Remember these words: Rose, Chair, Hand, Blue, Spoon. Draw a clock. Name as many animals as you can in one minute. What’s the date today? List words that start with the letter F. Recall the first five words.Since the 1980s, memory tests like these, often taken with paper and pencil and scored by clinicians trained to read the results, have been the mainstay of the diagnosis of Alzheimer’s disease, a brain disorder that erodes memory and thinking, eventually leaving a person unable to perform basic tasks. The condition affects an estimated 6.7 million Americans over age 65, according to the Alzheimer’s Association.While these symptom-based tests are very good at determining when a person’s memory and thinking aren’t normal, they’re not great at helping doctors suss out the cause of those impairments—which can include everything from vitamin and hormone deficiencies to small strokes, to tumors, to infections, to related disorders like Parkinson’s and Lewy body disease.Symptom-based tests are cited as one reason for the failures of early amyloid-clearing drugs for Alzheimer’s. Reviews of patient data following the clinical trials for two drugs—bapineuzumab and solanezumab–found as many as one-third of patients who were enrolled didn’t have the disease they were being treated for—the buildup of sticky pieces of beta-amyloid and tau proteins in the brain, which is the hallmark of Alzheimer’s disease.But doctors’ reliance on symptom-based testing could soon change. Under new draft guidelines for the diagnosis of Alzheimer’s disease, unveiled on Sunday at a large international gathering of physicians and researchers, these memory tests would take a backseat to biomarkers—proteins and other signals that can be detected in blood, spinal fluid, and on brain scans—that are telltale signs of the disease process unfolding in the brain.Such tests have been available to doctors and clinical trial participants but have not been widely applied to patients in clinical practice. Now, with expensive and risky new drugs coming to market that promise to slow the progression of the disease, there’s a new urgency for improved diagnosis.Getting the diagnosis right“Getting the diagnosis right is absolutely critical to be able to provide these new therapies to the right patients,” said Dr. Gil Rabinovici, who directs the Alzheimer’s Disease Research Center at the University of California at San Francisco.Dr. Rabinovici led a large study, published in 2019 in the journal JAMA, that showed just how impactful these biomarkers can be.Over two years, researchers gave brain imaging positron emission tomography, or PET, scans that use radioactive tracers to light up deposits of beta amyloid in the brain to more than 11,000 patients diagnosed with early memory and thinking changes with an uncertain cause.PET imaging of the brain changed the diagnosis for 35% of patients in the study—ruling out Alzheimer’s for 25% who were initially thought to have it and determining that Alzheimer’s was the cause for 10% of people whose deficits had initially been ascribed to a different cause.“And this was in specialty memory clinics,” Rabinovici said.The scans changed how doctors managed patients a whopping 60% of the time—typically prompting them to prescribe or discontinue memory-enhancing drugs such as donepezil, or Aricept, and memantine.Beyond drug treatments, a biomarker-based diagnosis can also improve a patient’s quality of life, says Dr. Charlotte Teunissen, a professor of neurochemistry at Amsterdam University Medical Center.Teunessin says emerging research shows that precise diagnosis by biomarkers leads to lower healthcare costs and less institutionalization. It keeps people at home in normal care for longer. “So it leads to less burden and also less healthcare costs,” said Teunissen, who is a co-author of the new guidelines.Rabinovici cheered the move to a biological basis for diagnosis.“This is a long-awaited advance for our field, where we are elevating care to start to apply some of these biomarkers that had been in the pipeline and have been in research and start to apply them to the care of patients in the real world. And I think that’s just that’s great progress,” said Rabinovici, who was not involved in the development of the new guidelines.The amyloid PET scans Rabinovici used in his trial have been FDA approved for more than 10 years, but while Medicare covered the cost of these scans for patients enrolled in research studies, the agency declined to cover the cost of the scans for most routine clinical evaluations.Now, with the first FDA approved medication—Leqembi—on the market, which requires evidence of beta amyloid build-up in the brain, Medicare is reportedly set to expand coverage for the amyloid PET scans that are required to see those deposits.New blood tests to diagnose Alzheimer’sTesting all patients suspected of having Alzheimer’s with invasive spinal taps and expensive brain scans made sense for research, but “it’s just no way to solve a mass public