"I think my mother may have Alzheimer's"

By William K. Summers, MD
© William K. Summers, MD

Astonishingly, 67% of Alzheimer's patients did not seek medical care for memory difficulties early in the disease. Perhaps this is be because they feel, "nothing can be done about it". Perhaps it is because of a fear of nursing homes. Most went to General Practitioners who misdiagnosed the problem. The patients were told their problem was "usual aging" or depression. Only three of ten patients were initially thought to possibly have Alzheimer's disease. Perhaps this is why the Medicare/Medicaid grossly underestimates the number of memory-impaired elderly in nursing homes. The government estimated only 34.7% of nursing home residents had dementia. Independent studies show the number is probably closer to 85%.

When pressed to make a diagnosis to explain memory impairment in an elder patient, doctors often sweep the person into the dustbin of Alzheimer's disease. This is done with minimal laboratory testing or brain scans. Then they offer little or no treatment. This is tragic.

The best approach is to spot the memory problem early. This is when intervention can be most effective. Certain antioxidants, vitamins, anti-inflammatory drugs, and hormones have been shown to slow the progression of true Alzheimer's disease. Applied early, this can mean substantial decrease in suffering.

Early intervention is also important even when the cause of the memory problem is one of the more than 70 illnesses that imitate Alzheimer's disease. For example, early neurosurgical intervention for normal pressure hydrocephalus ("water on the brain") is essential. Here damage to the brain is mechanical. Relief of the pressure killing nerve cells stops progression. Dementia related to excess alcohol use is also reversible in its early stages ..... but is not in its latter stages.

What are the early symptoms of Alzheimer's or other progressive dementias? Memory difficulty is the early symptom shared by all dementias. Short-term memory is usually first effected. Recent conversations, appointments, and things to do are forgotten. "Word-finding difficulties" (dysnomia*) occurs relatively early . This may be manifest by "recruitment" of the missing word or name from a loved one. It is not uncommon for me to sees a couple where the demented patient recruits half of the answers to questions from their spouse. The caregiver is often not aware of the recruitment until it is pointed out. Temporal disorientation is common. The early Alzheimer's patient will not know the weekday, month, season, or year. They excuse themselves as not caring about the date. A simple test is to give the person the date in detail. Wait one minute. Then ask for the day, date, month etc. If the person has difficulties, there should be concern. Poor math skills (dyscalculia*) often are an early sign. Alzheimer's patients cannot balance their checkbooks, and can get into financial difficulties. Fortunately, most Alzheimer's patients will understand the importance of non-payment of bills. They will seek help from their family. Getting lost (topographic disorientation*) is another presenting symptom. The patient may start to drive to the local super market, but ends up being found in a city thirty miles away by the police. Variations on this is becoming lost in ones own neighborhood , or even home. Mood changes can sometimes be the first symptom. This could include uncharacteristic depression, irritability, mood swings, crying, overconcern about money, insomnia, and weight loss. Depression is a commonly associated problem of dementia. Loss of ability to do simple requests (dyspraxia*) can be an early symptom. Many elderly will complain that their mate will occasionally be sent to the kitchen for an item, and forget to bring it back. This can be an early symptom if the forgetting the task is consistent (more than occasional). Odd beliefs (delusions*) can in rare cases be a presenting symptom. This is less common, and on evaluation is almost always accompanied by one or more of the above other problems.

If two or more of these are present in oneself or in a love one, and if symptoms have been present for more than three months, it is time to see a Dementia Care Specialist.

Next time we will investigate what constitutes a typical diagnostic evaluation versus a Dementia Care Specialist evaluation. Until then, thank you for your attention and here's ...

To your health!