In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed. Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics. 24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff. Some of these are discussed in detail in the links in this section.
First office visits typically last 45-60 minutes. Your doctor will review your intake form with you and gather a detailed medical history. A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors. Specialty laboratory testing may be recommended. Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.
To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.
Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.
Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.
To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.
A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.
Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.
The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.
The doctor in charge reports any findings in his medical notes.
Diagnosis is difficult, because there is no definite test for the disease. Only a post mortem can establish beyond doubt whether Alzheimer’s disease was present. Diagnosis is about 90 per cent accurate. It is important to rule out the presence of other conditions that can mimic the symptoms of Alzheimer’s disease, such as brain tumors, depression or some types of malnutrition. The range of diagnostic tests used may include a neurological examination (mental status examination) and a brain imaging scan such as a CT scan or MRI.
A.Neurological Examination (Mental Status Examination)
A mental status examination is used to assess the cognitive skills of the patient. It involves a series of questions that evaluates the mental function, thought process and the behavior of the patient. The following are categories that are used in evaluating conditions such as Alzheimer’s Disease, ADD-ADHD and memory loss:
- Appearance
- Behavior
- Speech
- Mood and affect
- Thought processes and content
- Perception
- Attention and concentration
- Orientation
- Memory
- Judgment
- Intelligence and information
- Insight
Indications and Contraindications:
A Neurological Examination is done to patients when conditions such as Parkinson’s Disease, Alzheimer’s Disease, ADD-ADHD, neurological trauma, psychological diseases, and memory loss is suspected.
How does it feel? How long will it take?
A neurological examination may take approximately 1-2 hours to be completed. During the test, the patient will asked simple questions regarding the date, month, year, time, events, numbers, personal experiences, and objects. Short term memory will also be assessed through repetition and recall exercises. Language and speech will also be evaluated, as well as moods such as anxiety, depression, emotional distress and attitude.
Effects after the test:
There are no side-effects to a neurological examination. In some cases, the patient may feel exhausted from the physical and mental tests by the end of the examination.
Interpretations of Results:
Normal Findings:All tested functions are found within the normal range
Abnormal Findings:
- The patient is having trouble staying alert and oriented
- The patient is not able to converse properly (delayed/rapid speech)
- The patient cannot follow instructions given
- Rreduction in spontaneous movements and fidgeting. You may also have reduced facial expressions, less blinking, small handwriting and slow, soft speech.
- Stooped posture.
- Mental state examination may reveal evidence of dementia and impaired memory or concentration. These changes are seen in over half of patients over 65 years.
- Mood: euphoric/dysphoric
- Impairment of the senses
- Memory Loss
B.Computed Tomography Scan of the Brain (CT Scan)
What is the Computed Tomography Scan (CT Scan)?
A Computed Tomography Scan is a procedure done that uses tomography x-ray films and computers to generate images of the brain for evaluation and diagnosis.
Indications and Contraindications
A CT scan is used to rule out brain disorders such as brain tumors, abscess, hematomas, aneurysm, hydrocephalus, bleeding and headaches. This test is also indicated to rule out CNS disease such as multiple sclerosis, cerebral palsy, stroke, Alzheimer’s Disease and Parkinson’s disease.
This test may not be performed to patients who have the following conditions:
- Allergic reactions to dye or iodine
- Pregnancy
- Unstable vital signs
How do you prepare for the Computerized Tomography Scan (CT Scan)?
- Avoid eating for 4 hours prior to your scheduled CT Scan if you will be administered a contrast material. No fasting is needed if contrast material will not be used for the CT scan.
- Inform your physician if you are taking any prescription or nonprescription medications. Follow your physician’s orders regarding intake of these medications before the test.
- Wear comfortable clothing to the exam. In some cases, you may be given a hospital gown to use during the test. Jewelry, dentures, wigs, clips, and hairpins must be removed before the test begins.
How does it feel? How long will it take?
The CT scan is a painless procedure that usually takes 15 minutes to an hour. A contrast material may be used for the CT scan. It can be administered orally or injected intravenously. If injected, you may feel a slight prick or tingling sensation as the contrast material is injected in to your veins.
You will be asked to lie down still and to hold your breath during the scan. If you are claustrophobic or having problems of staying still, a CT scan may cause you some discomfort during the test. If this is the case, you may be given light sedation that can help you relax.
Expected effects after the test:
Special instructions after the test:
Have a responsible adult drive you home after the procedure. It is necessary that you avoid driving at least an hour after the procedure if you were given a contrast material and if you were given sedatives for the procedure. For the next 24 hours, drink water frequently to expel the dye out of your body. Notify your physician if a delayed allergic reaction occurs and follow the treatment recommended.