health problem,” said Dr. Clifford Jack, a neuroradiologist at the Mayo Clinic in Rochester, Minnesota, who studies the use of brain imaging for the diagnosis of memory disorders.Jack is also a co-author of the new guidelines which are being developed on behalf of the Alzheimer’s Association and the National Institute on Aging. They were presented Sunday at the Alzheimer’s Association International Conference 2023, which is being held in Amsterdam.They build on 2018 guidelines for diagnosing Alzheimer’s in patients participating in clinical trials. They mark the first updates to the type of diagnosis used in clinical care since 2011.After the proposed guidelines are presented, they will be posted on the Alzheimer’s Association website for public comment for 30 days. After the public comment period, the study authors will revise them again and resubmit them for approval, which could come by the end of the year, Jack said.“We’re updating these criteria to modernize them to the modern era, where it is completely feasible to diagnose the disease biologically at a mass scale,” Jack said, “And two, there’s something you can actually do about the disease.”For the first time, the guidelines will direct doctors to use blood tests to detect signs of Alzheimer’s in the brain. Research shows these blood tests which have been developed alongside powerful new amyloid and tau-clearing therapies, are now nearly as accurate gold-standard tests for measuring Alzheimer’s proteins in spinal fluid.“In head-to-head comparisons, they’re basically equivalent,” Jack said.While some of these blood tests are available to doctors now through specialized labs that analyze them, none of them has yet received FDA approval, though Dr. Constantine Lyketsos, director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins, expects some will clear that hurdle within the next year.“It’s a huge advance,” Rabinovici said. “It’s something that five years ago I would have thought was science fiction that we can measure these brain proteins in the blood.”Blood tests will do several important things, Jack said, they will make the cost of diagnosis less expensive and more easily accessible to patients who can’t easily get to specialized memory centers and specialists.They will also allow doctors to better stage the disease, Jack said, since markers for Alzheimer’s disease show up in the blood before there’s evidence of disease on brain scans—something that will help doctors determine where a patient is in the progression of the disease.A diagnosis of Alzheimer’s before symptoms?The new guidelines propose a 6-stage classification where people are diagnosed first on the basis of biomarkers and later on the basis of symptoms.If the new guidelines are adopted as proposed, a person could soon be diagnosed with Alzheimer’s Disease on the basis of abnormal blood testing alone, even without any noticeable memory loss. That would be Alzheimer’s disease, stage 1.Jack said he knows that idea will not sit well with all of his colleagues.“This is a big controversy in the field,” Jack said.Right now, in order to start taking the new amyloid-clearing monoclonal antibodies, patients have to have evidence of beta-amyloid buildup in their brains, through tests of spinal fluid and brain scans. They also have to have symptoms of impaired memory and thinking that are judged to be in an early and treatable stage.There are clinical trials now underway testing whether these drugs can stop or significantly delay the development of memory loss in people who have evidence of amyloid in their brains, but who do not yet have symptoms. The results of those trials are still a few years away.“So in our new criteria, when we say, ‘Can Alzheimer’s disease be diagnosed in someone who is asymptomatic?’ The answer is an emphatic yes, from us,” Jack said. “Symptoms are the consequence of the disease. They’re not the definition of the disease.Jack points to the example of type 2 diabetes. The vast majority of people who are diagnosed with diabetes on screening blood tests for fasting blood sugars don’t have any symptoms.“Does that mean they don’t have diabetes? Because they’re not yet blind or they don’t have kidney failure? No, of course not. They have the disease,” Jack said.Making decisions about treatmentEvidence from autopsies shows that some people with normal thinking and memory die with loads of beta-amyloid in their brains.Jack believes eventually, everyone with beta-amyloid buildup in their brains will have impaired cognition, as long as they don’t die of something else—a broken hip followed by pneumonia; a heart attack, cancer—first.