually forgot how

to start his tractor; he was a farmer all of his life. The simple things went unnoticed but we

realized something was wrong when he would do things that were out of character or forgetting

the things he took most pride in. Alzheimer’s may not easy to diagnose, but not impossible. The

doctor worked hard to find a diagnosis, and he takes memory tests for the doctor to see how fast

it is progressing. The doctors do not stop making sure they have the correct diagnosis even after

the first one. They continue to look at the symptoms and how fast the dementia is progressing

and new brain scans are taken. Some people may say that Alzheimer’s dementia can not be

diagnosed until after death. They would be incorrect because all the factors the doctors take in

consideration and the elimination of the most common dementia’s.

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Works Cited

Cherry, Kendra. What is the Hippocampus? July 22, 2020.

https://www.verywellmind.com/what-is-the-hippocampus-2795231#:~:text=The

%20hippocampus%20is%20a%20small,associated%20with%20learning%20and

%20emotions. Accessed 1 November 2020

Fisher Center For Alzheimer’s Research Foundation. What Happens to the Brain

Alzheimer’s Disease? 2020. https://www.alzinfo.org/articles/what-happens-to-the-

brain-in-alzheimers-disease/. Accessed 1 November 2020.

Martone, Robert L., Piotrowski, Nancy A. Alzheimer's disease. By: Martone, Robert L.,

Piotrowski, Nancy A., PhD, Magill’s Medical Guide (Online Edition), 2019.

https://eds.b.ebscohost.com/eds/detail/detail?vid=44&sid=2503d722-acdf-41d5-

af10-0dba590b9523%40pdc-v-sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmU

%3d#db=ers&AN=86193878. Accessed 18 October 2020.

Mavilio, Alberto; Sisto, Dario; Prete, Florenza; Guadalupi, Viviana; Dammacco,

Rosanna; Alessio, Giovanni. RE-PERG in early-onset Alzheimer's disease: A

double-blind, electrophysiological pilot study. 2019.

https://eds.b.ebscohost.com/eds/detail/detail?vid=11&sid=2503d722-acdf-41d5-

af10-0dba590b9523%40pdc-v-sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmU

%3d#AN=145106294&db=fsr. Accessed 18 October 2020.

Neupsykey. The Scope of Dementia: Variants, Symptoms, Stages, and Causes.

https://neupsykey.com/the-scope-of-dementia-variants-symptoms-stages-and-

causes/. Accessed 1 November 2020.

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Phillips, Meredith L.; Stage  Jr., Eddie C.; Lane, Kathleen A.; Gao, Sujuan; Risacher,

Shannon L.; Goukasian, Naira; Saykin, Andrew J.; Carrillo, Maria C.; Dickerson,

Bradford C.; Rabinovici, Gil D; Apostolova, Liana G. Neurodegenerative

Patterns of Cognitive Clusters of Early-Onset Alzheimer's  Disease Subjects:

Evidence for Disease Heterogeneity. Accessed 18 October 2020.

Warner, James; Graham, Nori. A Pocket Guide to

Understanding  Alzheimer's Disease and Other Dementias, Second Edition.

https://eds.b.ebscohost.com/eds/detail/detail?vid=4&sid=d7d9bf87-b3ed-4f3a-

80e1-66a9b3414028%40pdc-v-sessmgr04&bdata=JnNpdGU9ZWRzLWxpdmU

%3d#db=nlebk&AN=1651927. Accessed 18 October 2020.