Early Diagnosis of Alzheimer’s by Dr. Brent Forester

August 7, 2015

Original post on Bridge blog

Over the holiday season, it is common for us to encounter family members whom we see only occasionally. With the passage of time we may notice that Grandma or Dad or Aunt Suzie has trouble keeping track of conversations or recalling the names of relatives. Or perhaps Uncle Joe needed multiple reminders about the time for Thanksgiving dinner and then got lost on the 15-minute drive that he has done countless times over the years. I am sure these scenarios are familiar to us all as memory loss is so common, even with normal aging. However, these subtle signs of memory loss are often unnoticed by the person who experiences them; these signs may even go undetected by close family members, such as a spouse, who have daily encounters with a loved one and cannot see the subtle changes as they happen.

So, when and why should someone seek help for a further assessment regarding concerns about memory loss? Although there is no single answer, the best first step is to have the person assessed by their primary care physician. The doctor will want to know how long the symptoms have been present, the severity of the memory loss and the impact that this is having on daily activities such as managing the checkbook, driving, working and making daily decisions. A primary care doctor well versed in issues pertaining to advancing age will also conduct a standardized cognitive assessment, such as the Mini-Mental Status Examination or the Montreal Cognitive Assessment, both of which can be administered in minutes in an office setting. These tests will detect objective signs of cognitive impairment that require further evaluation.

The reason not to wait is to make sure that treatable causes of memory loss are discovered early and treated effectively. Such treatable causes of memory loss with aging can include thyroid dysfunction, vitamins B12, Folate or D deficiency, unstable medical illness such as diabetes, emphysema and heart disease, medication side effects, or adverse effects of alcohol or other drugs. Finally, psychiatric illness, such as depression and anxiety, can present with signs of memory loss, confusion, impaired attention or other symptoms of cognitive impairment.

Once the underlying causes are identified and treated, repeat assessment of cognitive functioning can be completed to identify whether or not your loved one has Alzheimer’s disease. Although a frightening diagnosis, being aware of the cause of memory loss is vital in order to intervene with adequate pharmacological therapies, as well as to engage the patient and caregiver/family member with community resources, such as the Alzheimer’s Association’s care consultation program. The Alzheimer’s Association hires non-MD clinicians who specialize in the field of dementia care. These individuals can help provide families with community resources, such as support groups, and also the education that is required to navigate the complex health care and social services system. They can also help family caregiver planning with a goal to maximize quality of life for the afflicted individual. My personal perspective on the diagnosis of Alzheimer’s disease is that most individuals and families would rather know what is going on than ignore the added psychosocial and financial consequences in isolation and the associated health consequences for the caregiver as we discussed in the past few months.

Next month’s blog will talk about secondary prevention strategies for older adults who develop signs of memory loss and how to reduce the risk of progression to a severe problem such as Alzheimer’s. The treatment perspective for individuals with early signs of dementia is, for me, a very positive one focusing on what the individual is still able to accomplish and enjoy, rather than dwelling on the many inevitable losses associated with an illness that robs an individual of remote memories.  With early recognition, diagnosis and treatment intervention, the goal of maximizing quality of life can be realized.

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