Northwestern University Feinberg School of Medicine

Mesulam Center for Cognitive Neurology and Alzheimer’s Disease

Diagnosis & Treatment

Making a Diagnosis

The absolute diagnosis of Alzheimer's disease can only be made at autopsy. However, physicians at specialized centers can diagnose Alzheimer's disease with 90 percent certainty based on clinical information. To make the diagnosis the following may need to be conducted:

  1. A medical history and neurological exam
  2. Neuropsychological testing
  3. Neuropsychological testing involves a careful analysis of a person's memory, problem solving, language, attention, and visuospatial ability.
  4. Basic blood tests
  5. Blood tests may be used to help exclude other causes of memory difficulties. For example, a person with a thyroid disorder or a vitamin deficiency may have problems with his or her memory.
  6. Brain scans
  7. A brain scan such as an MRI or a CT scan may need to be done in certain patients to detect brain tumors or strokes. These disorders may cause memory problems.

Treatments for Alzheimer's Disease

Many treatments are being evaluated, but as of yet, there is no cure. There are a number of medications currently approved by the Food and Drug Administration (FDA) for the treatment of mild to moderate Alzheimer's Disease. Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razydyne) are medications which block the enzyme, acetylcholinesterase, which is one of the enzymes responsible for degrading acetylcholine. Acetylcholine is a neurotransmitter in the brain, which is crucial for the formation of memories. Clinical drug trials with these medications show that cognitive abilities can be improved over baseline for up to 6-12 months after starting a cholinesterase inhibitor. These medications have also been shown to improve some of the behaviors associated with Alzheimer's disease, such as apathy, delusions, and disinhibition. Common side effects seen with all of the cholinesterase inhibitors include nausea, diarrhea, and dizziness.

Another medication with a different mechanism of action has been approved by the FDA for the treatment of Alzheimer's disease. Memantine (Namenda) is a medication which helps improve cognition by blocking the overstimulating effects of excessive glutamate, a mechanism which appears to be a major factor in cell injury and death in Alzheimer's disease. Common side effects seen with memantine include dizziness, confusion and headache. Researchers are also trying to develop other methods of blocking the product of amyloid plaques or enhancing their clearance from the brain.

There are also a number of psychiatric medications, which are used to treat the behavioral disturbances which commonly develop in the later stages of Alzheimer's disease such as depression, apathy, aggressive behavior, delusional thinking and disinhibition. Medications used to treat these behavioral and psychiatric symptoms include antidepressants, antipsychotic and mood stabilizing medications.