Better diagnostics can change everything for people with dementia

Welcome to Neurotransmissions, a new First Opinion column on the revolution in dementia. This is the second in a three-part series on the dramatically changing world of dementia. Read the first part here.

As a dementia specialist, I think of my work as that of a writer. To diagnose a patient, I write the story of their problems, embellished with an exam, tests of cognition, and brain scans that show that organ’s structure and function. If this story nicely matches the textbook description of a disease that causes dementia, it’s a diagnostic story, what doctors call “a classic case.”

Barbara was one of my classic cases of the “amnestic variant” of dementia caused by Alzheimer’s disease. Classic because at her new-patient visit with me at the Penn Memory Center, her and her daughter’s vivid stories nicely matched how Alzheimer’s typically unfolds, beginning with annoying problems with memory. She repeated questions and accounts of recent events (that’s the amnestic part — forgot the answer, forgot she already told you) and later developed problems with multitasking. She was no longer able to organize the household finances. Preparing a meal was a challenge. Her brain MRI showed notable loss of tissue in the medial temporal lobes, regions of the brain where the seahorse-shaped hippocampi nestle, a brain structure critical to forming new memories.