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Researchers created a blueprint for detecting dementia and Alzheimer’s disease.

Detecting dementia and Alzheimer’s disease
Researchers create blueprint for better diagnosis

April 2013

by Natalie Gutierrez

Researchers have developed a smarter way to diagnose dementia and Alzheimer’s disease that could be achieved, in the very near future, from a smart phone or mobile device. Scientists at The University of Texas Health Science Center at San Antonio have created a first-of-its-kind algorithm that is more accurate than traditional clinical and diagnostic testing.

The new system is improving diagnosis and could make a huge impact in Mexican-Americans who are at higher risk for developing dementia but more difficult to diagnose. The test could be translated to work on smart phones and mobile devices for more efficient and accurate diagnosis.

Donald Royall, M.D., and his colleague Raymond F. Palmer, Ph.D., both of the UT Health Science Center, developed the new test. Dr. Royall is a professor and chief of the Division of Aging and Geriatrics in the School of Medicine. Dr. Palmer is an associate professor in the Department of Family and Community Medicine in the School of Medicine. They co-authored two studies on dementia published in the Journal of Neuropsychiatry and the Journal of Alzheimer’s Disease. Their latest research, which focuses on depression and its relation to dementia and Alzheimer’s, will be published in the Journal of Alzheimer’s Disease later this year.

Cultural query
"Before we began studies at the UT Health Science Center two years ago, little was known about dementia and Alzheimer’s disease in the Mexican-American population," Dr. Royall said. Studies are ongoing. "Mexican-Americans are thought to have higher rates of dementia and conditions such as depression and stroke that can be confused with Alzheimer’s disease. So we don’t know yet if the dementias to which they succumb are caused by Alzheimer’s disease, stroke, depression or a combination of the three."

Alzheimer’s ranks among diseases most feared by Americans. It is the sixth-leading cause of death in the United States and no cure exists. Dr. Royall said it is vital to better understand and accurately diagnose dementia especially in Mexican-Americans because this group will comprise a majority of the state’s population in the near future and is the fastest-growing minority in the nation.

"Disparities in access to care and language as well as cultural barriers and co-morbid conditions (the presence of more than one disease such as diabetes, heart disease and obesity) make it more difficult for physicians to diagnose and treat dementia in the Mexican-American population," Dr. Royall said.

From research to results
Using information and research Dr. Royall and his colleagues gathered from ongoing studies of 350 Mexican-Americans enrolled in research at the
UT Health Science Center, and with information from a battery of tests that participants undergo through the study (clinical exams, blood tests and cognitive and functional tests), researchers developed the more accurate method of assessing patients to determine if they are suffering from dementia and to study its causes.

The new system allows doctors to enter test results for analysis while negating information from language, education or cultural bias that may create confusion and misdiagnosis. The test produces an accurate assessment of the patient’s dementia status by ranking certain criteria.

"We were surprised to find through our studies that depression can be dementing in its own right," Dr. Royall said. "This explains the disability associated with depression and the difficulties doctors have in distinguishing it from Alzheimer’s disease. In fact, depression appears to double the risk of being diagnosed with Alzheimer’s. But unlike Alzheimer’s disease, depression can be treated. This system could be used to select patients who might better respond to antidepressant therapy."

An app for Alzheimer's?
Dr. Royall said researchers could possibly take this new system and create a computer application that could be used in doctors’ offices or could be accessed from smart phones or mobile devices by physicians who treat patients in rural areas or home health care settings for example. Dr. Royall has submitted a patent for the system that he currently calls "Latent Variable Dementia Case Finding."

The Texas Alzheimer’s Research and Care Consortium (TARCC) funded studies at the UT Health Science Center. Dr. Royall and his colleagues are seeking additional funding for brain imaging of study participants.

"Now we are looking to study the brain more carefully to see where diseases such as depression, dementia and Alzheimer’s are occurring and how they might be altering brain structures," Dr. Royall said. "All of this data could help physicians more effectively tailor treatment plans for individual patients."

Eric D. Vidoni, Ph.D., and Robyn A. Honea, Ph.D., both research assistant professors of neurology at The University of Kansas Medical Center, contributed to this research. Dr. Royall’s work is supported by the departments of psychiatry, medicine, and family and community medicine of the UT Health Science Center, and the Geriatric Research, Education and Clinical Center (GRECC) of the South Texas Veterans Health Care System, Audie L. Murphy Division.

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