Images show brain atrophy in a patient who was initially told outside of UCLA that he had no medical diagnosis, but later he was diagnosed with Alzheimer’s disease. Images: Courtesy of Dr. Aaron McMurtray.
With improvements in recent years in the ability of specialized centers to diagnose Alzheimer’s disease and other dementias, it has become increasingly clear that many patients who are seen in nonspecialized settings are misdiagnosed. “Memory loss in older adults is often considered to be Alzheimer’s disease until proven otherwise,” says Keith Vossel, MD, MSc, director of the Mary S. Easton Center for Alzheimer’s Disease Research at UCLA. “But as we collect more data, we’re learning that when physicians think a patient has Alzheimer’s disease, the imaging biomarkers suggest they are wrong about one-third of the time.”
The UCLA-Easton Center has a threepronged mission: to improve the quality of life for patients and caregivers of individuals with Alzheimer’s disease and related conditions, to support research to better understand these conditions and to develop new medications and treatments. “We aim to be a community resource for patients with memory loss and their physicians by providing the bestpossible diagnostic workup to ensure accurate diagnosis and appropriate state-of-the-art care,” says Aaron McMurtray, MD, medical director for dementia programs and for clinical programs of the UCLA-Easton Center. In addition to diagnosis and medication reviews, the center’s neurologists order ancillary services as needed, including homefall and driving evaluations.
Dr. Vossel notes that a combination of extensive neuropsychological testing, patient history, caregiver interviews and state-of-theart imaging tools, such as high-resolution MRI and FDG-PET, are often required to ensure that patients experiencing early signs of memory loss or other unusual cognitive symptoms are accurately diagnosed. “With high-resolution MRI, sometimes we pick up hippocampal sclerosis as the cause of the memory loss. With EEG, we might learn that seizures are the cause. With blood work, we can detect autoimmune diseases or vitamin deficiencies. And some dementias associated with movement disorders can involve subtle features that a neurologist would pick up,” he says. “All of us are being humbled by how challenging proper diagnosis can be.”
Accurate diagnosis and, beyond that, understanding the different presentations within various dementias are important both for tailoring medications and for preparing patients and families for the prognosis, Dr. Vossel explains. “The therapies we have can help a great deal with dayto- day symptoms. Although they do not slow disease progression, they can preserve independence longer,” he says. “But there are also drugs used for memory loss and Alzheimer’s disease that can exacerbate behaviors in frontotemporal dementia, and certain medications should be avoided for patients with Lewy body disease.” In terms of prognosis, he adds, understanding the likely trajectory of the disease can help patients and their families as they consider future plans, as well as point them toward potential measures and support necessary to ensure the patient’s safety as the disease progresses.
The UCLA-Easton Center houses a robust research program that includes pharmaceutical-sponsored and investigatorinitiated clinical trials, as well as large NIH-funded observational studies. The studies are open to individuals experiencing symptoms, as well as those believed to be at risk. Through participation in the research, patients can learn more about their disease from sophisticated biomarker imaging of tau and amyloid beta, or from extensive cognitive testing and longitudinal assessments. The center’s researchers also gather spinal fluid, as well as blood and genetic samples, from interested subjects to assess biomarker determinants of future risk in individuals who aren’t experiencing symptoms. Dr. Vossel’s own research centers around his key discovery that as many as 40% of patients with Alzheimer’s disease experience silent seizure activity during sleep that affects their cognition, and an additional 20% can develop overt seizures; his group has begun clinical trials to address and mitigate those seizures, with early evidence that doing so can improve cognitive outcomes.
“There’s a great deal we still don’t know about factors causing the disease and what increases individual risk,” Dr. Vossel says. “We hope to recruit diverse research participant pools to obtain answers.”