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By Louis Neipris, M.D., HealthAtoZ writer
Your mother may have recently asked you to balance her checkbook. You may have noticed that your father is becoming more hesitant or confused about driving, unable to negotiate simple turns or traffic signs.
It is easy to blame both difficulties on failing vision. However, more older people and their loved ones are asking the question, "Could this be Alzheimer's disease?"
Now, dementia is recognized earlier. Although there is no cure, diagnostic methods, treatments, and interventions to improve the quality of life make early diagnosis worthwhile.
How can you tell the difference between a "senior moment" and senile dementia?
Misplacing the keys now and again or occasionally forgetting someone's name are not signs of dementia. However, more frequent episodes with more serious consequences should raise concerns.
Signs of dementia involve a range of cognitive impairments. In addition to memory problems, there are also deficits in language and critical thinking. Signs include:
- Asking the same question repeatedly.
- Getting lost in familiar places.
- Trouble following directions.
- Disorientation to time, people, and places.
- Neglecting personal safety, hygiene, and nutrition.
Changes in behavior or personality may also accompany problems with memory. If you are having memory problems, don't wait for them to worsen. See your doctor for proper diagnosis.
What can cause dementia?
In Alzheimer's disease, the most common cause of dementia, a toxic substance called amyloid accumulates in the brain, and this is thought to be the underlying reason for the dementia. However, other conditions with different underlying causes can also cause dementia, which may appear similar to Alzheimer's, but differ in the way the disease progresses or in the presence of certain symptoms.
In multi-infarct dementia, also called vascular dementia, high blood pressure causes several small strokes, some of which may damage areas of the brain important for memory and behavior. Multi-infarct dementia appears more suddenly than Alzheimer's disease and tends to stabilize and then worsen after another stroke. Alzheimer's disease, on the other hand, is characterized by slow, progressive decline over an average of eight to 10 years.
In Dementia with Lewy Bodies (DLB), a protein seen in the microscope as a round, red substance (the "Lewy body") builds up inside brain cells. Different parts of the brain are involved than in Alzheimer's disease. Occasional hallucinations and delusions may occur in the moderate stage of Alzheimer's disease, but in DLB there are recurrent hallucinations, fluctuations in consciousness, and an inability to pay attention. These must be present for doctors to make the diagnosis.
Why is early diagnosis important?
For a significant number of people, early treatment may be able to reverse the condition. About 5 percent to 10 percent of people with memory problems are diagnosed with a treatable condition. The problem is reversible once the underlying cause, such as a thyroid abnormality, depression, or a nutritional deficit, is successfully treated.
Alzheimer's disease is an irreversible degenerative process. However, some patients benefit from cholinesterase inhibitors, drugs that may keep problems with memory, language and critical thinking from getting worse. These medications are helpful for only a limited time in the early stages of Alzheimer's, which is why early identification is important.
Another type of drug has been approved by the FDA for treatment of moderate to severe Alzheimer's. The drug, memantine (Namenda) works by regulating the activity of glutamate, a messenger chemical involved in learning and memory. It can cause dizziness and confusion among other side effects. Your doctor will want to see you regularly to make sure the medicine is working and to check for side effects.
If multi-infarct dementia is identified early, hypertension can be better controlled, and strokes and further loss of cognitive function can be prevented. The hallucinations of DLB are also treatable, and early recognition of these symptoms is critical.
An early diagnosis can allow a person to participate effectively in planning. Sound judgment is necessary for financial planning as well as making end-of-life decisions. An early diagnosis of Alzheimer's disease, although life shattering, can be a wake-up call to assure that your wishes - or those of a loved one - are carried out.
What should I tell my doctor?
- About all mental changes: Aside from problems remembering, important things to mention are mood swings, increased tiredness, inattention and trouble communicating.
- About all medications: Tell your doctor what you are taking, including vitamins and diet supplements. Bring all of your medications.
- About all physical symptoms: The mind and body are interconnected. Do not forget to tell your doctor what is ailing you, from head to toe. Mention fever, weight loss or gain, changes in appetite, and other symptoms. Describe your medical history and established diagnoses. It helps to bring a copy of your medical records.
This article was reviewed and updated June 2007.
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