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(MayoClinic.com) In this interview, Eric Tangalos, M.D., a primary care physician and co-director for education at the Alzheimer's Disease Research Center at Mayo Clinic, Rochester, Minn., explains why older people with memory problems should have a thorough diagnostic workup. If fears are confirmed, information and planning can smooth the path for the ensuing years.
In the earliest stage of the disease, a diagnosis can be really difficult. What you're looking for is something that doesn't fit with the individual's former level of function. That's why family members often notice the symptoms first. The disease affects more than just memory — it can involve language, problem solving or even how we draw a clock.
It's easy to misplace your car in the parking lot. That's happened to all of us. But most of us eventually find our cars. People with Alzheimer's lose the capacity to adjust and solve the problem of the lost car. In fact, they might jump to the conclusion that the car has been stolen.
Alzheimer's is a progressive disease that first manifests itself with problems usually related to memory. Over time, people have more difficulty with tasks. By the end of the disease process, Alzheimer's is pretty easy to recognize. Our goal is to find out from family as quickly as possible when something is truly amiss in order to do something about it.
What are the warning signs of Alzheimer's disease?The Alzheimer's Association's 10 warning signs are:
There's no biological marker at this time specific enough to prove that someone has the disease. The brain typically changes with Alzheimer's, and those changes can show up in a variety of characteristic ways. But that's not enough to make a diagnosis. There's a lot of overlap in what we consider normal and abnormal, so even if some areas change on CT or MRI, the person may still function quite well.
In our research, we use brain changes on MRI to help us assess the possibility of Alzheimer's. In most clinical settings, brain imaging should be used only to rule out such things as hemorrhages, brain tumors or strokes. However, we are getting closer and closer to defining Alzheimer's with both laboratory and imaging tests.
What other diseases should be ruled out?We'd want to check the thyroid, to rule out problems there. And, in many cases, the symptoms of depression can be mistaken for Alzheimer's — and vice versa. We also routinely look for vitamin B-12 deficiency and always try to make sure that the person is generally healthy and doesn't have some other serious medical problem that would complicate our diagnosis. A lot of our older patients have other medical problems that just make things worse — like heart disease, high blood pressure, strokes, diabetes, kidney disease, lung disease or any combination of these.
What other types of tests are helpful?A two- to four-hour battery of neuropsychological tests is a routine part of our Alzheimer's research at Mayo Clinic. We compare skill levels of people who may have Alzheimer's with those of people at the same age and education level. We know that an 85-year-old is not going to function as well as a 75-year-old. These tests show us exactly what people can and cannot do based on comparisons to standard tests of people with the same sex, education and age.
From these studies and knowing what support they have at home, we can tell if the person can still function independently or if he or she is really on the edge and should be looking for a safer living environment. Alzheimer's is not an all or nothing phenomenon, so this is why we always talk about what capacities are preserved and what capabilities may be lost.
What's the benefit of an early diagnosis?There are both drug and nondrug interventions. Drug therapy isn't a magic bullet, but it can delay or slow the progress of the disease. Alzheimer's drugs help some people more than others, but in general, you end up better on the drugs than not on them. With this disease right now, "better" is just not getting worse.
And an early diagnosis isn't just about starting drug therapy. You can change your home environment and simplify the world around you. The sooner you move into a structured environment, the more protected you'll be. The ideal setting is probably one that includes independent housing, assisted living and nursing services on the same campus. The same philosophy is at play throughout, so there's less to learn with each move.
What else can be done?People with Alzheimer's do better when they have a routine to follow. It allows them to refresh and reinforce their pattern of behavior every day. They get to relearn their habits over and over and this is good.
When you put them in strange surroundings, they don't do well. That's why they may have trouble when you bring them to your house for the holidays, or if they have to be hospitalized. A change in routine is not good for people with Alzheimer's — there are just too many problems to try and solve.
The change in routine is one of the reasons why people with Alzheimer's often have such a swift downturn after the death of a spouse. The spouse may have been helping to both think for and protect the person.
What do you hope to see in the future?I'd like to see people come in earlier for diagnosis. People hide their symptoms, or spouses cover for them. That's easy to understand because Alzheimer's is such a dreaded disease. But just because you have a memory problem doesn't mean you can't drive a car. We look for what you have retained and do our best to keep you as healthy and safe as possible with as little opportunity to fail.
©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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