As June is National Alzheimer’s Awareness Month, this is a good time to highlight this form of dementia. As of last year, the CDC estimates that there were 5.8 million people in the US living with Alzheimer’s. As the number of cases double every five years after 65, it is expected that the diagnosis will triple to almost 14 million by 2060.
As the brain succumbs to Alzheimer’s, the centers that control language, thought and memory become impaired. The usual characteristics that may develop begin with mild memory loss, evolving into difficulty in carrying on conversations and challenges with recognition of the environment. It has been shown that physical changes can occur well before objective findings develop, which is not a normal process for the ageing brain.
Although there are no specific risk factors assuring the development of the disease, there are some predictors of Alzheimer’s. The most common begins with age. Although it can develop earlier, the usual age of diagnosis develops after age 60. There is an increased likelihood of disease if there is a positive family history, but not an assurance. It is thought that adequate exercise, a healthy diet, limited alcohol intake and not smoking may bear favorably on not developing Alzheimer’s, as has also already been shown to improve health outcomes in cancer, diabetes, and heart disease.
As there is no “usual” presentation of early Alzheimer’s, sometimes the individual becomes aware of subtle changes in mentation. In other scenarios, it becomes evident to family and friends of such changes as the patient remains oblivious or is in denial when challenged with these observations. The CDC posts the following ten warning signs of dementia as scenarios that warrant evaluation:
- Memory loss that disrupts daily life:forgetting events, repeating yourself or relying on more aids to help you remember (like sticky notes or reminders).
- Challenges in planning or solving problems:having trouble paying bills or cooking recipes you have used for years.
- Difficulty completing familiar tasks at home, at work, or at leisure:having problems with cooking, driving places, using a cell phone, or shopping.
- Confusion with time or place:having trouble understanding an event that is happening later, or losing track of dates.
- Trouble understanding visual images and spatial relations:having more difficulty with balance or judging distance, tripping over things at home, or spilling or dropping things more often.
- New problems with words in speaking or writing:having trouble following or joining a conversation or struggling to find a word you are looking for (saying “that thing on your wrist that tells time” instead of “watch”).
- Misplacing things and losing the ability to retrace steps:placing car keys in the washer or dryer or not being able to retrace steps to find something.
- Decreased or poor judgment:being a victim of a scam, not managing money well, paying less attention to hygiene, or having trouble taking care of a pet.
- Withdrawal from work or social activities:not wanting to go to church or other activities as you usually do, not being able to follow football games or keep up with what is happening.
- Changes in mood and personality:getting easily upset in common situations or being fearful or suspicious.
Alzheimer’s does not have a cure, but there are treatments available. It is important to seek medical care at the first concern of dementia, particularly as there may be other reasons to develop dementia other than Alzheimer’s. There are various forms of testing that may include lab, imaging as well as cognitive evaluation. Neurocognitive screening, such as the Montreal Cognitive Assessment (MoCA) is standardized and reproduceable, as well as other formal evaluations which will help determine the severity and progression of dementia.
A diagnosis of Alzheimer’s dementia is important to make early and accurately, as the process is progressive and unrelenting. Accommodations will need to be made: future planning, arranging financial and legal issues, addressing safety concerns, making eventual living arrangements and developing a support network. Should there be concerns of developing dementia regarding you or your family, your first stop should be with your primary care provider. Early intervention is critical to best outcome,
Bradford Croft, DO
East Flagstaff Family Medicine