Alzheimer Disease (cont.)

Alzheimer Disease Symptoms

Alzheimer disease begins with a mild, slowly worsening memory loss. Many older people fear that they have Alzheimer disease because they can't find their eyeglasses or remember someone's name.

• These very common problems are most often due to a much less serious condition involving slowing of mental processes with age.
  
  
• Medical professionals call some of these cases benign senescent forgetfulness, age-related memory loss, or minimal cognitive impairment.
  
  
• While these conditions are a nuisance, they do not significantly impair a person's ability to learn new information, solve problems, or carry out everyday activities, as Alzheimer disease does.

 Early warning signs of Alzheimer disease include memory problems such as the following:

• Difficulty recognizing familiar people or things (not just forgetting a name)
  
  
• Trouble remembering recent events or activities
  
  
• Inability to solve simple arithmetic problems
  
  
• Problems finding the right word for a familiar thing
  
  
• Difficulty performing familiar tasks

As the disease progresses, however, the symptoms become more serious. They may include the following:

• Inability to carry out everyday activities, often called activities of daily living, without help - Bathing, dressing, grooming, feeding, using the toilet
  
  
• Inability to think clearly or solve problems
  
  
• Difficulties understanding or learning new information
  
  
• Problems with communication - Speaking, reading, writing
  
  
• Increasing disorientation and confusion even in familiar surroundings
  
  
• Greater risk of falls and accidents due to poor judgment and confusion

 In the later stages of the disease, the symptoms are severe and devastating:

• Complete loss of short- and long-term memory - May be unable to recognize even close relatives and friends
  
  
• Complete dependence on others for activities of daily living
  
  
• Severe disorientation - May walk away from home and get lost
  
  
• Behavior or personality changes - May become anxious, hostile, or aggressive
  
  
• Loss of mobility - May be unable to walk or move from place to place without help
  
  
• Impairment of other movements such as swallowing - Increases risk of malnutrition, choking, and aspiration (inhaling foods and beverages, saliva, or mucus into lungs)

These symptoms typically develop over a period of years. The disease progresses at different rates in different people.
 
Emotional problems such as depression and anxiety are common in older people. These problems can leave elderly people feeling confused or forgetful. Because these emotional problems are reversible in many people, it is important that they be distinguished from Alzheimer disease and other brain disorders.

When to Seek Medical Care

Some slowing of thinking processes is normal in aging. However, any change in thinking, memory, reasoning, attention, grooming, behavior, or personality that interferes with the person's ability to take care of himself or herself, maintain health and safety, or participate in activities that he or she enjoys warrants a visit to the person's health care provider.
 
An early diagnosis allows treatment to begin earlier in the disease, when it has the best chance of offering significant symptom relief. Early diagnosis also allows the affected person to plan activities and make arrangements for care while he or she can still take part in making the decisions.

Exams and Tests

Primary health care providers are able to diagnose and treat Alzheimer disease. Some health care providers specialize in the problems of older people (gerontologists) or of the brain (neurologists and psychiatrists). If you or a relative have symptoms that suggest Alzheimer disease, you may want to consult a specialist. 
 
When the health care provider hears that an elderly person is having one or more cognitive problems, he or she will probably suspect Alzheimer disease. However, many other conditions can cause dementia or dementia-like symptoms in an elderly person, including both medical and psychological problems. Many of these conditions can be reversed, or at least stopped or slowed. Therefore, it is extremely important that the person with symptoms be checked thoroughly to rule out treatable conditions.
 
The only way to confirm the diagnosis of Alzheimer disease is to look at the brain directly and to identify senile plaques and neurofibrillary tangles. This is possible only at autopsy, after a person's death. The diagnosis in a living person is usually made on the basis of symptoms and ruling out other conditions. This is done by a combination of medical interview, physical and mental examinations, lab tests, imaging studies, and other tests.
 
The medical interview involves detailed questions about the symptoms and how they have changed over time. Your health care provider will also ask about medical problems now and in the past, family medical problems, medications, work and travel history, habits, and lifestyle.
 
A detailed physical examination is done to rule out medical problems that might cause dementia. The examination should include a mental status evaluation. This involves answering the examiner's questions and following simple directions. In some cases, the health care provider will refer the person for neuropsychological testing.
 
Neuropsychological testing

Neuropsychological testing is the most accurate method of pinpointing and documenting a person's cognitive problems and strengths.

• This can help give a more accurate diagnosis of the problems and thus can help in treatment planning.
  
  
• The testing involves answering questions and performing tasks that have been carefully prepared for this purpose. It is carried out by a specialist called a neuropsychologist.
  
  
• It addresses the individual's appearance, mood, anxiety level, and experience of delusions or hallucinations.
  
• It assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions.
  
  
• Reasoning, abstract thinking, and problem solving are tested.

Lab tests

These include blood tests to rule out infections, blood disorders, chemical abnormalities, hormonal disorders, and liver or kidney problems that could cause dementia symptoms.
 
Imaging studies

Brain scans cannot detect Alzheimer disease. A scan usually is necessary to rule out other conditions such as brain tumors and stroke that can also cause dementia.

• MRI or CT scan of the brain may be done to rule out other brain conditions.
  
  
• Single-photon emission computed tomography (SPECT) scan is used in certain cases when the diagnosis of Alzheimer disease is especially doubtful. It is especially good at detecting certain less common causes of dementia.

Other tests:

Any of these tests may be ordered as part of the workup of dementia.

• Electroencephalography (EEG) is a measurement of the electrical activity of the brain. It can be useful in some cases to rule out other conditions.
  
  
• Genetic testing for apolipoproteins is sometimes used in research studies of Alzheimer disease risk, but it is of little if any value in confirming the diagnosis in individual patients. Other genetic tests are also not routinely done.

• Spinal tap (lumbar puncture) is a method of obtaining a sample of cerebrospinal fluid. This may be done to rule out certain other brain conditions that can cause dementia.

Next: When to Seek Medical Care »

Printer-Friendly Format

|

Email to a Friend