Book Excerpt: Is It Alzheimer's?

by Roger Granet & Eileen Fallon

The man is seventy-two. He's been forgetting things, things he should know. The worst was the other week. In his own neighborhood, he was lost, driving around in circles until he finally found his house. And he was always sharp; now he finds him self keeping quiet in social gatherings because he can't always follow what's been said. His wife doesn't seem to notice, but one of their grown children does on a visit from out of town. She calls the local hospital and gets the name of a neurologist.

The woman is sixty-one. She's been forgetting things, things she should know. The worst was the other week. In her own neighborhood, she was lost, driving around in circles until she finally found her house. She's scared. Too scared to tell her husband; he wouldn't be able to cope. And her children are busy launching lives of their own. She puts off going to the doctor, making light of her concern--after all, it's probably just part of getting older, and she hates to be a bother. She'll make an appointment sometime later.

What is the problem of our seventy-two-year-old? Because he lives in an area where there's a great deal of Lyme disease, his doctor suspects that that may be the cause of his memory difficulties. He is given, however, the full battery of tests used to diagnose memory loss, which include testing for Lyme disease if the patient lives in an area where it's known to be, or has traveled to such an area within the past few years. All the tests, including that for Lyme, come back negative, results that indicate the presence of Alzheimer's, a disease diagnosed by excluding all possible other causes of the memory problems. Yet his doctor knows that tests for Lyme often come back as false negatives, so he has the man tested again. The doctor's hunch pays off. This time the man tests positive for Lyme and is given a heavy course of antibiotics. His mental sharpness returns.

And what about our sixty-one-year-old? Unfortunately, fear prevents her getting a diagnosis right now. The fear is that she has Alzheimer's. In reality, how ever, she is suffering from vascular dementia, a loss of memory and other mental skills often caused by infarcts (small strokes) or by other conditions that affect blood flow to or within the brain. After Alzheimer's, vascular dementia is the single most common cause of dementia. Diagnosis would enable doctors to treat the cause of the strokes, notably hypertension (high blood pressure). Such treatment could possibly prevent further infarcts, and thereby slow the progress of the disease. Diagnosis would also alert her grown sons and daughters to their inherited risk; they do not realize that they could significantly lower their chance of developing vascular dementia by starting an eating and exercise plan designed to prevent high blood pressure, high cholesterol levels, and obesity, the three major risk factors for both strokes and heart disease. Undiagnosed and therefore untreated, this woman's condition will progress to the point that she must go into a nursing home, possibly much earlier than necessary. The two preceding stories are true. So is the following:

The woman is sixty-seven. She's been forgetting things, things she should know. The worst was the other week. In her own neighborhood, she was lost, driving around in circles until she finally found her house. She is scared. Scared but canny. She hides her problems, and her family, experiencing the psychological phenomenon known as denial, plays along; for instance, her grown son takes over the household accounts, claiming that he's working on them ''with" her. They could go on this way for years, her gradually losing more and more of herself, and their being unable to see it--and to prepare for the changes it must eventually cause in all their lives. But then an outsider's reaction breaks through the family's denial. The woman's husband suffers a severe stroke. In the hospital, as she maintains a vigil with her family, she meets a young nurse. The nurse immediately notices that something is wrong, and refers the family to a geriatric nurse, who in turns directs them to a memory disorder center for diagnosis.

And the sixty-seven-year-old? Though the testing at the memory disorder center indicates Alzheimer's, she is much "luckier" than the woman with vascular dementia. The center refers her to a protocol for tacrine, later sold as Cognex, the first drug on the market developed specifically for Alzheimer's. Fortunately, she responds extremely well to it. Later in the course of her illness she will be prescribed an antidepressant, which also works well. The social worker affiliated with the center alerts the family to the community services avail able to them, so she starts going to a local adult day center. As she declines somewhat and cannot be left alone in the morning to wait for the center's van, which arrives after the others in the household must leave for work, the county provides a homemaker who prepares her for her day, and stays with her until the van arrives. A proper diagnosis has led to medications and social services that delay her having to go into a nursing home for more than two years.

And those aren't the only benefits that come from diagnosis. It enables the family to plan financially for their mother's future, a vital aspect of family well being. Finally, her grown children read about the disease, noting advances that could well help them as they age. For instance, her daughters learn of studies that link estrogen loss to Alzheimer's, and they know that, for this reason alone, they must seriously consider estrogen replacement therapy. They become tied into the Alzheimer' s support and information network, and know that they will be alerted to, and will be able to take advantage of, other preventive strategies.

In short, diagnosis helps both the patient and the patient's family in a number of ways.

Not only are the three preceding stories true, the third one is that of the coauthor of this book. After her mother was diagnosed, her friends expressed their sympathy. A surprisingly large number, however, expressed fears of their own, with some variation of the following: "My mother (or father, or uncle) just isn't herself, and I know something must be wrong. But it isn't always Alzheimer's, is it? And how can we find out if it is?"

These questions made her realize the widespread need for solid, up-to-date information about Alzheimer's and other causes of severe memory problems, topics plagued by misinformation.

You've Been Worried About Someone
Just like the people whose questions inspired this book, you, too, are concerned about someone. Perhaps it's your father, your mother, or even your spouse. You've noticed that he or she isn't quite the same as before, and you've started to worry. You have a number of questions, but you just don't know where to turn to have them answered. In picking up this book, you've come to the right place.

First you will read about:

  • Symptoms of Alzheimer's and the disease itself.
  • Other causes of dementia that show similar symptoms.
  • How to find the right doctor, whether you live near or far from the patient.
  • How to cope with a patient who refuses to go to the doctor.
  • How the diagnosis is made.

And, after the diagnosis has been made, you'll read about:

  • Treating Alzheimer's, a two-tiered approach that involves treating both the disease itself and treating the behavioral aspects of the disease, such as anxiety, depression, and agitation.
  • The two currently approved drugs developed specifically for the disease.
  • Drugs developed for other diseases that may be useful in treating Alzheimer's.
  • Drugs developed for other diseases which treat the behavioral symptoms of Alzheimer's.
  • Coping with-nonmedical issues such as day care, home safety, and making the Alzheimer's patient feel safe and confident with specially designed activities.
  • What a diagnosis of probable Alzheimer's means for you and your family.

Importantly, you will see that you and other caregivers also have to be taken care of, that you can success fully allocate responsibilities and cope with daily demands, and that life can be improved by some professional counseling or therapy for yourself and other family members.

You will see that you're not alone, and that a number of very valuable organizations exist specifically to provide information and the support that helps family members cope. Finally, you'll read about what the future holds, from the value of greater public awareness to the promise offered by research--including genetic research--for more effective treatments and, possibly, a cure.

© Roger Granet & Eileen Fallon, Reprinted from the book, Is It Alzheimer's?, by arrangement with Avon Books, an imprint of HarperCollins Publishers, Inc. All rights reserved.

Roger Granet & Eileen Fallon are authors of the bestselling book, Is It Alzheimer's? What To Do When Loved Ones Can't Remember What They Should.