Diagnostics
Ultimately, the diagnosis of Alzheimer’s disease is a diagnosis of exclusion when the typical symptom pattern is present and when the shrinking processes of the brain can be demonstrated by cross-sectional imaging in the absence of findings that indicate a different cause of the dementia. Therefore, in order to clarify dementia, it is sometimes necessary to perform a comprehensive exclusion diagnosis. This includes first of all the careful documentation of the patient’s symptoms and medical history as well as the question of similar clinical pictures in close relatives.
The neurological examination often shows no abnormalities in early stages and serves to differentiate between other diseases of the brain and nervous system. A blood test can provide indications of the presence of metabolic disorders, vitamin deficiency, infectious diseases and excessive alcohol consumption. A tomography examination using computer or magnetic resonance imaging (CT and MRI) shows a typical picture of shrinking of the brain, especially in the area of the frontal, temporal and parietal lobes.
A relatively new procedure (PET = positron emission tomography) can show an altered energy metabolism of the affected areas of the brain. In the foreground of dementia diagnostics is the testing of intellectual capacity with neuropsychological test procedures such as the Mini-Mental-State Test. Such neuropsychological tests are used to detect and document intellectual deficits in areas such as orientation to space, time and person, language, memory or brain performance such as movement coordination. Ultimately, the diagnosis of Alzheimer’s disease can only be proven in an examination of brain preparations after the death of the affected person, in which deposits of the relevant proteins can be detected far beyond a certain level.
Therapy
There is currently no causal therapy for Alzheimer’s disease. Nevertheless, a number of measures can slow down the course of the disease, reduce the symptoms and improve the quality of life of those affected. The symptomatic therapy of dementia is based on influencing the neurotransmitter balance in the brain with drugs and on training the intellectual abilities of the patients; accompanying symptoms such as psychosis or depression can also be treated with drugs.
Various drugs are available to improve thinking and memory functions. For mild to moderate dementia, preparations that intervene in the metabolism of the messenger substance acetylcholine and increase its availability at the circuit points in the brain have proven to be effective. In advanced dementia, therapeutic success can be achieved by influencing the glutamate metabolism in the brain.
Drugs such as memantine shield the switching points between the brain cells from the damaging effect of the messenger substance, which is present in excess in Alzheimer’s disease. According to studies, Gingko-Biloba preparations also seem to have a small positive effect on the thinking and memory performance. The psychological symptoms such as aggressiveness or depression can be treated with common psychotropic drugs, but care must be taken not to administer any drugs that interfere with the metabolic pathways of the above-mentioned messenger substances in order to avoid a worsening of the dementia symptoms.
Non-drug treatment of Alzheimer’s disease includes, for example, memory training and counselling for relatives (e.g. care law). The question of care, treatment and accommodation of the patient is best clarified early on.
