Q & A on Caring for Alzheimer's and Dementia

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Experts Answer Your Questions on Alzheimer's and Dementia

1. Is memory loss a normal part of old aging?

Memory loss is not limited to aging, but has greater significance when we are older and we forget. Although memory changes begin in our 40s, the changes are so gradual and so small that people hardly notice. By the time people are in their 60s and 70s memory changes have continued and are much more noticeable to ourselves and perhaps to others.

The most common and normal changes in age-related memory loss are:

~ It takes us longer to recall names of people, places and things. Some call it a "senior moment" or the "it's on the tip-of-my tongue" syndrome.

~ It takes us longer to learn. This is because it takes us longer to process new information. But the adage "You can't teach an old dog new tricks" is just not true.

~ It is harder for us to screen out distraction. When we are young, we can do multiple things at the same time, but when we grow older, distractions are harder to screen out, making it harder to focus on the task at hand.

~ Keeping track of events, dates, phone numbers, and appointments is more challenging. Occasionally forgetting appointments or a birthday is normal as we grow older. Forgetting the phone number we have had for 25 years is not normal.

~ "What am I here after?" syndrome. Most of us do it: go into a room for a specific reason, stop in our tracks and ask "Why did I come here? What am I here after?"

There are various degrees of age-related memory loss. If you are concerned whether your loved one's memory loss is within the normal range, schedule an appointment with their doctor.

2. My mother was diagnosed with dementia. Is that the same thing as Alzheimer's disease?

I am asked this question frequently. The reason for the confusion is because dementia and Alzheimer's disease are used interchangeably. Dementia is not a disease; it is a syndrome that describes a number of signs and symptoms that are indicative of one or more diseases. Memory loss, shortened attention span, changes in personality, abilities and behavior are a few of the characteristics of dementia. There are hundreds of different types of dementia that produce similar symptoms.

Alzheimer's disease is the most common form of progressive dementia, meaning it gets worse over time. Other types of dementia are Lewy Body dementia, vascular dementia, Frontal Temporal Dementia and Parkinson's disease with dementia. Although the symptoms are very similar in the different types of dementia, they can also be very different because of the part of the brain that is affected.

It may help to think of dementia this way: Everyone with Alzheimer's disease has dementia but not everyone with dementia has Alzheimer's disease.

3. My dad who is 76 years old, has become very forgetful over the past couple of years. I am afraid he may have Alzheimer's disease. I don't know where to start or who to talk to about getting a diagnosis. Can you help me?

When a parent or a loved one begins to show signs of increased memory loss, it is normal and common to think the worst. It is important to get a thorough work-up to determine what the cause of his memory loss is.

The first place to start is with your relative's primary care physician. Ask for a memory screening. The Mini Mental Status Exam (MMSE) is an 11 question screening tool that evaluates memory, language, attention and calculation, recall and registration.

Someone who scores 30 points (maximum number of points) is considered within the normal range. A score of 24 or lower indicates cognitive impairment. The question then becomes "what is causing the changes?" The MMSE is a screening tool, not a diagnostic tool.

When a patient scores in the 24 point range, a doctor will usually order further testing to determine what the cause of his patient's cognitive impairment might be. These tests may be ordered by the primary care physician or the patient may be referred to a specialist such as a geriatrician, neurologist, or gero-psychiatrist.

A thorough work-up includes:

~ Blood tests to rule out vitamin deficiencies, thyroid functioning, infections, and other possible causes.

~ A thorough physical exam.

~ A psychiatric exam. It is often difficult to know if a person suffers from depression or dementia. Depression is often referred to as 'pseudo-dementia' because the symptoms look very much like dementia: loss of memory and initiative; changes in mood, personality and behavior are associated with both disorders.

~ A complete medical, social, occupational, and medication history given by the patient and also by family members, friends and other caregivers, if involved.

~ An evaluation of behaviors, usually given by family members.

~ CAT scan or MRI to see if there is any evidence of strokes or brain tumors.

Family members observations are very important in the diagnostic process because a person with cognitive impairment might not be able to accurately report changes in abilities, behaviors, and cognitive functioning.

After all these tests are performed and the results are reviewed, a diagnosis can be given. The only way to confirm a diagnosis of Alzheimer's disease is to perform a brain autopsy after death, but a diagnosis that includes careful evaluations in the above areas is 80-90% accurate.

If you are concerned, call your doctor today and ask for a memory assessment.

4. My husband refuses to admit he has a memory problem, when in fact, he was diagnosed with Alzheimer's disease 6 months ago. Why is he denying that he has a problem? He has always been pretty straightforward talking about himself in the past, but not now. Why?

It is often hard to know if a person is in denial about his memory loss or just forgets that he has a problem. It may help to think of it this way: denial is a refusal to admit that there is a problem. Denial is more of a conscious or sub-conscious decision that something exists.

Denial can protect a person with Alzheimer's disease (AD) as well as family members until they are ready to accept the diagnosis and the losses that AD causes. But this is usually not the case with people with Alzheimer's disease and probably is not the case with your husband. Your husband just simply forgets that he forgets. Keep in mind that memories are stored in the brain and when the memory center of the brain is damaged, memories can be lost.

Another part of our brain-likely in the right hemisphere-is responsible for giving a person insight into him or her self. If this part of your husband's brain is damaged, then he may not have self awareness or insight into himself and what he can and can't do.

5. I have heard that Aluminum causes Alzheimer's disease. Should I stop drinking out of aluminum cans and throw away my aluminum pots and pans.

The theory that aluminum causes AD has been controversial for the past 40 years. Early studies found a higher level of aluminum in the brains of people with Alzheimer's upon autopsy. But other studies did not. Some early research studies found a higher rate of AD in people who used antiperspirants and antacids, while other studies do not confirm this theory. Studies have found that people who worked around aluminum in their jobs are not at an increased risk of getting AD.

Aluminum can be found in the air we breathe, the water we drink and the food we eat. It can be found in cosmetics and added to some medications to make them more effective. And we all have aluminum in our bodies.

The aluminum in pots and pans or in soda cans does not leak into the foods at a high enough level to cause a risk. And some foods we eat do have aluminum in them.

The current thinking is that there is not enough convincing evidence that aluminum increases a person's risk of developing AD.