Catching memory loss before it’s too late.
Text: Yvonne Vahlensieck
The earlier dementia is diagnosed, the more can be done about it. A research team in Basel is working to identify the very first signs of Alzheimer’s disease.
Everyone forgets things now and then – even Andreas Monsch, Head of the Memory Clinic at the University Department of Geriatric Medicine at the Felix Platter Hospital. “Up to a certain point, such lapses are normal. That’s why we all use aids like this one,” he says, holding up the smartphone he entrusts with his schedule.
Sometimes, however, increasing forgetfulness can be a warning sign for the onset of dementia caused by Alzheimer’s disease. The Memory Clinic FELIX PLATTER specializes in early diagnosis of cognitive impairments: Each year, the clinic assesses around 1,000 people using specially developed cognitive tests, comprehensive medical examinations, and magnetic resonance imaging (MRI) brain scans that reveal changes in the brain’s structure and allow other causes such as tumors to be ruled out.
The team’s goal is to be able to diagnose dementia at the earliest possible stage so that help can be offered as soon as possible. Although there is still no treatment with the capacity to heal or halt Alzheimer’s disease, there are drugs which help to slow disease progression. Furthermore, clarity is of great value to the families of those affected: “For 90 percent of relatives, the diagnosis comes as a relief. It means they know what they are up against and it allows them to deal with the situation more effectively,” Monsch explains.
Diagnosis before symptoms arise
This is why researchers at the Memory Clinic are working to improve early diagnostics even further. They hope to develop tests to detect dementia before major symptoms occur in everyday life. “The brain is very good at compensating. Impairments can go unnoticed for a long time, even if the disease has already been ongoing for months or years,” says Sabine Krumm, a psychologist who specializes in neurocognitive processes.
Her research takes an innovative approach: Thanks to MRI scans, we know that the first harmful accumulations of Tau proteins typical of Alzheimer’s occur in an area of the cerebral cortex roughly the size of a fingernail, known as the perirhinal cortex. Among other tasks, this region of the brain is responsible for recognizing complex images and objects. “Accordingly, we are working with new cognitive tests to assess these particular functions. After all, memory loss may not necessarily be the very first sign to occur.”
The perirhinal cortex is involved in telling apart living creatures – a more complex task than distinguishing between objects such as tools, for example, as living creatures often share numerous features. Krumm administered tests to subjects at an early stage of Alzheimer’s disease, a task in which they had one minute to list as many animals and fruits, and then as many tools and vehicles, as they could. For animals and fruits, they performed significantly worse than a healthy control group, while for tools and vehicles no difference was observed.
Krumm believes that tests of this sort have the potential to enable much earlier detection of Alzheimer’s dementia. To test this hypothesis, she is leading a study in which 400 cognitively healthy individuals with an average age of 75 perform a series of cognitive tests over a number of years, and undergo an MRI scan each time. It is predicted that 25 to 30 of the subjects will develop dementia over the next few years. Krumm can then retrospectively analyze the test results to look for the very first measurable differences between the subjects that remained healthy and those who became ill.
Monsch believes that this project will lay important groundwork: “If a drug to treat Alzheimer’s is discovered, we would want to use it before symptoms occur.” After all, brain cells that have been destroyed cannot grow back. If we want to conquer this terrible disease, we need to be able to diagnose it before patients realize they are affected.
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