Forgetfulness or Alzheimer's?

by Food and Drug Administration (FDA)

(Page 2 of 3)

While most people understand at least some of the horrifying aspects of Alzheimer's disease, DeKosky says a big challenge is educating people regarding the widely held assumption that people are supposed to have memory impairment as they age.

"There's this huge prejudice where we think people should have severe mental impairment as they get older," he says. Memory loss, disorientation, and confusion are not part of the normal aging process, he explains. They are symptoms of dementia, and the most common form of dementia is Alzheimer's.

"You need to look at the functional consequences of what someone cannot remember," DeKosky says. "If mom forgets where she put her car in the parking lot at the mall, that's not abnormal. But if she walks home from the mall because she forgot she took her car, that's not normal. Memory is the first and worst change, but you will also see social withdrawal and less willingness to interact with others."

Alzheimer's warning signs include memory loss affecting job skills; difficulty performing familiar tasks; language problems; time and/or place disorientation; poor or decreased judgment; problems with abstract thinking; misplacing things or putting them in inappropriate places; mood, personality or behavior changes; and passivity and loss of initiative. If you notice several of these symptoms in yourself or a loved one, consult a doctor for a complete examination and evaluation.

There are three broad stages to Alzheimer's. In the beginning, the patient may notice his or her own forgetfulness and will solicit others' help or write lists. In the second phase there will be severe memory loss, particularly for recent events. A sufferer may often remember long-ago events while being unable to remember a just-viewed TV show. In this stage, disorientation usually begins, dysphasia (inability to find the right word) may occur, and mood changes happen that can be unpredictable and sudden. By the third stage, people with Alzheimer's experience severe confusion and disorientation, and may suffer hallucinations or delusions. Some may become violent or angry, while others may be docile or helpless. In this stage, sufferers may wander without purpose, experience incontinence, and neglect personal hygiene. Once someone with Alzheimer's becomes bedridden, the complications of bedsores, feeding problems, and infections can make life expectancy very short.

Behavioral symptoms of Alzheimer's result from changes taking place in the brain. The patient neither intends nor can control this behavior. Because families are so often involved in caring for people with Alzheimer's, family education, counseling, and support are vital. (See "Taking Care.")

Alzheimer's disease can be definitively diagnosed only by examination of the brain after death. But physicians can make a probable diagnosis while the patient is still alive by doing a comprehensive evaluation, including a complete health history and physical exam, mental status assessment and neurological tests, blood and urine analysis, electrocardiogram (EKG), and x-rays. They may conduct additional tests, such as computerized tomography (CT scan), electroencephalography (EEG, or recording of brain wave patterns), and formal psychiatric assessment.

The tests are important to rule out other potential causes of dementia, such as vitamin B12 deficiency, pernicious anemia, hypothyroidism, or tumors. Documenting symptoms over time, in a diary-like fashion, also helps doctors understand the person's illness.

New Studies

Researchers continue to study drugs and other substances as possible treatments for Alzheimer's. Carefully designed and conducted studies are necessary to give a clear picture of safety and effectiveness before any approval can be considered.

A recent report in The New England Journal of Medicine found that mental deterioration from Alzheimer's was slowed by an average of seven months by either selegiline (Eldepryl, Atapryl), a drug normally prescribed for Parkinson's disease, or high doses (2,000 I.U. per day) of vitamin E.

In addition to trials with conventional drugs, alternative therapies are also being researched.

"There have been a number of studies on the usefulness of Ginkgo extract [a popular herbal medicine derived from the leaves of Ginkgo trees] in Alzheimer's," says Neil S. Buckholtz, chief of the dementias of aging branch, neuroscience and neuropsychology program, National Institute on Aging, National Institutes of Health. "The bottom line is that this is an interesting compound, but we are still not sure if it works in Alzheimer's disease. We are now funding a small study on Ginkgo. But you have to look at the risks vs. benefits these are not benign compounds."

Nevertheless, DeKosky expects to see more studies on "natural" or alternative-type therapies like Ginkgo. "Those studies should be done," he says, "so we know whether it's helpful, patentable, or even to say it does not work."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.