question: Does a person with Dementia or Alzheimer’s knows they have the disease?
comment: Generally these conditions get worse over time and people recognise that they are forgetting things that they should be able to remember easily. These days most elderly people know that dementia or Alzheimer's are likely to be the cause when this happens too frequently, eventually however there may come a time when they even forget about the condition.
passages: Further neurological examinations are crucial in the differential diagnosis of AD and other diseases. Interviews with family members are also utilised in the assessment of the disease. Caregivers can supply important information on the daily living abilities, as well as on the decrease, over time, of the person's mental function. A caregiver's viewpoint is particularly important, since a person with AD is commonly unaware of his own deficits. Many times, families also have difficulties in the detection of initial dementia symptoms and may not communicate accurate information to a physician.
   Supplemental testing provides extra information on some features of the disease or is used to rule out other diagnoses. Blood tests can identify other causes for dementia than AD—causes which may, in rare cases, be reversible. It is common to perform thyroid function tests, assess B12, rule out syphilis, rule out metabolic problems (including tests for kidney function, electrolyte levels and for diabetes), assess levels of heavy metals (e.g. lead, mercury) and anaemia. (It is also necessary to rule out delirium).
   With the increased risk of antipsychotics for people with DLB, educated caregivers are able to act as advocates for the person with DLB. If evaluation or treatment in an emergency room is needed, the caregiver may be able to explain that, in the words of Gomperts "patients with DLB are essentially 'allergic' to haloperidol and other neuroleptics". Caregiver training, watchful waiting, identifying sources of pain, and increasing social interaction can help minimize agitation. Individuals with dementia may not be able to communicate that they are in pain, and pain is a common trigger of agitation. Medical alert bracelets or notices about medication sensitivity are available and can save lives.
   CT scan or MRI can confirm dementia via observation of ventricular dilation and cortical substance degeneration.
  
  Pick's disease can be confirmed via CT scan or MRI with atrophy of frontal and temporal lobe roots.
  
  Alzheimer's is a disease confirmed by atrophy of the parietal and temporal lobe ganglia along with changes in the cortical ganglia found in a CT scan or MRI.
  
  Section::::Treatment and prognosis.
   Routine blood tests are also usually performed to rule out treatable causes. These tests include vitamin B, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function, and liver enzymes. Abnormalities may suggest vitamin deficiency, infection, or other problems that commonly cause confusion or disorientation in the elderly.
  
  Section::::Diagnosis.:Imaging.
   Diagnosis of MCI is often difficult, as cognitive testing may be normal. Often, more in-depth neuropsychological testing is necessary to make the diagnosis. the most commonly used criteria are called the Peterson criteria and include:
  
  BULLET::::- Memory or other cognitive (thought-processing) complaint by the person or a person who knows the patient well.
  
  BULLET::::- The person must have a memory or other cognitive problem as compared to a person of the same age and level of education.
  
  BULLET::::- The problem must not be severe enough to affect the person's daily function.
  
  BULLET::::- The person must not have dementia.
   Section::::Diagnosis.:Techniques.
  
  Neuropsychological tests such as the mini–mental state examination (MMSE) are widely used to evaluate the cognitive impairments needed for diagnosis. More comprehensive test arrays are necessary for high reliability of results, particularly in the earliest stages of the disease. Neurological examination in early AD will usually provide normal results, except for obvious cognitive impairment, which may not differ from that resulting from other diseases processes, including other causes of dementia.
   Alzheimer's disease is usually diagnosed based on the person's medical history, history from relatives, and behavioural observations. The presence of characteristic neurological and neuropsychological features and the absence of alternative conditions is supportive. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Moreover, it may predict conversion from prodromal stages (mild cognitive impairment) to Alzheimer's disease.
   The screening blood tests typically include full blood count, liver function tests, thyroid function tests, lipid profile, erythrocyte sedimentation rate, C reactive protein, syphilis serology, calcium serum level, fasting glucose, urea, electrolytes, vitamin B-12, and folate. In selected patients, HIV serology and certain autoantibody testing may be done.
  
  Mixed dementia is diagnosed when people have evidence of Alzheimer's disease and cerebrovascular disease, either clinically or based on neuro-imaging evidence of ischemic lesions.
  
