Early Alzheimer’s Disease results from aging of your brain and the loss of cells, and most commonly begins in the memory section of your brain. Early Alzheimer’s Disease can be easily hidden by the suffering person and typically is missed by the average physician. People with early Alzheimer’s Disease are not usually examined by Alzheimer’s specialist. My referrals tend to be patients with more advanced stage disease; therefore, primary care physicians are in the best position to identify early AD but typically fail to do so.
Why are primary care physicians failing to aggressively screen for Alzheimer’s Disease? And why would a person want to hide early memory loss and avoid a diagnosis of Alzheimer’s Disease? The answer to these questions is the same. Most people, including doctors, perceive Alzheimer’s Disease as a disease that attacks old people with minimal options available for prevention or treatment. Why pursue early discovery of a disabling disease if there is nothing you can do about it? In reality, much can be done. Current research strongly supports multiple interventions that reduce your risk of Alzheimer’s Disease as well as aggressive medical intervention to slow down the progression of memory loss and significantly delay the onset of disability.
Critical to the success of medical intervention is early diagnosis and treatment. The memory loss of Alzheimer’s Disease is a result of brain cell loss. Aging is the major contributor to brain cell loss. As we age, we lose brain cells and our brain shrinks. We have a reservoir of cells, an excess amount, we can lose before we lose memory. How fast we lose our reservoir is influenced by multiple factors, many of which you can impact; however, everyone who lives long enough, ultimately loses his reservoir and experiences the early memory loss of Alzheimer’s Disease. The earlier you identify Alzheimer’s Disease, the more memory cells you have to treat, the more effective the medical treatment.
Diagnosis of early Alzheimer’s Disease requires identifying a deficit in short term memory combined with at least one other cognitive deficit.
The Mini-Cog is a very simple and effective test for early Alzheimer’s Disease. It is 90% sensitive and 90% specific for Alzheimer’s Disease, meaning out of 100 patients with Alzheimer’s Disease, the Mini-Cog will identify at least 90. Three steps are required for the test: Immediate recall of 3 items, 1 minute recall of the same 3 items, and a clock drawing. During the one minute interval between recall, the person being tested should be distracted with simple cognitive exercise such as spelling “WORLD” in reverse, repeating five numbers forward and reverse, and assessing similarities.
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If you have a positive Mini-cog exam, it is highly likely you have early Alzheimer’s Disease. On the other hand, a negative Mini-cog does not rule out Alzheimer’s Disease. You should be screened annually starting at 65 years of age and earlier if you have a family history of Alzheimer’s Disease or multiple risk factors. Most importantly, remember that early diagnosis is good thing. If you live long enough you will experience the memory loss of Alzheimer’s Disease. If you start treatment early, you will definitely prolong the quality of your life and possibly avoid disability.