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Why diagnosis, treatment of dementia can be difficult
Dr. Daniel Cobb in Gainesville, Monday, July 2, 2018, leads The Neurology Center of North Georgia, a medical practice that specializes in neurological and sleep disorders. - photo by David Barnes

Just like there’s no one treatment to stop Alzheimer’s disease in its tracks, it often takes more than one test to confirm a diagnosis.

“Diagnosing Alzheimer’s involves a complete assessment that considers all possible causes,” according to the Alzheimer’s Association.

Testing includes physical and neurological exams, with the doctor looking for signs of stroke, Parkinson’s disease, brain tumors, fluid accumulation on the brain and other illnesses that may impair memory or thinking.

A medical workup frequently includes imaging tests.

Once Alzheimer’s is diagnosed, a treatment plan is then developed.

“The medicines we have now are just to slow it down,” said Dr. Daniel Cobb, founder of The Neuro Center in Gainesville. “We don’t have anything to reverse the condition.”

He added that most people live five to seven years after diagnosis.

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“We give medication to basically make the unaffected brain work faster and better to compensate for the part of the brain that’s being damaged,” Cobb said. “Eventually, the disease takes over.”

While drugs primarily target memory and thinking issues, non-drug treatments are being developed for behavioral and other physical symptoms of Alzheimer’s and dementia that, if untreated, could speed up a patient’s health decline.

Those symptoms might include agitation, anxiety, apathy and depression.

“That’s the No. 1 reason why people are put in assisted living facilities and nursing homes, because it’s just too much for the caregiver,” said Whitney Wharton, an Emory University and Alzheimer’s Association researcher.

The Alzheimer’s Association recommends non-drug approaches or therapies, such as working with patients to separate them from whatever may be upsetting them and engaging in regular physical activity to potentially reduce irritability and aggressive behavior.

Psychotropic medications, such as antidepressants, may need to be considered when the dementia-related behavior has not responded to therapies. However, the U.S. Food and Drug Administration has found that using antipsychotics to treat dementia-related behaviors in elderly persons with dementia was associated with increased mortality.

Results of a clinical trial suggest that nabilone — a synthetic cannabinoid — may be effective in treating agitation in people with Alzheimer’s disease, according to the Alzheimer’s Association.

Cobb said he likes to refer Alzheimer’s and dementia patients to ReGain, a service of the Northeast Georgia Health System.

ReGain is an outpatient rehabilitation program that offers physical, occupational and speech therapy for patients with acute medical conditions and neurological disorders.

Also, patients may be referred to a computer-based program that tests whether they are “cognitively, mentally safe to drive a car,” Cobb said. “We put a lot of people through that to try to figure out if they are safe driving around, and most of them are not.”

Overall, Cobb said he’s encouraged by the amount of research into Alzheimer’s and dementia-related diseases.

“What science is trying to figure out is if we can prevent plaques and tangles from being deposited in the brain, slow down the deposition if we can’t stop it, or reverse it if someone already has the plaques and tangles.”

According to the National Institutes of Health, “in the Alzheimer’s brain, abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function.”

Other parts of the Alzheimer’s patients brain indicates a particular protein, known as tau, bunching up or becoming twisted in tangles.

“Those plaques and tangles disrupt the nerves from being able to transmit information,” Cobb said.

And once a patient is diagnosed, “it may be difficult to determine the exact cause,” according to the Alzheimer’s Association.

One thing concerning doctors is the number of people being diagnosed with dementia is increasing “because of the aging population and earlier diagnosis,” Cobb said.

“A lot of people are coming in earlier and earlier saying they’re having memory problems, and they’re wanting to be tested.”