  Section::::Diagnosis.:Pathology.
   Some mental illnesses, including depression and psychosis, may produce symptoms that must be differentiated from both delirium and dementia. Therefore, any dementia evaluation should include a depression screening such as the Neuropsychiatric Inventory or the Geriatric Depression Scale. Physicians used to think that anyone who came in with memory complaints had depression and not dementia (because they thought that those with dementia are generally unaware of their memory problems). This is called pseudodementia. However, in recent years researchers have realized that many older people with memory complaints in fact have MCI, the earliest stage of dementia. Depression should always remain high on the list of possibilities, however, for an elderly person with memory trouble.
   Section::::Alzheimer’s disease and amyloid-beta PET imaging.
  
  More than 44 million people worldwide have been diagnosed with some type of dementia, with two-thirds of this population likely to suffer from a mild, moderate or even severe form of AD. This number is expected to double by 2030 and triple by 2050. Accurate diagnosis and early identification of cognitive and functional impairment due to AD and other etiologies are critical for optimization of patient care and initiation of appropriate therapies. Despite the importance of early and accurate detection of dementia, in practice, many individuals are misdiagnosed or remain even undiagnosed.
   In the first stages of dementia, the signs and symptoms of the disorder may be subtle. Often, the early signs of dementia only become apparent when looking back in time. The earliest stage of dementia is called mild cognitive impairment (MCI). 70% of those diagnosed with MCI progress to dementia at some point. In MCI, changes in the person's brain have been happening for a long time, but the symptoms of the disorder are just beginning to show. These problems, however, are not yet severe enough to affect the person's daily function. If they do, it is considered dementia. A person with MCI scores between 27 and 30 on the Mini-Mental State Examination (MMSE), which is a normal score. They may have some memory trouble and trouble finding words, but they solve everyday problems and handle their own life affairs well.
   Since the disease was first described by Alois Alzheimer in 1906, the only certain way to determine if a person indeed had the disease was to perform a biopsy on the patient's brain to find distinctive spots on the brain that show the buildup of amyloid plaque. Doctors must diagnose the disease in patients with memory loss and dementia based on symptoms, and as many as 20% of patients diagnosed with the disease are found after examination of the brain following death not to have had the condition. Other diagnostic tools, such as analysis of cerebrospinal fluid, magnetic resonance imaging scans looking for brain shrinkage and PET scans looking at how glucose was used in the brain, had all been unreliable.
   Section::::Criteria.
  
  BULLET::::- Definite Alzheimer's disease: The patient meets the criteria for probable Alzheimer's disease and has histopathologic evidence of AD via autopsy or biopsy.
  
  BULLET::::- Probable Alzheimer's disease: Dementia has been established by clinical and neuropsychological examination. Cognitive impairments also have to be progressive and be present in two or more areas of cognition. The onset of the deficits has been between the ages of 40 and 90 years and finally there must be an absence of other diseases capable of producing a dementia syndrome.
   Cognitive impairments occur in about 40 to 60 percent of patients with multiple sclerosis, with the lowest percentages usually from community-based studies and the highest ones from hospital-based. Impairments may be present at the beginning of the disease. Probable multiple sclerosis sufferers, meaning after a first attack but before a secondary confirmatory one, have up to 50 percent of patients with impairment at onset. Dementia is rare and occurs in only five percent of patients.
   Diagnostic tests can be used to establish some features of the condition and distinguish them from symptoms of other conditions; diagnosis may include the person's medical history, physical exam, assessment of neurological function, testing to rule out conditions that may cause similar symptoms, brain imaging, neuropsychological testing to assess cognitive function, sleep studies, or myocardial scintigraphy. Laboratory testing can rule out conditions such as depression, abnormal thyroid function, syphilis, HIV, or vitamin deficiencies that may cause symptoms similar to dementia.
   The "New York Times" reports that illnesses such as the flu and hydrocephalus, as well as side-effects to common medications, can produce symptoms in the elderly that are difficult to distinguish from ordinary dementia caused by aging. However, if the real cause of the effects is caught early enough, the effects can be reversed. According to studies cited in Cunha (1990), approximate 10% to 30% of patients who have exhibited symptoms of dementia might have a treatable or reversible pathologic process to some extent.
  
