Despite the clinical fact(s) that someone may be experiencing or manifesting obvious memory loss, cognitive dysfunction and/or dementia, there is no definitive clinical, radiographic or laboratory test that is specific for Alzheimer Disease, Senile Dementia of an Alzheimer's Type (SDAT) or any other form of chronic, progressive mental/mind dysfunction.⁴¹ Thus, the "diagnosis" of memory loss, cognitive dysfunction or dementia syndrome is almost exclusively a "clinical" or "bedside" diagnosis made by the physician, not the laboratory or radiology department. However, there are number excellent clinical tools to help the clinician more closely evaluate an individual patient suspected of memory loss or cognitive dysfunction. Many of the laboratory and/or radiographic tests used to evaluate memory problems, cognitive decline or dementia can be "supportive" of a diagnosis, but rarely will the test, short of an autopsy, lead to a specific "definitive diagnosis". And since there is no specific treatment for any of the "named" clinical syndromes that involve memory loss, cognitive dysfunction or dementia, Integrative Medical diagnostic efforts are directed at determining potential causative factors involved in producing or aggravating the condition that can actually be treated. Identifying potentially "treatable" underlying causative or contributing factors, such as toxic metal burden (mercury, lead, etc.), Vitamin B12 deficiency or vascular (circulatory) insult ("multi-infarct dementia") and others allows the development of an individualized treatment or preventive program. The concept is based on correcting whatever real or potential contributing or causative factors that are identified in order to encourage and allow self-healing to occur. The idea of the Integrative Medical approach is to optimize all functional, structural and/or biochemical processes whenever possible.

Normal Versus Optimal Laboratory Interpretation:

In order to optimize functional performance the clinical interpretation of the results of testing will vary depending on the physician's perspective... the clinical problem of "normal" versus "optimal". Normal is based on "statistical" data. It is usually "defined" as any value that is found in a statistically derived bell-shaped or Gaussian curve of group or "herd" derived values. The reference values used to make a Gaussian "normative" curve are obtained from a "representative" group of selected individuals conjured to be representative of "normal". More often than not, this group is simply the first and only available persons that seem to appear healthy and otherwise "normal" to the person(s) establishing the curve. Optimal, on the other hand, is specifically individualized to the affected person. It is based on previous norms in the same patient or has been defined by various national societies, such as the American Academy of Anti-Aging Medicine (A4M), as the value one would see in someone of the same sex at 28 to 32 years of age and where their individually determine value should be located in the 3rd quartile (50-75%) of that group.

The following Integrative Medicine list of diagnostic tests for memory loss, cognitive dysfunction or dementia can be very helpful and informative in evaluating for the presence of memory-cognitive problems and in designing an individually optimized prevention or treatment program. The tests have been categorized into functional groups and may be annotated with a brief explanation of usefulness and/or significance. While the following list is not meant to be complete and additional tests could be added, the list as presented is fairly comprehensive. The clinical interpretation of the listed individual laboratory results are made from an "optimal" rather than simply "statistically normal" perspective:

Blood Tests	more >>
Urine Tests	more >>
Functional (Regulation) Tests	more >>
Radiological Imaging	more >>
Mental Status Exam	more >>

Blood Tests
Standard Health Screening Tests are helpful in identifying potentially treatable factors in memory loss, such as thyroid imbalance, mineral deficiencies (potassium, magnesium, etc.), anemia and others. There are a number of additional screening blood tests that may be also helpful in identifying potentially treatable factors affecting mental-mind function. Included in this group would include vitamin levels (B12, Folate, etc.), C-reactive protein, Erythrocyte Sedimentation Rate (ESR), Anti-Gluten or Anti-Gliadin Antibodies(a marker for wheat toxicity), Immune Competency testing, Estrogen level in females, Testosterone level in males, IGF-1 (Insulin-like Growth Factor 1), Homocysteine level (challenged with oral Methionine before measurement), Hemoglobin A1C (a measure of abnormal tissue glycation in the presence or absence of overt clinical diabetes), Anti-Oxidant levels such as Coenzyme Q10, Vitamins C and E, Glutathione levels, and possibly tests for Mold, Fungus, Mycotoxins and other stealth infections, such as Lyme disease, Nanobacter infection and others.

