Category Archives: Diagnosis & Tests

New Biological Definition Of Alzheimer’s Advances

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Historically, Alzheimer’s Dementia (AD) has been defined by visible symptoms, simply because that was all that was available. Around the mid 1990’s, various researchers began pushing for the development of a biologically-based specification of the disease, separate from the manifested symptoms. Among other things, this allows reasoning about the onset of AD before manifestation of symptoms, much like cancer or heart disease. It is believed that the AD process may begin decades before any outward sign of memory loss or other decline.

In 2007, leading AD clinicians formed an international working group (IWG) and proposed using amyloid PET scans, MRI, CSF (cerebrospinal fluid) levels of Aβ and tau, genetic testing, brain structural changes, and subtle cognitive changes to diagnose AD at an earlier stage than before. The NIA/AA (National Institute of Aging, and the Alzheimer’s Association) set up a separate leadership group, and in 2011 it proposed a related set of diagnostic guidelines for AD research that utilized separate criteria for three stages of disease: preclinical AD, mild cognitive impairment, and dementia. The current NIA/AA research framework draws on these two efforts and their personnel.

The workers stress, both in the framework publication and in an associated editorial, that this work is directed at research, and will only slowly begin appearing in the clinical context. But it is expected that the new framework will markedly improve research communication and advances.

Links to media articles on the new framework:
New biological research framework for Alzheimer’s seeks to spur discovery
Alzheimer’s disease redefined: New research framework defines Alzheimer’s by brain changes, not symptoms
New Definition of Alzheimer’s Hinges on Biology, Not Symptoms

Links to two different publications of the framework:
NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease
NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease

All the links have been added to Neuro-Psych and to Alzheimers > Neurology & Neuroplasticity

Diagnosing Dementia & MCI Using Computers

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The first two bodies of work below use computer-based games to research the decline of 3D navigational skills (one of the first symptoms exhibited by the onset of dementia of all kinds), and the diagnosis of mild cognitive impairment (MCI), respectively. The third study reports on the correlation that “Less Daily Computer Use is Related to Smaller Hippocampal Volumes in Cognitively Intact Elderly”.

Sea Hero Quest

Sea Hero Quest is a collaboration between Alzheimer’s Research UK, Deutsche Telekom, the game designers Glitchers and scientists at 7 British universities. Recognizing that one of the first symptoms of dementia is loss of navigational skills, Sea Hero Quest mobile was designed to help researchers to understand the mental processes involved in 3D navigation, while at the same time providing a sea journey quest taken by a son attempting to recover the memories his father has lost to dementia. There are three sections to the game: navigation, shooting flares to test orientation, and chasing creatures. Each section is scientifically valid as well as fun and exciting. The game was launched in 2016 and, according to its website (below), nearly 3 million people have played the game up to now,. This amount of play has generated effectively 80 years worth of data, in turn equivalent to about 12,000 years of typical lab-based dementia research.

Here are three links to media articles about the game:
Sea Hero Quest: the mobile phone game helping fight dementia
Game shows that ability to navigate declines at young age
https://blog.strong-brain.com/wp-admin/post.php?post=2135&action=edit
Here is the Wikipedia entry for the game:
Sea Hero Quest [Wikipedia]
And here is the actual game site on the web, where you can download the Mobile and/or VR versions of the game:
Sea Hero Quest [Site]

Virtual Super Market (VSM)

The study reported here uses as “Virtual Super Market” Virtual Reality (VR) brain-training-style program to assess mild cognitive impairment on the part of the player. It is of definite interest since the testing game and assessment can be carried out without an administrator. Here is a link to a media article about the work:
Mild cognitive impairment (MCI) detected with brain training game

Here are a link to the original study together with an earlier prototype work:
A Preliminary Study on the Feasibility of Using a Virtual Reality Cognitive Training Application for Remote Detection of Mild Cognitive Impairment
Can a Virtual Reality Cognitive Training Application Fulfill a Dual Role? Using the Virtual Supermarket Cognitive Training Application as a Screening Tool for Mild Cognitive Impairment

Computer Use Time Can Correlate With Cognitive Decline

The study followed 27 ‘cognitively-healthy’, dementia-free adults aged 65 or older over 9 years in Portland. On the one hand, the study used MRI scans to measure the volume of the volunteers’ hippocampus, and on the other hand, data on computer use among participants was collected via mouse movement detection software. Embedded sensor technology monitored their mobility, sleep, socialisation, digital activities and medication intake. The research results showed that an additional hour of computer use each day was linked to a 0.025% larger hippocampal volume, leading to the conclusion that lower computer usage could be used to predict cognitive decline.

