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As you age, it’s normal to forget things. It might seem like every day, you forget something. And some days, it might seem like you’re forgetting everything.

The question that plagues us all is heart-stopping: is that forgetfulness normal or a sign of something more serious? More than 5 million Americans are living with Alzheimer’s, and experts have determined that one in three seniors dies with the disease or another dementia, so the concern is understandable. It’s a scary diagnosis with no cure, so having facts about the disease can help you face whatever the future holds.

 

FACT: It doesn’t happen overnight.

The disease starts very slowly, and patients are often inclined to brush off the first symptoms. Lourdes neurologist G. Peter Gliebus, MD, says Alzheimer’s almost always begins with forgetfulness.

“After the age of 50 to 60, the memory is just not as sharp,” he says. “That’s what we call benign forgetfulness. You forget something, and it eventually comes back to you. That’s normal.”

“But if a person begins telling the same story over and over, asking the same questions or taking part in events and then having no recollection of all or part of those events, it could be the beginning of something more serious. It could be that a person starts making mistakes with paying bills or accidentally double-dosing on medications,” explains Gliebus.

“Overall, you don’t just wake up with this impairment overnight. It starts with the kind of forgetfulness that doesn’t really affect the abilities of daily living,” he adds.

In rarer cases, Gliebus says, the disease can first become apparent through visual-spatial problems or trouble getting to a familiar location.

“It can present with navigational problems, not noticing objects in front of you or more pronounced language deficits, like having a hard time coming up with words.”

The most important thing to do when you notice forgetfulness – even if you think it’s not a big deal – is to consult an expert.

“People try to postpone the diagnosis as much as possible, so they won’t come in until things have advanced. But as a medical professional, it’s my job to tell people to get evaluated as soon as they notice symptoms. Sometimes it’s difficult at the beginning to tell the difference between Alzheimer’s and benign forgetfulness. There’s no magic eight ball here, and evaluation is the only way to answer the question.”

FACT: Forgetfulness doesn’t have to mean Alzheimer’s.

If you or someone you love has begun to forget things, there’s no reason to think Alzheimer’s just yet. Family physician and TV medical expert Jennifer Caudle, DO, says many issues can cause Alzheimer’s-like symptoms.

“Interestingly, the symptoms of depression as we get older can mimic the symptoms of Alzheimer’s: apathetic mood, lack of interest and memory loss. It’s important to keep that in mind because in many cases, older folks may be prone to depression.”

Many older people experience some mild cognitive impairment, which can also look like early Alzheimer’s, but isn’t nearly as menacing.

“It’s a complicated way of saying they have more memory problems than other people their age, but it isn’t Alzheimer’s,” Caudle says. “These folks may lose things or have trouble coming up with words, but they can still take care of themselves and do their normal activities.”

Another big factor to consider when evaluating Alzheimer’s-like symptoms is medication.

“Medications have different side effects, and some of them can seem like symptoms of Alzheimer’s,” Caudle says. “If someone receives a new medication or a different dose, that can cause side effects. When there’s a concern about Alzheimer’s, we always want to know, ‘What’s different? What’s changed?’”

If the symptoms develop suddenly, Caudle says, it’s vital to make sure the patient hasn’t experienced an undetected stroke, which can also affect cognition and ability to speak over time.
Even a lackluster diet can cause worry over possible Alzheimer’s.

“Sometimes nutritional deficits cause major problems,” Caudle says. “Vitamin B-12 and folic acid deficiencies can cause memory loss and dementia-like symptoms. The important thing about all of this is understanding that if mom or dad isn’t acting right, there’s a wide range of things that can be causing it. That’s why getting a prompt evaluation is so important. It could be reversible just by taking a pill or taking away a pill.”

 

FACT: It’s better to talk about it now.

If you have received a diagnosis of Alzheimer’s disease, it can be difficult to know what to do next.
Julie Thomas, RN, associate director of clinical services for the Alzheimer’s Association’s Delaware Valley Chapter, says getting that diagnosis can be extremely overwhelming.

“What should happen next and what does happen next are often different things,” she says. “It’s overwhelming not only for the patient but for the family as well.”

Thomas counsels older people to make an effort to put plans in place before they’re diagnosed.
“The first questions should be, ‘Are my legal and financial plans intact? My power of attorney?” she says. “They know they’re eventually going to be unable to care for themselves as they age, but only a small percentage have actually planned for it. Too many times we see people waiting to work through these issues, and then they’re in crisis mode and it’s now a burden on their families.”

Thomas says sitting down with your family to talk about the future should be a priority.

“Know that this is probably not going to be a one-time conversation. You should plan to have follow-up conversations, as many as are needed, so you can work not only through the logistics, but also the emotions,” she says. “People experience this thing we call anticipatory grief. People say, ‘I don’t want to think about my parent not being around.’ We’re just not good with death. These conversations are going to require a step-by-step approach.”

Thomas says patients with Alzheimer’s disease often benefit most from reaching out to someone who isn’t their doctor or family member. Support, she says, is sometimes the best medicine.

“Psychologically, once you start the process you’re almost confirming the diagnosis. It’s difficult for people to reach out and get the help they need because there’s something inside saying, ‘Maybe this is not true, maybe this is not happening,’” Thomas says.

“But you need to reach out to someone beyond the physicians and the medical support. We have a 24/7 helpline, and we connect people with others who are going through a similar process and facilitate peer-to-peer phone calls. If people can say, ‘OK, this person’s been through this,’ it relieves some of the anxiety associated with the unknown.”

 

FACT: Research is advancing.

There’s no doubt about it: Alzheimer’s disease is scary, and it can be something aging people worry about, even if they haven’t developed symptoms. The good news is science and research are progressing faster than the disease. Soon, your doctor may be able to rule out Alzheimer’s with a simple blood test being developed at Rowan University.

“We made a very simple discovery in 2010,” says researcher Robert Nagele, PhD, director of the Biomarker Discovery Center at Rowan University’s New Jersey Institute for Successful Aging. “Everybody is walking around with thousands of antibodies in their blood that attack their own cells. They’re called autoantibodies.”

Nagele explains that as the body experiences normal wear and tear, debris is produced, and targeted autoantibodies clear that debris from the blood. Nagele applied the discovery to his Alzheimer’s research, and through testing discovered he could identify the presence of specific autoantibodies that clear debris produced by Alzheimer’s disease.

“We mixed up the blood samples of people who had Alzheimer’s and people who didn’t and asked, ‘Using the antibodies, can we distinguish which have Alzheimer’s?’ We were able to do it with 96-percent accuracy on our first try.”

Research shows Alzheimer’s is one of many diseases that is present in the body for up to a decade before symptoms develop. Nagele’s blood test (which he anticipates could be FDA-approved – with the necessary funding – in a single calendar year) could offer people time to plan for the future.

“Alzheimer’s begins so small, usually with little memory complaints,” Nagele says.

“The problem for physicians is at that point they don’t know if it’s Alzheimer’s or something much more benign, and it’s too early to see anything on an MRI. Now we can take a single drop of blood and see whether it’s Alzheimer’s. And theoretically, we could use this test to detect the disease 10 years before you have a single symptom.”

July 2017
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