Understanding Memory Loss and Dementia

As we all grow older, we become a little forgetful. Sometimes, however, that forgetfulness becomes more severe and may be the earliest sign of dementia.   How many jokes are there about losing one’s car keys or getting lost driving? The most common form of dementia is Alzheimer’s disease. While medical science does not fully understand or know how to cure dementia, there are many things that can be done to help patients and their families understand what is going on. We at Raleigh Neurology Associates are experienced in the diagnosis and treatment of patients with dementia.

Alois Alzheimer

Who was Alzheimer and why does the disease carry his name?

Alois Alzheimer (pictured above) was a German neuropathologist who lived and worked in the 19th century. He described the pathologic findings of several patients with dementia. These observations proved to be the foundation for all subsequent studies of dementia.  Neuroscientists who followed Alzheimer honored the importance of his work by naming the disorder Alzheimer’s disease. Countless studies over the ensuing years have verified and substantiated Alzheimer’s seminal work.

How common is Alzheimer’s disease?

Alzheimer’s Disease has been estimated as affecting up to 10% of individuals in their early 60s and roughly 40% of patients over 85. This obviously presents a major public health problem since by the year 2020, over 55 million Americans will be over 65. It is the 3rd most expensive illness to treat following cancer and heart disease. Most of those costs involve home care and nursing home care. Over the last 25 years with advances in neurology, neurochemistry, neuroradiology, and medical genetics the full spectrum of dementia has come to be more fully understood.

What is dementia?

Dementia itself is formally defined as an acquired persistent decline of at least 2 of 5 spheres of cognitive function, which interferes with occupational or social functions or interpersonal relationships. While dementia of the Alzheimer type is clearly the most common of these disorders, we now understand that it is only one of many diseases, which manifest themselves with progressive cognitive impairment

The areas of cognitive function of concern are  loss of memory, loss of visual-spatial skills (getting lost while driving or getting lost in familiar places), impairments in executive function (the inability to do simple mathematics like handling the checkbook or making change in the store; the inability to carry out tasks of abstract reasoning; and impaired judgment), changes in personality, and unexplained changes in mood.  What really distinguishes dementia of the Alzheimer type from the other dementias is that impairment of memory is the primary neurological deficit. If a patient exhibits signs of dementia with relatively good preservation of recent and remote memory, the individual probably does not have Alzheimer’s disease.

How is the diagnosis of dementia made?

The medical and neurological evaluation of dementia is a process of looking for definable and treatable medical problems that could otherwise explain the dementia. For example, thyroid disease, B-12 deficiency, or electrolyte disturbances are among the many potentially treatable problems that may present clinically with dementia mimicking Alzheimer’s disease. A wide range of blood tests, therefore, is part of the initial evaluation of any patient with dementia. Imaging procedures such as computerized tomography (CT Scan) or magnetic resonance imaging (MRI) are necessary to look for specific structural abnormalities of the brain like tumors or strokes that can produce a dementia that might resemble Alzheimer’s disease. CT and MRI do not make a diagnosis of Alzheimer’ Disease.  The procedures are done to rule out other illnesses. In advanced cases they may reveal shrinkage or atrophy of the brain, but in early cases the studies may be surprisingly normal. Although a definitive diagnosis of Alzheimer’s Disease can really only be made at autopsy, a wealth of data suggests that a physician who makes the diagnosis based on a good neurological history and a physical coupled with the appropriate laboratory and imaging procedures will be correct 90% of the time. That is a level of diagnostic accuracy that is rather extraordinary.

What is the course of Alzheimer’s disease?

Early on in the illness, memory loss dominates the clinical picture with mild personality changes seen in many patients. Families begin to struggle with issues of independence, driving safety, and power of attorney while patients often deny or minimize that anything is wrong. As time goes on, the issues of safety become more troublesome. Falling, misuse of electrical appliances, wandering, and emotional outbursts of agitation and anger begin to surface. In some patients, as the disease progresses, the burden of care necessitates home care assistance or even nursing home placement.

Are there any treatments for Alzheimer’s disease?

We unfortunately have a very limited understand of what causes Alzheimer’s disease. Our therapeutic options are few in number.  Several medications called cholinesterase inhibitors (Aricept™, Reminyl™, and Exelon™) may transiently improve cognitive function and may slow the course of the disease over the short term. Namenda™ was recently approved by the FDA for use in patients with more severe Alzheimer’s disease to help with cognitive decline and agitation. A wide variety of anti-anxiety and anti-depressant medications are available to help patients and families cope with the emotional aspects of the disease. Fundamentally, we do not yet have much to alter the relentless progression of the disease, but hopefully as we gain more understanding of the disease itself, such medicines will become available in the future.

Are there community-based resources to help families of patients with Alzheimer’s disease?

Many support services are available to patients and their families in our community. The Alzheimer’s Association and The Wake County Council on Aging are but two of these resources, listed below we have numerous others that will help with care giving. Clinical and basic science research is being done throughout the world to help both present and future patients with this disease. Patients and their families should give serious consideration to participating in such research for it is only with such help that this disease will be unraveled and conquered.

What should I do if I think I have Alzheimer’s disease or if I am worried that someone in my family has it?

North Carolina Aging Resources 

Alzheimer’s Association

Adult Day Care and Day Health Programs

Aging Services Directory

Area Agencies on Aging

Councils and Departments on Aging

Senior Centers of North Carolina

Full Circle of Care

Triangle J Area Agency on Aging

Resources For Seniors (Wake County)

Meals on Wheels of Wake County