  Section::::Causes.
   Dementia with Lewy bodies can only be definitively diagnosed after death with an autopsy of the brain—diagnosis of the living is referred to as "probable" or "possible". DLB is often misdiagnosed or confused in its early stages with AD. Another complicating factor is that DLB can occur along with Alzheimer's; autopsy may reveal previously undiagnosed Lewy bodies in as many as half of people with AD. Despite the difficulty in diagnosis, a prompt diagnosis is important because of the serious risks of sensitivity to antipsychotic medications and the need to inform both the person with DLB and the person's caregivers about potentially irreversible side effects of those medications. In comparison to many other neurodegenerative diseases, the management of DLB is difficult, so an accurate diagnosis is important.
   Assessment of intellectual functioning including memory testing can further characterise the state of the disease. Medical organisations have created diagnostic criteria to ease and standardise the diagnostic process for practising physicians. The diagnosis can be confirmed with very high accuracy post-mortem when brain material is available and can be examined histologically.
  
  Section::::Diagnosis.:Criteria.
   Changes in eating frequently occur. Caregivers of people with late-stage dementia often provide pureed diets, thickened liquids, and assistance in eating, to prolong their lives, to cause them to gain weight, to reduce the risk of choking, and to make feeding the person easier. The person's appetite may decline to the point that the person does not want to eat at all. They may not want to get out of bed, or may need complete assistance doing so. Commonly, the person no longer recognizes familiar people. They may have significant changes in sleeping habits or have trouble sleeping at all.
   The early stages of Alzheimer's disease are difficult to diagnose. A definitive diagnosis is usually made once cognitive impairment compromises daily living activities, although the person may still be living independently. The symptoms will progress from mild cognitive problems, such as memory loss through increasing stages of cognitive and non-cognitive disturbances, eliminating any possibility of independent living, especially in the late stages of the disease.
  
  Life expectancy of people with AD is reduced. Following diagnosis it typically ranges from three to ten years.
   Pseudodementia (otherwise known as “depression-related cognitive dysfunction”) is a condition whose presenting symptoms appear as dementia, but may result from a misdiagnosis of depression or the adverse effects of medications being taken. This form of dementia is not the true form and does not result from the same cognitive changes. Once the depression is properly treated or the medication therapy is changed, the cognitive impairment can be effectively reversed. Generally, dementia involves a steady and irreversible cognitive decline but in some cases there may be different outcomes. In addition, diminished mental capacity and social withdrawal are commonly identified as symptoms in the elderly but oftentimes is due to symptoms of depression. As a result, elderly patients are often misdiagnosed especially when healthcare professionals do not make an accurate assessment.
   One study examined dementia severity in elderly schizophrenic patients diagnosed with Alzheimer's disease and dementia versus elderly schizophrenic patients without any neurodegenerative disorders. In most cases, if schizophrenia is diagnosed, Alzheimer's disease or some form of dementia in varying levels of severity is also diagnosed. It was found that increased hippocampal neurofibrillary tangles and higher neuritic plaque density (in the superior temporal gyrus, orbitofrontal gyrus, and the inferior parietal cortex) were associated with increased severity of dementia. Along with these biological factors, when the patient also had the apolipoprotein E (ApoE4) allele (a known genetic risk factor for Alzheimer's disease), the neuritic plaques increased although the hippocampal neurofibrillary tangles did not. It showed an increased genetic susceptibility to more severe dementia with Alzheimer's disease than without the genetic marker.
   BULLET::::- Many genes in addition to "APOE ε"4 underlie late onset AD. ADNI data has helped to identify or confirm 10 of the approximately 20 risk genes currently identified
  
  BULLET::::- Cerebrovascular disease can accelerate disease progression in AD.
  
  BULLET::::- Both the cognitively normal and MCI groups are pathologically heterogeneous. Some people show no signs of AD, some show signs of progressing to AD quickly, and others show signs of progressing to dementias other than AD.
  
  Section::::Diagnosis of AD and the prediction of future AD.
   The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. Clinically, people with pseudodementia differ from those with true dementia when their memory is tested. They will often answer that they don't know the answer to a question, and their attention and concentration are often intact, and they may appear upset or distressed. Those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned. The symptoms of depression oftentimes mimic dementia even though it may be co-occurring
  