Urine Tests
Urine evaluation in memory loss-cognitive dysfunction syndromes are usually limited to evaluating for silent urinary infection that could be a final stressor that pushes a marginally compensated patient into full blow mental symptoms, evidence of underlying kidney disease (protein in the urine, inability to concentrate minerals or excrete water, etc.) and/or testing using toxic metal Chelation Challenge testing for excessive biological burden of toxic metals (EDTA, DTPA or DMPS challenge testing).

Functional (Regulation) Tests
Physiological function tests can be used to evaluate for the presence of "memory" or "cognitive" disturbances in subliminal physiologic function, as well as for underlying "causative" factors for clinical mental deterioration. For example, an ECG (electro-cardiogram) could show the presence of atrial fibrillation that is causing a showering of blood clots from the heart to the to the brain. A HRV (Heart Rate Variability) test may demonstrate a subliminal disturbance in the sympathetic-parasympathetic "cybernetic" autonomic nervous system that could affect regional blood flow to the brain leading to reduced performance. Non-invasive Vascular Testing used for evaluation of both the Macro (large vessel) and Micro (capillary small vessel) circulation of the neck and brain can reveal the presence of blood flow problems that may not be apparent on physical exam. The use of Immune Antigen Recall (Mantoux) testing may sometimes be used to evaluate neuro-endocrine-immune Memory function.

Radiological Imaging
CT scan of the brain, MRI scan of the brain, PET scan of the brain are the main technologies used to evaluate memory loss, cognitive dysfunction and dementia. These tests are expensive are usually not all done on each patient. They are generally employed to look for potentially treatable conditions, such as stroke, tumor, blood clots, etc. Both CT and MRI are accurate ways of examining the physical structure of the brain. The best structural test for the more subtle changes in the brain due to abnormal vascular tissue glycation and related micro-circulatory changes (scientifically called "ischemic paraventricular leukoencephalopathy, also sometimes called Leukoariosis"⁴¹) is MRI testing. Although it is statistically "common" to see these micro-circulatory changes in the U.S. population as "aging" progresses, when healthy aged populations are studied these "statistically normal" micro-circulatory changes do NOT occur (statistically "normal", but NOT "optimal"). PET scanning is used to look at changes in brain metabolism, but the meaning of most changes has yet to be determined by statistical science, so the clinical applicability of PET results to the problem of memory loss, cognitive decline or dementia is currently being evaluated.

Mental Status Exam
A number of clinical ("bedside") mental cognitive screening interviews and tests designed to evaluate memory and cognitive ability have been developed and tested. These tools allow the clinician to examine and determine mental status for the presence of memory loss or cognitive decline. The following screening tools can facilitate earlier detection of memory-cognitive problems: the Mini Cog test, the CA-CWL (Consortium for Alzheimer's Disease Comparison Word List) test, the MMSE (Mini-Mental State Exam) test, the GPCOG (General Practitioner Assessment of Cognition) test, MIS (Memory Impairment Screen) test and/or Montreal Cognitive Assessment test.^53-59 Each of these tests takes from two to twelve minutes to perform. Usually only one or two are administered to a single patient for diagnostic purposes. Statistically speaking, the sensitivity of these tests range from a low of 54% (Mini-Cog) to a high of 100% (Montreal Cognitive Assessment) and the specificity ranges from 86% to 96%. In other words, they have good to excellent diagnostic accuracy and are useful bedside tools for evaluation of current and ongoing mental status.

REFERENCES

41. Knopman DS. Dementia and Cerebrovascular Disease. Mayo Clin Proc. 2006;81(2):223-230