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Forgetful Parent? Is it because of just old age or could it be ALZHEIMER'S?

March 2006
Forgetful Parent? Is it because of just old age or could it be ALZHEIMER'S?

Dear Dr Harjee,

My mother is 70 years old and I find that she is forgetful. Is this Alzheimer's disease (AD)?

This question is raised in my office at least a couple of times a day by concerned family members.

The diagnosis of Alzheimer's disease is usually the burden of the primary care physician such as myself. Symptoms: The individual may appear with behavioral and mood changes. AD is marked by agitation and depression. Some individuals are aware of their diminishing mental function, but the majority are not aware or never acknowledge this fact. Many patients will become defensive when forgetfulness is mentioned. Memory lapses can be very subtle indeed, or more obvious as in a decline in the ability to calculate or use numbers (abstract thinking). Key information needed to diagnose this condition relates to orientation, behavior in social circumstances, and the ability to carry out simple tasks.

Dementia is the fourth leading cause of death in the population over age 65 years of age. The most common cause of dementia, Alzheimer's disease, afflicts about 5 million people in the United States and perhaps more than 37 million people worldwide. The prevalence of Alzheimer's disease is 10-15% in the population over 65 years, 20-30% in the those over 80 years, and 50% of those over 85 years. There is no clear data as to how to prevent AD, and it is projected that about 16 million Americans are expected to have AD by the year 2050. According to the National Institutes of Health the cost of caring for Americans with AD is at least $100 billion per year. The consequence of AD is emotional distress for patients and their family members, depression and frustration. AD is also associated with a decrease in life expectancy and increased hospitalization.

Studies have shown that by early diagnosis and intervention, both patient's and family members' quality of life may be improved, and nursing home placement may be delayed. Studies have also shown that early diagnosis can create cost savings for the Federal Government as well as for personal resources.

Risk factors of AD are age, family history, certain genetic markers that can be discussed with your doctor, Down syndrome, female gender, diabetes, and cardiovascular conditions such as hypertension and high cholesterol.

Examination: Your doctor will do a Mini Mental State Examination (MMSE) which checks for orientation to time and place, concentration, language, recall, and the ability to follow commands. The initial evaluation after the MMSE will also include a series of blood tests, including a complete blood count (CBC), thyroid function tests, measurements of vitamin B12, serum calcium, and glucose, and a test for syphilis. An MRI of the head is recommended as a marker and later to see if there is progression of the condition.

Differential diagnosis: The examination will help to rule out other causes of memory problems. Researchers from Denmark report that in their test group of patients showing minor memory problems, Alzheimer's disease was to blame in fewer than half the cases. About 20% of the patients had problems that could be reversed with treatment. Experts note the 20%-reversible rule is probably true the world over. Depression is the most common reversible culprit, but thyroid disease, pernicious anemia, stress, brain injury, nutritional deficiencies, infections, reactions to medication, and a brain-fluid circulation problem also can mimic Alzheimer's disease. People often fear telling their doctors about the symptoms they may be experiencing, but experts say it's important to seek help because, many times, treatment can be successful.

Medical management: For those with Alzheimer's there is now drug therapy to halt the progression of AD. Drugs such as Aricept, Namenda, and Reminyl are now prescribed and have minimal side effects such as nausea, diarrhea, and weight loss --and these can be avoided by titrating the dose. It is important to continue to do what is prescribed on a daily basis, e.g. regular exercise and good nutrition to keep blood pressure in control and to prevent diabetes and high cholesterol.

Social management can also help ease the burden on both patients and family members. A calm, structured environment may help the person with Alzheimer's disease to continue functioning as long as possible. It is important to read regularly to keep the mind active; for the elderly, playing board games and bingo are also recommended. Music keeps the mind stimulated, as does doing crossword puzzles regularly. Social interactions can keep old contacts and build new friendships. It is also important to have outside activities to get fresh air and to be in touch with nature.

Recent observations mention lower incidence of AD in the Asian population, which may be a result of the use of curry powder, cumin, and haldi (turmeric). This was popularized by President Bill Clinton during his term in the White House. However, these are only supplements and have no medicinal value, and relying on them is not sound health management.

In answer to your question, I believe it may be worth a trip to the doctor for an MMSE, some basic lab work, and an MRI of the head. I hope this will shed some light and allow you to make a good decision for your mother now and to keep in mind for yourself for the future as well.

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