Diagnosing Alzheimer's Disease
In part two of our five part series on memory disorders, Celisa Bonner, LCSW provides easy-to-understand examples for each of the five main factors in diagnosing Alzheimer's disease including amnesia, aphasia, anomia, apraxia and agnosia.
Featured Speaker:
Celisa Bonner, LCSW
Celisa Bonner is a licensed clinical social worker and the Clinic Coordinator for the Madonna Ptak Center for Alzheimer’s Research & Memory Disorders Clinic where she has worked for over 16 years. She is also a wife and mother. Her passion is counseling caregivers in their journey through Alzheimer’s disease and related dementias. She also enjoys educating others about the disease process and it’s dynamics. She does this through the Governor’s Dementia Care & Cure Initiative for the state of Florida, while being the Co-Chair for the Pasco & Pinellas counties. Transcription:
Diagnosing Alzheimer's Disease
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Deborah Howell (Host): Welcome to BayCare HealthChat. I'm Deborah Howell and I invite you to listen as we discuss some of the criteria for Alzheimer's Disease. Today, we'll find out all about the five A's of Alzheimer's diagnosis. Plus a sixth factor to take into account. I'm joined by Celisa Bonner, Licensed Clinical Social Worker and Clinic Coordinator for the Madonna Ptak Center for Alzheimer's Research and Memory Disorders Clinic. Celisa, what a pleasure to have you with us today.
Celisa Bonner, LCSW (Guest): Thank you so much. I'm excited to be here.
Host: Well, let's dive right in, shall we?
Celisa: Sounds good.
Host: Okay. So, the diagnostical statistical manual says that a person must exhibit two of the following criteria in order to be diagnosed with Alzheimer's disease. And by the way, these cognitive changes must be of a gradual progression in which they're not obvious at first. So, the person may or may not be aware of these things developing. All right. So, let's take the five A's one by one and have you describe them for us. First memory impairment and or amnesia?
Celisa: This is basically memory loss. This is difficulty in short-term memory, which later progresses to a decline in long-term memory. They can forget information about themselves and even their loved ones. This is often most noticeable, is the memory loss.
Host: Okay. Kind of heartbreaking. Second, aphasia.
Celisa: Aphasia is problems understanding what is being said and problems expressing thoughts with words. They may even have the effect of losing the ability to read and write. In later stages, speech may become more impossible to understand, and it may even be difficult to determine how much of what the caregiver is saying is really being comprehended. And a vast majority of people with Alzheimer's disease, memory loss or amnesia is really more prominent than language impairment or aphasia.
Host: Third, anomia.
Celisa: Anomia is when someone has word finding difficulty in speaking and writing. Maybe that person knows what they need, but they cannot find the right word to express what they need. And so that's anomia.
Host: Got it. And we're moving onto the fourth one, which is apraxia.
Celisa: Apraxia, if you'll look at the word or hear the word apraxia, it has an X in it, and that really means action. So, this is a loss in voluntary motor skills. Maybe they do have the capability to perform an action, but the brain and the muscles required to carry out the task really aren't communicating. So, they lose the ability to perform the activities of daily living like dressing and bathing and grooming, walking, and even eating. Because of these changes, they really have a high risk in falls. So, really try to keep them active as much as possible to try to delay this physical change that's caused by apraxia.
Host: Got it. And fifth, we have agnosia.
Celisa: So agnosia, the word has an N and an O in it. So, that's really about knowledge. They have lost the ability to recognize an object, maybe even a face or a voice or a sound or even a specific place. They don't recognize that this is their home. So, not only do they lose the ability just to name the object, they also lose the ability to describe what it's used for.
Host: It's a sobering list and finally, this is not an A, but it has some bearing, disturbance in executive function.
Celisa: So, what's executive functioning? It's basically our mental processes that allow us to plan, to focus attention, to remember instructions and to juggle multitasking successfully. So, if we have a decline in that, we might have a struggle with thinking, self-monitoring, self-control, planning, problem solving, organization, and time management. So, that's a big one. If there's a little bit of change in executive function you're not going to be successful in completing any kind of task, especially multitasking.
