Don’t You Forget About Me
● By Aimee Cormier
By Lisa Hanchey
As we approach middle age, we sometimes become more forgetful – misplacing our keys, blanking out on a name or forgetting where we parked our cars. But, while occasional memory lapses are part of the normal aging process, other symptoms such as behavioral changes, depression and chronic short-term memory loss could signal a more serious condition: Alzheimer’s disease.
Writer and radio personality Christee Atwood started noticing changes in her mother’s behavior over 10 years ago. “I started suspecting changes in Mom as she did things like getting confused on activities she’d been doing forever and continually changing her mind back and forth on simple decisions,” Atwood says. But, it wasn’t until 2003 that she actually wrote the “A” word -- Alzheimer’s -- in her journal.
Defining Alzheimer’s Disease
The Alzheimer’s Foundation of America defines Alzheimer’s disease as “a progressive, degenerative disorder that attacks the brain’s nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes.”
Alzheimer’s disease is a type of dementia. “When we talk about dementia, 90 percent of the time we are referring to Alzheimer’s disease,” explains Dr. Diana Fernandez, a neurologist at the Neurology Center with Our Lady of Lourdes Regional Medical Center. “There are certainly other types of dementias, but for the most part, the most common dementia is Alzheimer’s disease.”
The first case of Alzheimer’s disease was described and diagnosed by Dr. Alois Alzheimer in 1901. A 51-year-old female patient had been admitted to a mental asylum in Frankfurt, Germany, with cognitive behavioral symptoms. After she died, her brain was sent to Dr. Alzheimer, where his autopsy confirmed an organic cause for her condition -- dubbed Alzheimer’s disease.
Statistically, Alzheimer’s disease is the ninth leading cause of death in people over the age of 65. Currently in the United States approximately 5 million people are diagnosed with the condition. By the year 2050, an estimated 14 million individuals will have Alzheimer’s disease.
Who Is At Risk?
The greatest risk factor for developing AD is age. After age 65, the risk of Alzheimer’s doubles every five years. “It usually doesn’t affect anyone before age 60, and the average age is 65,” Roberts explains.
But, that can change with family history, particularly parents, grandparents and siblings. “There is definitely a genetic component to Alzheimer’s disease, so you have to look at your family history,” Fernandez says.
What Are The Symptoms?
Typically, the first sign of Alzheimer’s disease is memory loss. While it is normal to have some memory loss with aging, patients with this condition have noticeable differences. “What you realize with Alzheimer’s is that it’s the new memories that people have problems with,” explains Dr. Rachel Roberts, a family medicine specialist at Women’s & Children’s Hospital in Lafayette. “People might remember what they did when they were 16 years old, but they can’t remember what they did yesterday. So, what you notice is that disconnection between asking them historical questions versus trying to ask them what errands they ran yesterday.”
Mood changes are a key trigger in diagnosing Alzheimer’s disease. “Over time as Alzheimer’s disease progresses, you notice that people develop changes in their behavior and their mood,” Roberts confirms. “They can become very apathetic – they don’t care as much anymore about things. They might not seem to have the same vested interest in things like hobbies.”
Behavioral problems are also a sign of progression. “Patients get to the point where they don’t know where they are, they don’t know who they are,” Roberts observes. “They get aggressive, hostile, confused and depressed.”
Atwood became suspicious when she noticed personality changes in her mother, a former news reporter. “She became more argumentative and seemed angry more often,” Atwood observes. “I now realize that this was the point where she was fighting with herself and we were just seeing the outside signs of it. She knew something wasn’t right, because Mom had been a brilliant lady and these changes were probably very obvious to her.”
When It’s Time To See A Doctor
When people start exhibiting signs other than just occasional forgetfulness or word-finding difficulty, it might be time to see a physician. “There have to be some other red flags in terms of cognitive changes -- not just being unable to remember certain things, but having trouble with focusing, planning and following instructions,” Fernandez says. When the person is unable to function well alone with his activities of daily living – taking care of his household, his finances – all that would suggest that there is definitely a problem.”