“In older people, you can name any disease that can be diagnosed in asymptomatic people, and there will be some people who will die of other causes,” Jack said.He says that doesn’t mean that people with Alzheimer’s disease don’t deserve a good diagnosis and good care.For some people, going through all the steps to find out if they qualify to take the new drugs may not be worth it for the estimated benefit, which can be difficult for patients and caregivers to see or measure, said Lyketsos, at Johns Hopkins. Lyketsos noted he’s having about a dozen of these conversations each week with his patients right now, driven by curiosity about the new drugs.He says right now, after patients demonstrate some early difficulty in thinking and memory on those paper and pencil tests, he might order some simple tests to rule out other things like vitamin deficiencies and low thyroid hormone.If he still suspects Alzheimer’s, he talks to them about getting a spinal tap or brain scan to get a better understanding of what’s causing their symptoms.If those tests suggest beta-amyloid may be driving their problems, he next looks at genetics—people who have a gene called APOE4, can be more vulnerable to dangerous brain swelling while taking monoclonal antibodies to clear amyloid.Doctors also have to see if patients need other medications—such as blood thinners for atrial fibrillation—that might further complicate the use of amyloid-clearing drugs.Finally, while people may have biomarkers for Alzheimer’s disease, it may not be the only condition causing their dementia. A brain MRI scan would be needed, Jack said, to rule out other problems like bleeding in the small blood vessels of the brain or other types of memory-stealing disorders.“And the patient would then be presented with a choice,” Jack said. “You know, we could do all this screening assessment. And if everything looks good, you can go on treatment. Or maybe you’re just not interested in the screening assessment, and we’ll skip the whole thing. So that’s how that’s how it’s going to have to work for patients right now,” he said.Rabinovici said there is increased interest in from patients in getting a diagnosis and doing it earlier than they might have before.“I think for many years, people had a bit of a nihilistic approach, including doctors about diagnosing Alzheimer’s because they felt like there was little that we could offer patients and families,” he said, noting that he didn’t agree with that. He thinks any information that can help patients plan and guide their care is valuable.“But now that we actually have therapies… I think that will really catalyze the field and elevate care,” Rabinovici said.Meg Tirrell contributed reporting

Imagine putting on a headset and being transported inside your body, getting to see what your surgeon will see and taking a look at the issue up close.That's how Cincinnati Children's Hospital helped prepare one Wyoming, Ohio, boy for his open-heart surgery and it's changed his life in more ways than one.Brayden Otten is no stranger to hospitals.Eight hours after his birth his parents learned his heart wasn't normal. "Sometimes it only forms a small ventricle on the left side of the heart or no ventricle at all. In Brayden's case it was small," his dad John Otten said.From that moment, Brayden's life went down a different path.It was on with several surgeries, but still full of fun, baseball, fishing and love from his furry family members."He's been really strong making sure he's as normal as any kid out there," said his dad.Recently, Brayden's cardiologist noticed some changes and experts saw this as a chance to create a new future for him."Basically, do a revision of initial open-heart surgeries and create two ventricles where there used to be only one," Otten said.They explained it to the 12-year-old in a language he knows well, gaming.They took his video game talent and amplified it to put Brayden and his heart at the center, using virtual reality. "It was amazing. We handed it to him. All of a sudden he put it on, knew exactly what to do and was in the space," said Director of Congenital Heart Surgery at Cincinnati Children's Hospital Dr. David Morales.Morales took Brayden inside his heart.Video showed him detailing every step of the procedure as Brayden explored the inner workings of his ticker."It breaks it down. It takes away all that technical jargon," said Brayden's mother Michelle Otten."Doctor Morales was saying, 'Ok, so this is where I'm gonna make this cut," she said. Brayden was a natural in this virtual space. "I thought it was pretty cool," he said.It was a full-circle moment for Dr. Ryan Moore who has known Brayden since birth and is spearheading this technology."As someone who grew up with video games and is a gamer, it means a lot to me that I was talking to Brayden's parents, after that experience now he wants to become a doctor who develops games to help save kids," said Moore, Director of the Heart Inst. Digital Healthcare Innovation Group at Cincinnati Children's Hospital.Brayden's family said there was a noticeable shift in his confidence after the virtual reality experience. No one really knew how long Brayden's recovery would take in the hospital.Doctors thought maybe three to four weeks.But Brayden was sent home around two weeks after his surgery and will be able to spend Christmas with his family.