Host: Can you give us a good concrete example of someone exhibiting these kinds of struggles?
Celisa: Sure. So, let's say for tying your shoes, maybe the caregiver is telling their loved one, hey, we're about to get ready to leave. So, I want you to go and tie your shoes. So, with aphasia, I'm wondering, what are you telling me to do? Because I can't understand the words that you're using. With amnesia, I don't even remember what you've told me to do if to do anything at all. So, I've already forgotten about it. And with agnosia, I'm really confused about what is a shoe in the first place. And then with apraxia, I can't even make my hands do what you're asking me to do. And then with anomia, I can't even find the words to tell you that I do not know what you're asking me to do.
Host: Okay, that is very concrete. And we want to repeat again. So, if a person has any of these two criteria, meaning the five A's we just talked about, plus the disturbance in executive functioning; there's a very good chance that person has Alzheimer's. What should a spouse or a family member do if they see signs of these changes in their loved ones?
Celisa: So, I really recommend that they try to talk with their spouse or their family member about the concern that they have and specifically, what did they see and then reach out to their primary care physician to discuss these changes. It might even be helpful for a caregiver just to keep a log or write down some things that they may see.
So they will not be forgetting of what they need to share with that doctor. And then the primary care physician will follow through making appropriate referrals, probably to a neurologist, which is a doctor that specializes in brain health. And then that neurologist is going to order a comprehensive battery of diagnostic tests, which could be a brain scan, maybe even a sleep study, a comprehensive battery of labs and also neuropsychological testing, which is an assessment by a psychologist that also specializes in brain health.
Host: So there's an entire team working for the better health of this person.
Celisa: Correct.
Host: Well, Celisa, as you were listing those final things, I feel like we have more podcasts to do because there's so much to cover.
Celisa: There is, there's a lot to cover to really understand the brain is a unique organ and it's our control center for everything that we do. If we have any change in it, it's going to affect our daily lives and how we're used to carrying out things.
Host: Sure. All of this has been so enlightening. Thank you for the good information and for the good work you do today.
Celisa: All right. Thanks so much for letting me share.
Host: And that wraps up this episode of BayCare HealthChat. For more information, or to get connected with one of our providers contact the Memory Disorder Center in Clearwater at (727) 298-6025. And the Memory Disorder Center in St. Pete at (727) 825-1595. There's also lots of great information at BayCareMemories.org.
Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. This is Deborah Howell. Have yourself a terrific day.
Diagnosing Alzheimer's Disease
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Deborah Howell (Host): Welcome to BayCare HealthChat. I'm Deborah Howell and I invite you to listen as we discuss some of the criteria for Alzheimer's Disease. Today, we'll find out all about the five A's of Alzheimer's diagnosis. Plus a sixth factor to take into account. I'm joined by Celisa Bonner, Licensed Clinical Social Worker and Clinic Coordinator for the Madonna Ptak Center for Alzheimer's Research and Memory Disorders Clinic. Celisa, what a pleasure to have you with us today.
Celisa Bonner, LCSW (Guest): Thank you so much. I'm excited to be here.
Host: Well, let's dive right in, shall we?
Celisa: Sounds good.
Host: Okay. So, the diagnostical statistical manual says that a person must exhibit two of the following criteria in order to be diagnosed with Alzheimer's disease. And by the way, these cognitive changes must be of a gradual progression in which they're not obvious at first. So, the person may or may not be aware of these things developing. All right. So, let's take the five A's one by one and have you describe them for us. First memory impairment and or amnesia?
Celisa: This is basically memory loss. This is difficulty in short-term memory, which later progresses to a decline in long-term memory. They can forget information about themselves and even their loved ones. This is often most noticeable, is the memory loss.
Host: Okay. Kind of heartbreaking. Second, aphasia.
Celisa: Aphasia is problems understanding what is being said and problems expressing thoughts with words. They may even have the effect of losing the ability to read and write. In later stages, speech may become more impossible to understand, and it may even be difficult to determine how much of what the caregiver is saying is really being comprehended. And a vast majority of people with Alzheimer's disease, memory loss or amnesia is really more prominent than language impairment or aphasia.
