How can we improve dementia diagnoses?

Every other month, our Center hosts a case conference called the Clinical-Pathological Correlation conference focused on educating young clinicians and researchers on the complexity of diagnosing the dementias. Many may know that while clinicians can estimate a dementia diagnosis closely, the ultimate diagnosis must come from autopsy reports after death. While the dementia field has made great strides in understanding the diversity of dementias and how each varies from the other symptomatically, dementia itself is quite complex and there is still much we do not understand about this class of diseases. This conference reinforces the necessity for brain donors to truly expound our knowledge of the disease.

What makes accurately diagnosing a dementia so complex? In many cases, a person living with dementia may have multiple age-related syndromes manifesting at once. For example, hypertension and vascular dementia commonly occur together. In addition, it’s common for an older adult to experience more than one type of dementia. Because of this, differentiating between the “mixed bag” of symptomatic culprits can be challenging.

Each month, we see this complexity in action at the Clinical-Pathological Correlation conference. This conference shares the dementia journey of a previous patient at the University of Michigan Cognitive Disorders Clinic or a previous research participant at our Center who not only underwent clinical observation, but also opted to participate in our brain donation program. The conference begins with a summary of the deceased patient’s clinical history from the overseeing physician. The physician shares common concerns the patient or their family may have voiced during their time visiting the clinic or our research Center. Because our research participants and clinic patients are seen every year, the physician will report on health changes over time, changes in medications, imaging results such as MRI or PET scans, and more.

Neuropsychology measures are also captured in the dementia diagnosis process. Neuropsychology is the connection between the brain, cognitive function (thinking), and behavior. Neuropsychological assessments for dementia include the mini-mental status exam (MMSE) and the Montreal cognitive assessment (MoCA). During this conference, a neuropsychologist will share the results of these tests and how they may have changed over time. These measures, in tandem with the clinical history and imaging results, compose the full picture a physician utilizes to determine a dementia diagnosis while the patient is living.

As is the case in many instances of clinical diagnoses, these results may lead the physician down a path of one diagnosis, and then, after death, the patient’s pathology may resemble something different. This isn’t always the case, however. There are many instances when the physician’s clinical diagnosis directly mirrors the pathological diagnosis. This variance speaks to the necessity for continued research and understanding. There is still so much work that needs to be done to ensure that every patient receives an accurate diagnosis, in the clinic, while alive, so that interventions, life planning, and more can be carried out appropriately. This is only possible with the generous contribution of brain donations.

Brain donations allow physicians and pathologists to study how a clinical diagnosis may resemble or correlate with the pathological diagnosis. It is through this research that additional clinical criteria can be developed, and physicians can improve their accuracy in diagnosing patients. Brain donation is the ultimate gift to research, as it is the gift of knowledge that gives for decades to come. If you or a family member may be interested in participating in our brain donation program, please find more information here.