A team of nurses in a COVID-19 unit at a Kentucky hospital came together for a ceremony to honor patients who died from complications of COVID-19. “There was one week where we lost a person every day," said Brittany Dawson, a CNA at UofL Health-Jewish Hospital in Louisville.Nurses gathered on a roof patio for a “rock cleansing ceremony,” writing the initials of patients they lost on a rock, saying a few words and placing the rocks inside a vase with water. At the end, a nurse poured the water over plants at the hospital. “I didn't even know that I needed to cry so much until that happened,” Dawson said.During the emotional ceremony, nurses held hands and comforted each other, much like they’ve done with patients suffering from COVID-19 since March.“We’re holding their hand as they take their last breath,” CNA Amber Stull said. “They don't have anybody. They're alone and you can see that they're alone and scared.”The nurses honored the patients for putting up a tough fight with the deadly virus and in many instances having to do so alone.Now, the nurses must continue their own daily fight as the pandemic continues and the number of cases and deaths from COVID-19 climb.“It’s emotionally draining. We’re doing everything we can here,” said Shona Neal Smith, RN. “Usually you go home physically drained. This is that times five, sometimes 10.”Watch the video above to learn more.

Dr. Raul Magadia and his team all gathered in the basement of their Anniston, Alabama, hospital last month for a big announcement he was preparing to make through the intercom system.That system is usually reserved for emergency codes.But Magadia, an infectious disease specialist at the Northeast Alabama Regional Medical Center, had other plans on May 25.He was about to share that in a few minutes the hospital would discharge the last Covid-19 patient from their COVID-19 unit. It was a surreal milestone, he later told CNN, for staff who have been on the front lines of the battle against the virus for more than a year. "We were really aiming for some good news after 13, 14 months of horrible news," Magadia said. "That moment ... that we had zero (patients), it's an unbelievable feeling."On the other side of the country, inside the Zuckerberg San Francisco General Hospital, similar celebrations took place in late May after hospital staff announced they had no COVID-19 patients — for the first time since March 2020."It's incredibly hopeful for us," said Dr. Susan Ehrlich, the hospital's CEO. "It was a very fatiguing year and a half, very stressful."Both facilities say they have since seen several COVID-19 patients — but numbers remain so low they don't compare to the harsh peaks they experienced over the winter.Across the United States, other hospitals have welcomed similar milestones in recent weeks, which health experts largely credit to COVID-19 vaccinations.A Utah hospital said in mid-May they had no COVID-19 patients for the first time in more than 430 days, calling the news a "welcomed light." Shortly after, a Minnesota hospital said it was shutting down its COVID-19 unit following a gradual decrease of patients. In Connecticut, one hospital recently saw its COVID-19 patients drop to one.More than 22,400 Americans are hospitalized with COVID-19 nationwide, according to data from the Department of Health & Human Services. That's more than an 83% decrease from the country's peak in early January, when more than 136,000 Americans were hospitalized with the virus.But with uneven vaccination rates across the U.S., some hospitals are still struggling amid recent upticks in COVID-19 patients — almost all of whom are unvaccinated — and worry about another surge fueled by summer gatherings.It's what concerns Magadia as well."It's really looking good. We're seeing the light at the end of this long, long tunnel, but we're not quite out of the woods yet," he said.Some hospitals still see surge of patientsLate last month, the University of Kansas Health System recorded several days with only one or two COVID-19 patients. That's a far cry from early December, when staff were treating more than 200 COVID-19 patients, according to Dr. Steven Stites, the chief medical officer."We had COVID-19 patients everywhere," he said. "That was clearly the worst, darkest days of the pandemic for us."Now, those who are getting hospitalized because of the virus have not been vaccinated, Stites says."If you're here sick with Covid, you've not been vaccinated," he said. "We've had one person who had been vaccinated that I can think of off the top of my head."It's a pattern other hospitals have noted, too. In Alabama, Magadia said close to 95% of patients hospitalized because of COVID-19 since vaccinations began have been