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According to the Alzheimer’s Association, there are currently over 7 million people around the country living with Alzheimer’s disease—and that amount is expected to skyrocket to 13 million by 2050. And as the number of people living with the condition increases, so does the price tag for their care. The organization also reports that the health and long-term care costs for dementia patients is currently $384 billion and by 2050, it will be $1 trillion.
Despite this prevalence and cost, Alzheimer’s disease and other types of dementia are not as understood as they could be. One example of the consequences of this misunderstanding takes place in the doctor’s office.
“An NBC news report found that doctors were not discussing memory concerns with patients, which is a critical first step in diagnosis,” explained Ruth Fidler, MS, HTL (ASCP)cm, Autopsy Coordinator and Evisceration Technician at Baylor University Medical Center, in the NSH Laboratory Webinar Forget-Me-Not: How to Demystify Dementia.
Understanding Dementia
Fidler says that one of the reasons people don’t necessarily understand dementia is because of several widely held misconceptions.
“It cannot be stressed enough that dementia is a syndrome; it is not a disease process itself. There are many causes of dementia, and they have many overlapping symptoms and variations. Not all cognitive senescent, or natural aging, changes result in dementia and dementia is not considered a definitive, normal aging process,” Fidler said. “Simultaneously, not all dementia cases are considered Alzheimer’s disease because dementia and Alzheimer’s disease are not synonymous terms. Additionally, diagnosis of dementia is a comorbidity, not a cause of death, except that in some patients, and in some cases, the patients forget to eat or the patients forget to breathe and death occurs.”
So what is dementia? Fidler explains it this way: “Dementia is a frequent syndrome of neurodegenerative disease of the cerebral cortex. Unlike stroke, trauma, and other injuries that lead to localized brain damage, degenerative disorders can affect the brain in multiple areas that are linked together.”
The diagnosis of dementia is confirmed postmortem, and there are some tell-tale clues that histotechnologists can look for in the lab. Many types of dementia are associated with the development of protein aggregates that are resistant to normal cellular degradation, and they can be recognized by hallmark histologic baselines. Some of the characteristics histotechnologists can look for are plaques and tangles, inter- and extraneuronal structures, astrocytic gliosis, scarring, and tissue necrosis.
“Many of these things can be seen on H&E and are confirmed with IHC coordinating test markers,” said Fidler.
Dementia is as complicated as it is prevalent, and unfortunately, it’s still often misunderstood by even the healthcare professionals charged with diagnosing and treating it. To get more clarity about dementia, and the role histologists play in confirming it, watch NSH’s Forget-Me-Not: How to Demystify Dementia webinar. Fidler provides more details about types of dementia and how they’re characterized, as well as techniques used in the lab to identify the condition.
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