Alzheimer's Disease Part I: Diagnosis

Because most of my readers reside in the age group that begins to worry about memory loss, I have decided to write a series of essays on Alzheimer's Disease. 

Alzheimer's disease is one of 75 or so medical illnesses that can cause memory impairment and cognitive decline. This all inclusive term for memory impairment is dementia. The causes of dementia can be recalled using the acrostic, COGNITIVE. (Making-up mnemonics enabled me to graduate from medical school.):

• Chronic traumatic encephalopathy--closed head injuries caused by blows to head
• Opiates and other drugs
• Grapes make alcohol that destroy brain cells causing memory impairment
• Neurological illnesses such as Parkinson's, multiple sclerosis, Huntington's
• Insipid infirmity--Alzheimer's is a slowly progressing memory defect leading to an infirm condition
• Tumors of the brain
• Infections of the brain such as meningitis, HIV, Jakob-Creutzfeldt
• Vascular defects such as strokes
• Endocrine abnormalities such as diabetes, thyroid and adrenal illnesses 

Of all the illnesses that cause dementia, Alzheimer's is the most common. Approximately 50% of people with dementia have Alzheimer's as the cause of their memory disturbance. About 10% of people with dementia have excessive alcohol intake as the cause of their cognitive decline. Another 10% of people with dementia have vascular causes--small strokes of the brain (multi-infarct strokes). The other 30% of dementias are caused by dozens of illnesses represented by the COGNITIVE acrostic. 

A study at Boston University School of Medicine showed that 110 of 111 autopsies conducted on professional football players had signs of chronic traumatic encephalopathy. More closed head injury investigations (car accidents, falls, physical abuse, sports) may move traumatic blows to the head as one of the leading causes of dementia. 

An initial sign of Alzheimer's disease may be depressive symptoms--waking in the middle of the night with the inability to return to sleep, appetite disturbance, decreased libido, poor concentration, and apathy. These depressive symptoms may mean brain cells are dying. Early treatment of depression may prevent or slow down the progression of Alzheimer's. Of course, older people can have primary depression unrelated to Alzheimer's. 

Alzheimer's begins insidiously:

• Short term memory begins to fade. 
• The Alzheimer's patient fails to recall events of the past few days---a phone call from the grandchildren, conversations with a friend--while recollections from long ago remain intact. 
• Names and telephone numbers are forgotten. 
• Attempts to cover up intellectual deficits result in social withdrawal, confabulation (making up stories), and exaggeration of personality traits. 
• Endeavors to complete tasks requiring logical reasoning produces anxiety and irritability. 
• Inhibitions vanish. 
• Planning deteriorates. 

Alzheimer's patients who function fairly well in the day may have a difficult time at night--the so called "sundown" syndrome. During the golden hour shadows lengthen. The fading light diminishes environmental cues. With increasing darkness Alzheimer's patients become disoriented. Confusion precipitates anger, agitation, paranoid delusions, illusions, and hallucinations.

As the illness progresses daytime confusion rivals nocturnal agitation. 

• Remote memory begins to fade. 
• Details regarding occupation, family life and childhood events grow fainter. 
• Eventually loved ones go unrecognized.
• Vulgar language, neglect of personal hygiene and disregard for conventional rules of conduct mark the progressive downhill course.
• As mental functions gradually deteriorate, imprecise vocabulary degenerates to incomprehensible speech.
• Eventually the names of body parts are forgotten.
• The insidious deterioration advances to anorexia, malnutrition, infection, loss of respiratory drive and death. 

Next: Causes, Contributors and Co-Conspirators of Alzheimer's Disease