unvaccinated."It's really a compelling point that vaccines work," Magadia said.In central Oregon, Dr. Jeff Absalon, the chief physician executive for the St. Charles Health System, said they are still "in the middle of a surge of Covid patients." Roughly 98% of hospitalized COCID-19 patients since March have been unvaccinated."We have spent a few weeks near our highest point recently," he said. "We're still in the thick of the pandemic."Absalon is not sure why the numbers remain high.Local leaders have continued to push vaccination efforts, but Absalon suspects the recent uptick may be due to increased community transmission among unvaccinated crowds as the weather warms up as well as due to the frequent tourists traveling to the area.He says they are also testing current COVID-19 patients for variants of the virus."Our vaccination rates in our county are quite good but, with all that being said, we're clearly not at a herd immunity level," he said.Younger Americans hospitalizedWyoming, which has one of the lowest COVID-19 vaccination rates in the U.S., recently saw hospitalization numbers climb again, state data shows.Dr. Jeffrey Chapman, chief medical officer at the Cheyenne Regional Medical Center in the southeastern part of the state, says he and staff members are worried over a recent rise in COVID-19 patients."When we see literally numbers doubling and tripling in a week, we get scared," he said.With lower age groups lagging in vaccination numbers, the hospital's COVID-19 patient demographics have shifted younger."Two-thirds of the people we have in the intensive care unit ... are 50-60, whereas in the past, it was almost all 70s and 80s," Chapman said. "And we've actually seen a small number of pediatric patients, which we haven't seen for quite some time.""So I think one can postulate that, because younger age groups are vaccinated at a lower frequency ... we're seeing more people at a younger age that are requiring hospitalization," Chapman said. "Can I say association? Yes. Can I say causation? I don't have absolute data to back that up, but I don't think it's unreasonable to say that."Older Americans, who were prioritized for shots, have some of the highest COVID-19 vaccination coverage numbers. As a result, parts of the country have reported their COVID-19 patients have skewed younger, to crowds that aren't vaccinated. But now that vaccines are widely available, U.S. officials have stressed the importance of younger groups getting their shots, too — both for their own safety and to help their communities suppress the spread of the virus. And a recent increase in COVID-19 hospitalizations among people 12 to 17 reinforced the importance of vaccinations as well as prevention measures against the virus, according to a study released Friday by the Centers for Disease Control and Prevention."In the month leading up to the recommendations of the Pfizer COCID-19 vaccine for teens and adolescents 12 and older, CDC observed troubling data regarding the hospitalizations of adolescents with Covid-19," CDC Director Dr. Rochelle Walensky said during a White House COVID-19 briefing."More concerning were the number of adolescents admitted to the hospital who required treatment in the intensive care unit with mechanical ventilation," Walensky said, adding the data "force us to redouble our motivation to get our adolescents and young adults vaccinated."'Post-Covid stress disorder'As hospitals continue to treat COVID-19 patients, one of the biggest challenges they're facing is exhausted, emotionally overwhelmed staff.In Kansas, Stites said there is underlying fatigue and mental and physical exhaustion."There's just been a lot of pain and suffering amongst healthcare personnel" who often were the last ones to see a COVID-19 patient alive and had to communicate the bad news to families, he said. "I think that there is a scar, there is a wound that is deep in your mental psyche about what this disease really means."It's somewhat of a "post-Covid stress disorder," he said."This is having a personal toll on the people that are committed to helping others," Absalon, in Oregon, said. "One of the things that's particularly difficult right now is that they're taking care of people that have chosen not to be vaccinated. And it's very heartbreaking to see that at this point in the pandemic a lot of what we're seeing in the hospital is preventable."In Wyoming, Chapman looks at the hospital's COVID-19 patients every morning and every night to ensure they're prepared for another surge."I don't want to see people get sick, and I don't want to see people die, so that's part of my anxiety. What can I do to stop this?" he said. "I personally believe the vaccine is the answer to that."