Suppose you notice that you have more trouble remembering things than you did before. The names of people you know well "slip your mind." Over time, you forget more and more new information so that you constantly forget where you put things like your car keys. At night you sometimes get lost on familiar roads that you have traveled often. You become progressively more anxious that you have developed early Alzheimer's Disease. The question is, what should you do?
According to the Alzheimer's Association "every 67 seconds someone in the US develops Alzheimer's." In 2014 there are about 5.2 million Americans with this disease. It is one of the top ten causes of death in America. A woman is more likely to develop Alzheimer's Disease than breast cancer during her lifetime.
A good answer to the question of what you should do if you are concerned that you may be developing this dreaded disease is to see your personal physician. There are pencil and paper tests that can identify cognitive decline in a variety of forms. If there is evidence of a dementia, your doctor will likely run a battery of tests to determine if you have a treatable type.
The tests may include studies for Vitamin B12 deficiency, thyroid disease, and others including a brain imaging test looking for shrinkage of the brain or evidence for conditions such as normal pressure hydrocephalus that can cause dementia. A thorough history and physical exam is very important to guide the physician as to which tests are most appropriate for a given patient.
While there are several forms of dementia, the most common one is Alzheimer's Disease. It is typically thought of as a neurological condition, however, it was first identified by a psychiatrist, Alois Alzheimer. He had a patient in 1901 who had memory loss, confusion, and hallucinations. After the patient died he had the opportunity to do microscopic studies on the patient's brain. In addition to being a psychiatrist, he was a very capable neuropathologist. He discovered the hallmark abnormalities of this illness, which are known as amyloid plaques and neurofibrillary tangles. The disease was named after him by one of the most prominent psychiatrists of his time, Emil Kraepelin.
Ironically, most psychiatrists at that time considered psychiatric illness to have a biological cause, but some years later Sigmund Freud, a neurologist developed psychoanalysis that considered a majority of psychiatric conditions to have a psychological etiology. Today, most psychiatrists consider that many psychiatric illnesses have a primary biological cause but others have significant psychological and social causes.
Alzheimer's Disease is one of those illnesses that is a physical, biological disorder of the brain. Along with the well-known memory problems, there are a range of other neurological disturbances such as difficulty with language and difficulty performing familiar complex motor tasks such as buttoning a shirt. However, there are also a variety of psychiatric manifestations that may be found.
These include apathy, hallucinations, paranoid delusions (believe someone is stealing their things, for example), striking out at others, wandering, depression, anxiety, and sexual disinhibition. Actually, these psychiatric manifestations are more challenging for caregivers than the memory and other more neurological ones.
Unfortunately, there is no treatment at this time that can cure Alzheimer's Disease. However, there are medications that may slow down progression of the illness. It is often necessary to use other medications to help manage some of the manifestations such as use of an antidepressant for depression, an antipsychotic for hallucinations or delusions, and the like. Of equal or greater importance is the use of behavioral strategies to assist patients.
For example, an agitated patient may calm down with distraction and redirection. Patients with inappropriate sexual behavior may respond to being redirected to their own room, provided a regular toileting schedule, providing a one piece outfit, and sensory interventions such as massage.
Caring for a patient with Alzheimer's is often very challenging such that the disease is not only a problem for the patient but also for their caregivers. If the disease becomes far enough advanced, it may be necessary for the patient to be admitted to a day program or inpatient facility with trained staff to provide the care the patient needs.
Alzheimer's Disease has become the most costly disease in the US. Expenditures are going to rise as our population ages since the incidence of Alzheimer's rises with age. Much more research on treatment is sorely needed.
Peter M. Hartmann, MD
