[Early diagnosis of Alzheimer's disease]

The diagnosis of dementia of Alzheimer type (DTA) in the early stage of the disease may be possible with the development of specialized memory consultations. After this diagnosis, we can inform family and even the patient in some cases, monitor the progression of disease, give or not treatment, and help family for daily life management (money, car driving, administration papers, etc.). The first step is to analyse the memory complaints of the patient and if possible of his family. The difficulties in everyday life are more informative than an anxious complaint of memory and some IADL deficiency appear early: difficulty to use phone, drugs, transports or checks. The patient examination by a practitioner or a neurologist has to be complete, even if normal in most of the cases. The practitioner has to explore without specific material, the main cognitive domain: the "5 words test" illustrates a useful memory tool, analysing two types of recall. We also must observe writing, digit span, naming and verbal fluency. The examination by a psychologist using standardized batteries of tests must always be driven by this clinical exploration using common scales like MMS or ADAS. In very early DTA, we may observe a cognitive decline limited to some aspects of memory (free long term recall, cued recall, working memory...) with a decline of the most controlled attentional tasks. An isolated memory disorder has to be identified either as onset of DTA or as an aging related cognitive decline (ARCD): the difference is qualitative and may appear only on repeated exams by experimented psychologist.