Host: Third, anomia.
Celisa: Anomia is when someone has word finding difficulty in speaking and writing. Maybe that person knows what they need, but they cannot find the right word to express what they need. And so that's anomia.
Host: Got it. And we're moving onto the fourth one, which is apraxia.
Celisa: Apraxia, if you'll look at the word or hear the word apraxia, it has an X in it, and that really means action. So, this is a loss in voluntary motor skills. Maybe they do have the capability to perform an action, but the brain and the muscles required to carry out the task really aren't communicating. So, they lose the ability to perform the activities of daily living like dressing and bathing and grooming, walking, and even eating. Because of these changes, they really have a high risk in falls. So, really try to keep them active as much as possible to try to delay this physical change that's caused by apraxia.
Host: Got it. And fifth, we have agnosia.
Celisa: So agnosia, the word has an N and an O in it. So, that's really about knowledge. They have lost the ability to recognize an object, maybe even a face or a voice or a sound or even a specific place. They don't recognize that this is their home. So, not only do they lose the ability just to name the object, they also lose the ability to describe what it's used for.
Host: It's a sobering list and finally, this is not an A, but it has some bearing, disturbance in executive function.
Celisa: So, what's executive functioning? It's basically our mental processes that allow us to plan, to focus attention, to remember instructions and to juggle multitasking successfully. So, if we have a decline in that, we might have a struggle with thinking, self-monitoring, self-control, planning, problem solving, organization, and time management. So, that's a big one. If there's a little bit of change in executive function you're not going to be successful in completing any kind of task, especially multitasking.
Host: Can you give us a good concrete example of someone exhibiting these kinds of struggles?
Celisa: Sure. So, let's say for tying your shoes, maybe the caregiver is telling their loved one, hey, we're about to get ready to leave. So, I want you to go and tie your shoes. So, with aphasia, I'm wondering, what are you telling me to do? Because I can't understand the words that you're using. With amnesia, I don't even remember what you've told me to do if to do anything at all. So, I've already forgotten about it. And with agnosia, I'm really confused about what is a shoe in the first place. And then with apraxia, I can't even make my hands do what you're asking me to do. And then with anomia, I can't even find the words to tell you that I do not know what you're asking me to do.
Host: Okay, that is very concrete. And we want to repeat again. So, if a person has any of these two criteria, meaning the five A's we just talked about, plus the disturbance in executive functioning; there's a very good chance that person has Alzheimer's. What should a spouse or a family member do if they see signs of these changes in their loved ones?
Celisa: So, I really recommend that they try to talk with their spouse or their family member about the concern that they have and specifically, what did they see and then reach out to their primary care physician to discuss these changes. It might even be helpful for a caregiver just to keep a log or write down some things that they may see.
So they will not be forgetting of what they need to share with that doctor. And then the primary care physician will follow through making appropriate referrals, probably to a neurologist, which is a doctor that specializes in brain health. And then that neurologist is going to order a comprehensive battery of diagnostic tests, which could be a brain scan, maybe even a sleep study, a comprehensive battery of labs and also neuropsychological testing, which is an assessment by a psychologist that also specializes in brain health.
Host: So there's an entire team working for the better health of this person.
Celisa: Correct.
Host: Well, Celisa, as you were listing those final things, I feel like we have more podcasts to do because there's so much to cover.
Celisa: There is, there's a lot to cover to really understand the brain is a unique organ and it's our control center for everything that we do. If we have any change in it, it's going to affect our daily lives and how we're used to carrying out things.
Host: Sure. All of this has been so enlightening. Thank you for the good information and for the good work you do today.
Celisa: All right. Thanks so much for letting me share.
Host: And that wraps up this episode of BayCare HealthChat. For more information, or to get connected with one of our providers contact the Memory Disorder Center in Clearwater at (727) 298-6025. And the Memory Disorder Center in St. Pete at (727) 825-1595. There's also lots of great information at BayCareMemories.org.
Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. This is Deborah Howell. Have yourself a terrific day.