Atwood acknowledges that it was difficult to have that conversation with her mother’s doctor. “There was no way for me to get it diagnosed, even when I realized something was wrong, because that would have included a discussion with her doctor without Mom present and I couldn’t make that happen,” she recalls. “When I finally worked my way into the exam room with her, we had reached 2005. This was when a broken ankle and hospitalization seemed to accelerate the changes. Even when she got home and off the medicines, she remained confused. During her recovery period, we started going to the doctor together regularly and I was finally able to bring up the symptoms (very carefully). After lots of memory questions and discussion, the doctor assessed the situation. That was when, without saying the A-word, we got Mom started on medication.”
Diagnosing The Disease
Alzheimer’s disease is primarily a clinical diagnosis. “It is what the neurologist sees by talking to the patient and doing some cognitive testing in the office, which addresses, to some extent, every part of the brain,” Fernandez says. “But, for the most part, it’s the history -- how the patient is behaving, what the physician sees in the office and, most importantly, what the family describes. From that encounter, the neurologist should be able to make a diagnosis of Alzheimer’s. And if not sure, then adjunct testing can be done either to prove or to go in a different direction and to establish if it is a different type of dementia.
For cognitive testing, doctors use combination in-office examinations, including the Mini-Mental State Exam and the Montreal Cognitive Assessment. Occasionally, doctors follow up the mental status exams with brain images or a spinal tap. “We do this not because we can determine Alzheimer’s from brain imaging, but because we can rule out other things,” Roberts explains.
Unfortunately, there is no definitive way to diagnose Alzheimer’s disease, other than through an autopsy. “It’s a clinical diagnosis,” Roberts confirms. “You see the symptoms, see the progress and hear the family members talk about the changes. Sometimes, it’s up to the family member to explain to us what’s really going on.”
Treating The Disease
Sadly, no cure for Alzheimer’s disease exists. But, treatments are available to delay the progression of symptoms. “There are treatments available that help in a modest way,” Fernandez offers.
The FDA has approved two classes of medications for treating Alzehimer’s -- cholinesterase inhibitors and NMDEA receptor antagonists. Cholinesterase inhibitors are used in the early to moderate stages of the disease. Common names for these drugs include Donepezil (Aricept), Galantanine (Razadyne), and Rivastigmine (Exelon). A second type of medication, memantine (Namenda), is for treatment of moderate to severe Alzheimer’s. “These medications help the patient’s cognitive function – memory, comprehension, activities of daily living and, in general, global function,” Fernandez explains. “It is sometimes used for behavioral improvement, but to a much lesser extent.”
Patients frequently ask about the benefits of taking vitamins and supplements, such as multivitamins, folic acid, Ginko Biloba, and Vitamin B12. So far, these have not proven effective. “There have been several small trials that have not shown a positive effect on Alzheimer’s disease,” Fernandez confirms.
Steps To Prevent The Progression Of Alzheimer’s
As a person ages, his brain, like the rest of his body, needs to stay active. “Decline comes from inactivity, just like with your body,” Roberts says. “So, even if you are at high risk for Alzheimer’s disease, you can stay active and stay working that mind to slow the progression.”
Other recommendations include maintaining a healthy diet, exercising, staying socially active and stimulating the brain. “A question that I am asked a lot in my practice is whether crossword puzzles help,” Roberts reveals. “And, they are not a bad thing, but they do not stimulate your brain too much. So, if you actually read the newspaper, something that requires a little bit more complex concentration, focus, comprehension and understanding, I consider that to be a way of stimulating your brain more than just doing crosswords puzzles or little games like that.”
Advice For Patients And Caregivers
If you or a loved one is diagnosed with Alzheimer’s disease, take action. “I would recommend first of all, when you recognize it and the diagnosis is new, start the medication as soon as you can,” Roberts suggests. “Also, get educated. Learn as much as you can. Because, one of the most common things in Alzheimer’s families is that the frustration is overwhelming. Patience is the most important thing with this disease.”
Of utmost importance is to talk to your doctor. “The doctor should instruct and counsel not just the patient, but also the family members about the condition,” Fernandez says. “And, there are several organizations that provide great help for caretakers, including the Alzheimer’s Association and the Alzheimer’s Foundation.”
For more information, contact the local Alzheimer’s Association chapter at (800) 272-3900 or alz.org, or contact the Alzheimer’s Foundation of America at (866) 232-8484 or alzfdn.org.
Editor’s Note: At press time, we learned Christee Atwood’s mother passed away surrounded by her family on Dec. 14, 2014. We extend our heartfelt condolences to Christee and her family.