Here is a link to a media article about the study:
Computer use could help predict early-stage Alzheimer’s

Here is the original research study:
Less Daily Computer Use is Related to Smaller Hippocampal Volumes in Cognitively Intact Elderly

Here is the Wikipedia entry for Hippocampus:
Hippocampus [Wikipedia]

All the links have been added to Diagnosis & Tests.

The Eyes May Know About Alzheimer’s

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Finding inexpensive non-invasive tests to detect early Alzheimer’s is a major goal for many research groups. A very promising route is to use eye scans since the retina, exposed at the back of eye, is actually part of the central nervous system. Researchers at Cedars-Sinai Hospital in Los Angeles have taken that route, and have developed a scanning mechanism, similar to standard ophthalmic instruments, which can examine the retina and determine the amount of retinal plaque — similar to brain plaque seemingly involved in Alzheimer’s — present in the retina. Promising trials correlating the amount of retinal plaque present with the amount of brain plaque present are underway, where the amount of brain plaque is estimated by means of (expensive and difficult) PET scans.

Here are links to three media articles about the work:

Can this eye scan detect Alzheimer’s years in advance?
Clinical study shows that retinal imaging may detect signs of Alzheimer’s disease
Cedars-Sinai Device May Provide Early Detection of Alzheimer’s Disease

And here is a link to the main research article:
Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease

It’s interesting to note that a similar approach has been developed for early diagnosis of Parkinson’s disease:
Eye test may detect Parkinson’s before symptoms appear

All links are contained in Alzheimer’s > Diagnosis & Tests

Category: Diagnosis & Tests

Family & Friends Can Help Diagnose Alzheimer’s

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Since Alzheimer’s attacks the brain, the major visible changes to a person descending into Alzheimer’s are changes in behavior. So it is certainly no surprise that in general, the people who can most knowledgeably speak to a person’s behavioral changes are that person’s family and friends. Because of this, the “AD8, A brief informant interview to detect dementia” was developed at Washington University for use in interviewing family and friends. It contains eight yes-no questions dealing with issues such as:

Less interest in hobbies/activities

Trouble handling complicated financial affairs (e.g., balancing checkbook, income taxes, paying bills)

Trouble remembering appointments

A pdf of the complete AD8 is available here; Permission to use the AD8 can be obtained here.
(It would seem that a combination of the AD8 with the UPSIT “scratch and sniff” test would make a moderately good inexpensive screening combination.)

These links to some articles on the AD8 have been posted in
Alzheimer’s > Diagnosis & Tests:

The AD8 and its Use as an Alzheimer’s Screening Test

Family, Friends Seem Best at Spotting Early Dementia

And these research publication links have also been posted in Alzheimer’s > Diagnosis & Tests. The first link is the original publication on the AD8, and the others are follow-ups:

The AD8: A brief informant interview to detect dementia

Relationship of dementia screening tests with biomarkers of Alzheimer’s disease

The impact of dementia prevalence on the utility of the AD8

Reply: The impact of dementia prevalence on the utility of the AD8

Four New Links in Diagnosis & Tests of Alzheimer’s

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In Alzheimers > Diagnosis & Tests:

Scientists warn that new drugs will require earlier diagnosis of Alzheimer’s Announcement about success of solanezumab leads to calls for improved testing to identify those who would benefit from slowing of mental decline

Researchers: Saliva test may reveal Alzheimer’s They caution the results of a recent study are small, and more tests will be needed to judge its accuracy.

Saliva seen as possible diagnostic tool for Alzheimer’s disease …study suggests that analyzing certain chemical compounds in saliva could provide a cheap, noninvasive way to learn whether the brain has begun to undergo the changes that culminate in loss of memory and cognitive function.

Study: Middle Age Memory Failures Can Predict Alzheimer’s 18 Years Before Diagnosis The changes in thinking and memory that precede obvious symptoms of Alzheimer’s disease begin decades before…