Is it Alzheimer's ... or Just Forgetfulness?
When family members observe confusion and memory difficulties, it is alarming but quite often attributed to age. Everyone has forgotten where they parked the car, or the name of an acquaintance at one time or another, and many healthy individuals are less able to remember certain kinds of information as they get older. However, there are some differences between Alzheimer's disease (AD) and normal age-related memory (ARM) difficulties.
- The person with AD forgets whole experiences
- The person with ARM forgets parts of an experience
- The person with AD rarely remembers later
- The person with ARM often remembers later
- The person with AD gradually becomes unable to follow written or spoken directions, to use notes, and to care for themselves
The 10 Warning Signs of Alzheimer's are (also see Alzheimer's manual):
- Memory loss affects job performance
- Difficulty performing familiar tasks
- Problems with language are noticed
- Disorientation of time and place
- Judgment becomes poor or weakened
- Abstract thinking is affected
- Items are misplaced because they put things in inappropriate places (such as the iron in the freezer)
- Changes in mood or behavior
- Changes in personality
- Loss of initiative
Because forgetfulness and confusion can be caused by a number of disease processes, a complete assessment is used to rule out many health problems some of which are listed below. They fall under four different categories: R-Reversible, I-Irreversible, T-Treatable, or M-Manageable. Some as you will notice fall into more than one category.
- Kidney problems R-I-T-M
- Liver disorders R-I-T-M
- Brain tumors R-I-T-M
- Bladder infections R-T-M
- Nutritional disorders R-T-M
- B 12 Vitamin shortage R-T-M
- Sodium - Magnesium - or Potassium imbalance R-T-M
- Medication interaction, side affects, or drug intoxication R-T-M
- Tranquilizers (or other psychotropic medications in inappropriate dosages for the individual) R-T-M
- Electrolyte imbalance R-T-M
- Diabetes-high blood sugar R-T-M
- Hypertension-high blood pressure R-T-M
- Certain infectious diseases R-T-M
- Stress -(in younger individuals usually due to job stress and over involvement) R-T-M
- Slight strokes T-M
- Brian seizures TM
- Head injuries TM
- Normal pressure hydrocephalus TM
- AIDS (acquired immunodeficiency syndrome) TM
- Meningitis TM
- Thyroid problems TM
- Syphilis TM
- Sleep Apnea TM
- Anxiety TM
- Severe depression TM
- Parkinson's Disease I-T-M
- Pick's Disease I-M
- Huntington's Chorea Disease IM
- Creutzfeldt-Jakob Disease (Mad cow disease) IM
- Probable Alzheimer's Disease IM
Therefore, to diagnose the cause of forgetfulness and confusion it requires a process of elimination to rule out many disease conditions that can cause dementia. Family physicians, but most often a team of specialists, can piece together the results of many tests to come up with diagnosis. Routine laboratory testing is quite limited and other tests should be ordered as indicated by the individuals clinical picture. When all else is ruled out the bottom line can be 'probable Alzheimer's.' Alzheimer's Disease cannot be definitively diagnosed until an autopsy is performed.
A complete assessment to determine 'probable' Alzheimer's requires:
- A complete medical history - and information provided by family and friends is needed to report the patients current ability to carry out daily activities.
- Basic medical tests - of blood and urine may be done to eliminate other possible diseases. In some cases small amounts of spinal fluid also may help.
- Neuropsychological tests - are tests of memory, problem solving, attention, counting, and language. They pinpoint specific problems.
- Brain scans - these pictures of the brain include computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). By looking at a picture of the brain a knowledgeable health care provider can detect abnormalities. These help to rule out other possibilities such as thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease.
- Pharmacological evaluation - to rule out medication interaction or misuse
What else could it be? Twenty percent of suspected Alzheimer's cases turn out to be something else, and often is something that can be treated or even reversed.
It is in the best interest of the patient to thoroughly assess the situation. After diagnosis, should the diagnosis be probable Alzheimer's family members have a better idea how to plan for the future, and what steps in treatment should be taken.
Medication to treat Alzheimer's should not be prescribed unless a diagnosis of the patients condition has been thoroughly assessed. Two medications currently being used are ARICEPT and Exelon. They are not a cure but are used to treat some of the major symptoms in mild to moderate stages of the disease. It would be unfortunate to have these medications prescribed if the person was suffering from another health condition. A knowledgeable physician can discuss the side affects, and repercussions of taking these medications. Ask to be fully informed.
If the diagnosis is Alzheimer's, or a related dementia, the Alzheimer's Association can offer educational material in the form of books, video and audio tapes, pamphlets, and support groups. Additional information about how to tell the patient, family and friends about the diagnosis, planning for care, respite, respite financial assistance, safe return program, entitlements, and self care can be provided. In Nebraska there are two help lines available everyday to help with concerns and questions. For the Great Plains Chapter call 1-800-487-2585. For Omaha and 13 eastern Nebraska counties call 1-800-309-2112.
To find out more about Alzheimer's, visit the Alzheimer's section at the Answers4Families web site. If you would like to see additional information, call the Alzheimer's Association of the Great Plains at (402) 420-2540 and ask for Geri Hepp. For residents in Omaha and eastern Nebraska, visit the Midlands Chapter web site at: http://www.alz.org/midlands/.
Written by the Lincoln LIFE Office.