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Summary
- Alzheimer’s disease affects 7 million people in the U.S., and that may double by 2060.
- Miller School researchers have refined a method that will allow primary care physicians to quickly identify patients with a greater risk for Alzheimer’s.
- Dr. David Loewenstein has developed a three-minute virtual reality screener that can reveal whether a patient has true memory impairment, an indicator of Alzheimer’s risk.
Alzheimer’s disease has been called a public health crisis, one that affects nearly 7 million Americans. Without significant medical breakthroughs in prevention and treatment, that number may double by the year 2060.
Part of the work in addressing the Alzheimer’s public health issue lies in fast, accurate diagnosis. Researchers from The Center for Cognitive Neurosciences and Aging (CNSA) at the University of Miami Miller School of Medicine have refined a method that will allow primary care physicians to quickly identify and refer patients with greater risk for Alzheimer’s.
Early identification of Alzheimer’s is important because, by the time a patient is exhibiting symptoms of cognitive impairment, it often means that the disease is so far advanced that treatment becomes very difficult.
“We want to look at the cognitive markers for Alzheimer’s disease that are more sensitive than existing neuropsychological measures, which will give us an idea that there’s something going on years before traditional tests that are given in regular centers,” said David Loewenstein, Ph.D., the director of CNSA and a professor of psychiatry and behavioral sciences and neurology at the Miller School.
Biology vs. Symptoms in Alzheimer’s Disease
Alzheimer’s disease is characterized in part by a buildup of amyloid and tau proteins that produce biomarkers in the blood. However, not everyone with an amyloid buildup shows symptoms of cognitive impairment and not everyone with cognitive impairment has a buildup of amyloid.
“There are people who, when they die, autopsy reveals that they’ve had amyloid in their brain for many years, but they never had cognitive deficits in life,” said Dr. Loewenstein. “Then there are those who experience what’s called the Alzheimer’s cascade. Certain things begin to happen where the whole system starts to unravel, and you get brain organ failure.”
People can live for years with a buildup of amyloid plaques without issue. Preventative treatments like infusion therapies aren’t always desirable or effective and can actually cause harm.
To properly identify and treat Alzheimer’s, it’s important to map the symptoms of cognitive impairments onto the underlying biology. And just like with cancer, the earlier it’s caught, the better.
Cognitive Tests to Detect Alzheimer’s
The CNSA has already developed a critical tool for detecting Alzheimer’s, called the Loewenstein-Acevedo Scales for Semantic Interference and Learning test, or LASSI-L. Unlike other cognitive tests, which are given under optimal conditions with no distractions, the LASSI-L zeroes in on the types of memory issues specific to patients with Alzheimer’s.
The patient is given a list of 15 words divided into three categories—for instance, “fruit,” “clothing” and “musical instruments.” To begin the test, the administrator primes the patient by reminding them of the three categories and asking them to recall the words on the list. Patients with early Alzheimer’s typically have no issues with this first task.
Next, patients are asked to remember a list that includes different items in the same three categories. If a patient has Alzheimer’s, they’ll have great difficulty recalling the words on the second and subsequent lists because of a phenomenon known as “proactive interference.” Memorizing old words affects their ability to remember new ones.
“What we’re doing is testing that weakness in processing and encoding and recalling semantic information. What was easy to learn over the first two trials becomes very difficult, because those same semantic cues are now affecting their ability to process and learn the new information,” said Dr. Loewenstein.
Quick Identification of Alzheimer’s Risk
The LASSI-L (and later the LASSI-D, a digitized version) is an important instrument for early diagnosis of Alzheimer’s. The test is adjustable and designed to work in many different ethnic and cultural groups across the world.
While the test only takes 20 minutes, that’s still typically too much time for a primary care physician. Staffing resources and clear directives about who should take the test are also often implementation barriers.
In response to these practical issues, Dr. Loewenstein and his colleague, Rosie Curiel, Cid, Psy.D., worked to develop a much quicker version of LASSI-L. The new test is a three-minute virtual reality screener that can reveal whether a patient has true memory impairment in a fraction of the time of normal cognitive challenge tests.
“We know it works because we administer patients the bigger neuropsychological test batteries and we can see how accurate these mini-tests are,” Dr. Loewenstein said. “So, if with further research they continue to be successful, we’ll be able to give those tests in community settings, in health care offices, and they can quickly tell a health care professional if there is an objective cognitive problem.”
If the three-minute test reveals cause for concern, providers can order a blood test for plasma biomarkers. An elevated level of biomarkers plus a poor result on the three-minute test would prompt a primary care physician to refer a patient to a memory specialist for further evaluation.
“We believe that early cognitive detection is very important, because it’s the impact that the disease has on a person, their family and their quality of life,” said Dr. Loewenstein. “Let’s get cognitive measures as early as we can, understanding that when you see the earliest clinical changes, you want to map onto the biology. It’s going to be a total epidemic unless we can slow this disease down.”
Tags: Alzheimer’s disease, cognitive decline, cognitive stress tests, Department of Neurology, Dr. David Loewenstein, Dr. Rosie Curiel Cid, memory disorders, neurology, psychiatry, Psychiatry and Behavioral Sciences
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Sources 2/ https://news.med.miami.edu/challenging-alzheimers-disease/ The mention sources can contact us to remove/changing this article |
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