Interpretation of Results:
Normal Findings:
- There is no evidence of a disease in the x-ray images from the CT scan.
- Normal results illustrate the absence of foreign materials, growth, bleeding and build-up in the brain, blood vessels and skull.
Abnormal Findings:
- Presence of foreign objects such as glass and other fragments can be seen through the CT scan.
- Fluid-filled ventricles- hydrocephalus
- Presence of tumors (benign and malignant)
- Cerebral infarction
- Ventricular displacement and enlargement
- Cerebral aneurysm
- Brain infection and abscess
- Stroke
- Bleeding and swelling
Notes:
Inform you doctor of your current medical conditions such as asthma, heart conditions, diabetes, and kidney disease
Inform your doctor if you are breastfeeding. Strictly follow the instructions given to you by your doctor. Usually, breastfeeding can only be resumed 2 days after the procedure to avoid passing of the dye to your child
CT scanners have a maximum weight limit. CT scanners cannot support over 300 pounds of weight.
C.Magnetic Resonance Imaging (MRI)
What is a Magnetic Resonance Imaging?
An MRI procedure uses magnetic fields and radio waves to produce images of organs and body structures. MRI is a diagnostic radiology procedure that visualizes the CNS, joints, extremities, spinal cord, back and neck, kidney, breasts and liver.
Indications and Contraindications
Indications for MRI include:
- Evaluation of headaches
- Neurological signs of CNS diseases
- Neck and back pain
- Detection of brain tumors, injury, bleeding
- Diagnosis for stroke
Contraindications:
- Patients who are pregnant
- Patients with intrauterine device
- Patients with medication patches
- Patients with unstable vital signs
- Patients with implanted metal objects such as pacemakers, ear implants, metal fragments on eyes, aneurysm clips, and infusion pumps
- Patients with artificial heart valves
- Patients undergoing chemotherapy
How do you prepare for Magnetic Resonance Imaging?
There are no dietary restrictions necessary before the MRI procedure. All metallic objects on the body such as jewelry, dentures, clips, belts, coins and cards should be removed before starting this procedure. It is also recommended that you empty your bladder before the MRI.
How does it feel? How long will it take?
MRI is a painless procedure that usually takes 30 minutes to an hour. A contrast material may be used for the MRI. It is injected intravenously in your arm. This usually takes 1-2 minutes. You may feel a slight prick or tingling sensation as the contrast material is injected in to your veins.
During an MRI, the patient is required to remain still. There will be times that you will be asked to hold your breath. For some patients, lying motionless during an MRI can be uncomfortable and some are claustrophobic inside the equipment. In these cases, you will be lightly sedated to help you relax.
You may hear a thumping sound while the test is going on. If necessary, you can request for earplugs. In rare cases, it is normal to feel warm on the area being examined.
Expected effects after the test:
Normally, there are no effects after the procedure. In some occasions, allergic reactions due to the contrast material used may develop. Notify your physician of effects such as allergies or infection on the IV site and follow the treatment prescribed to you by your doctor.
Special instructions after the test:
You may drive home without assistance after the procedure. However, if you were given a contrast material and sedatives during the procedure, avoiding driving and have a responsible adult to drive you home. For the next 24 hours, drink water frequently to expel the dye out of your body. Notify your physician if a delayed allergic reaction occurs and follow the treatment recommended.
Interpretation of Results:
Normal Findings:
- There is no evidence of a disease in the x-ray images from MRI scan.
- Normal results illustrate the absence of foreign materials, growth, bleeding and build-up in the brain, blood vessels and skull.
Abnormal Findings:
- Enlargement- hydrocephalus
- Presence of tumors- cerebral tumor
- Demonstration of hemorrhage and abscess
- Blockage and narrowing of blood vessels
- Cerebral aneurysm
- Brain infection and abscess
- Abnormal findings that indicate multiple sclerosis
Notes:
Inform you doctor of your current medical conditions such as sickle cell anemia, heart conditions, diabetes, and kidney disease.
Inform your doctor if you are breastfeeding. Strictly follow the instructions given to you by your doctor. Usually, breastfeeding can only be resumed 2 days after the procedure to avoid passing of the dye to your child
MRI equipments have a maximum weight limit. It cannot support over 300 pounds of weight.
The Right Diagnosis and Treatment for Alzheimer’s Disease
Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.
Patients Medical’s Personal Approach to Alzheimer’s Disease
Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.
We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.
Next Steps:
Poor health can significantly affect your life. Improve your life by changing to good health. Call our patient coordinator at 1-212-679-9667 or click on Request an Appointment to schedule an appointment with one of our doctors for evaluation and testing.
We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.
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Article Last Updated: 06/26/2009