Alzheimer’s disease is the most common cause of dementia, accounting for up to 60-70% of dementia cases. As of 2021, more than six million Americans and one in nine people aged 65 and older are living with Alzheimer’s disease.
However, despite the vast prevalence of Alzheimer’s disease and continually growing comprehension of its pathology, the rate of misdiagnosis continues to remain high—the 2021 World Alzheimer’s Report estimates that up to 30% of people diagnosed with Alzheimer’s disease are misdiagnosed. There are many intracranial causes of cognitive impairment that can be mistaken for Alzheimer’s.
Below, we detail several examples of intracranial causes of cognitive impairment, unique defining pathologies of Alzheimer’s disease, and the need for more reliable, affordable, and accessible longitudinal cognitive assessment tools to improve diagnostic accuracy.
When an individual presents symptoms of cognitive impairment, such as increased memory loss and confusion, difficulty learning new information, or challenges with problem-solving, it can be easy to jump right to Alzheimer’s disease. While Alzheimer’s disease is clinically characterized by a variety of progressive cognitive deficits, there are many intracranial causes of cognitive impairment. Several examples are detailed below.
Although there are similar cognitive impairments in Alzheimer’s disease and other neurological conditions, Alzheimer’s has unique defining pathologies. Most commonly, Alzheimer’s disease is characterized by beta-amyloid plaques and neurofibrillary tangles resulting from abnormal tau hyperphosphorylation. These distinct pathologies are crucial in making an Alzheimer’s disease diagnosis and are commonly identified through imaging and diagnostic procedures, such as magnetic resonance imaging, positron emission tomography, and cerebrospinal fluid analysis.
However, identifying cognitive impairments that may be indicative of Alzheimer’s disease typically begins with pencil and paper cognitive assessments, such as the Mini-Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA). These assessments are purely cognitive batteries, meaning they are not necessarily able to distinguish between cognitive impairment due to a unique defining pathology of Alzheimer’s versus intracranial causes of cognitive impairment.
As Alzheimer’s is a progressive disease, obtaining a timely and accurate diagnosis is critical for effective intervention and treatment. Given that simple cognitive assessments are not suited for Alzheimer’s diagnosis and diagnostic tools are expensive, invasive, and rather inaccessible, there is an urgent need for new tools to aid in Alzheimer’s diagnosis.
To improve diagnostic accuracy, there is a need for:
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