Alzheimer's Disease

Alzheimer's Disease (AD) is a progressive, age-related brain disease that impairs thinking and behavior. An estimated 2.5 million American adults are affected. AD is the most common form of dementing illness, which causes declines in intellectual functions and in the ability to perform routine activities.

AD usually has a gradual onset. Problems remembering recent events and difficulty performing familiar tasks are early symptoms. Additionally, the Alzheimer patient also may experience confusion, personality change, behavior change, impaired judgment, and difficulty finding words, finishing thoughts, or following directions. How quickly these changes occur varies from person to person, but the disease eventually leaves its victims totally unable to care for themselves.

Symptoms Of Alzheimer's Disease

Alzheimer's Disease is a dementing illness. Dementia involves loss of memory and loss of intellectual abilities severe enough to interfere with routine work or social activities. These symptoms may occur in middle-aged and older adults. They include:
  • Language problems, such as trouble finding words
  • Problems with abstract thinking
  • Poor or decreased judgment
  • Disorientation in place and time
  • Changes in mood or behavior
  • Changes in personality

These symptoms typically cause problems in everyday activities and they may be recognizable in the following ways:
  • Frequently getting lost in familiar surroundings or losing one's way to a familiar destination
  • Forgetting appointments or errands
  • Forgetting names of familiar people
  • Problems handling money, getting dressed, reading or writing
  • Not being able to use the tools of daily living such as a key or radio

The overall result is a noticeable decline in personal activities or work performance.

Can Other Conditions Produce The Same Symptoms?

Yes. More than sixty other disorders have symptoms similar to Alzheimer's Disease, so one must not assume that someone has AD just from the signs mentioned earlier.

Among the other most common causes of dementia symptoms are: stroke, depression, drug intoxication, thyroid disease, nutritional deficiencies, AIDS, tumors, head trauma, subdural hematoma, and normal pressure hydrocephalus.

In addition, there are the "related disorders" that also cause dementia: Huntingdon's disease, Parkinson's disease and Creutzfeldt-Jakob disease.

That many of the conditions that produce similar symptoms to AD are treatable emphasizes the importance of a complete medical assessment for patients experiencing dementia symptoms. Reversible causes of dementia symptoms can be depression, nutritional and vitamin deficiencies, drug interaction, thyroid imbalances, infections, blood chemistry imbalances, tumor, blood clots, normal pressure hydrocephalus, and excessive pressure in the brain from spinal fluid. In contrast, there is no effective treatment for Alzheimer's Disease at this time. If a diagnosis of Alzheimer's Disease is assumed without adequate evaluation, the patient with a treatable condition could be deprived of treatment.

What Is "Normal" Memory Loss

At some time, everyone forgets the name of an acquaintance, or where s/he parked the car or put his/her keys. Everyone forgets things as s/he goes about daily activities. Usually, we don't think anything of such brief memory lapses. Often, what has been forgotten is something of little importance and eventually the information is remembered.

Although most of us expect our bodies and our reflexes to slow down with age, physicians now recognize that many healthy individuals are also less able to remember certain types of information as they get older. Health care professionals use the term "age-associated memory impairment" (AAMI) to describe minor memory difficulties that come with age.

AAMI is neither progressive nor disabling, whereas some dementias are both. AAMI is often most noticeable when the person is under pressure. Often when s/he relaxes, s/he can usually recall the forgotten material without difficulty.

No "treatment" for age-associated memory loss has been developed. However, writing reminders, making lists, repeating messages or names out loud, and allowing more time to remember names may be helpful.

In addition to AAMI, minor memory difficulties may be caused by distractions, fatigue, grief, depressions, stress, illness, medication, alcohol, vision or hearing loss, lack of concentration, or an attempt to remember too many details at once.

In general, it may be beneficial to cut back on alcohol, eat well-balanced meals, and make sure that medications are being taken as prescribed and are not themselves causing problems.

Recognizing Dementia

How can you tell if memory loss is more serious than AAMI? How can you tell if it is dementia?

Dementia is progressive. AAMI may remain unchanged for years. Most individuals with AAMI can compensate for memory loss with reminders and notes. However, memory loss associated with dementia will begin to interfere with the normal activities of daily life. In addition, dementia will affect more than memory.

For instance, Alzheimer's Disease affects the ability to use words, work with numbers, solve problems, and use reasoning and judgment. Alzheimer's Disease also may result in changes in mood and personality.

When "forgetfulness" starts to affect the ability to carry on daily activities, it is cause for concern. Even in advanced old age, memory loss that interferes with everyday life is not normal. It may indicate a form of dementia, and the individual should undergo a complete evaluation to find out the cause.

Testing For Alzheimer's Disease

There is no single diagnostic test for Alzheimer's Disease. However, a complete medical and neurologic evaluation is strongly recommended to account for any dementia symptoms that appear.

A complete evaluation should include:

  • A detailed medical history, provided by the patient and someone who knows the patient well. This is necessary to establish progressive intellectual deterioration and identify personality changes, problems with memory and difficulty with daily activities.
  • A thorough physical and neurologic examination, including tests of sensory and motor systems to rule out other disorders.
  • A mental status test essential to evaluate orientation, attention, recent recall and the ability to calculate, read, write, name, copy diagrams, repeat, understand and make judgments.
  • A psychiatric assessment to rule out psychiatric disorders.
  • Neuropsychological testing to measure a variety of functions including attention, orientation, language skills and perception.
  • Routine laboratory tests, including blood work, urinalysis, chest x-ray, electroencephalography (EEG), computerized tomography (CT Scan), and electrocardiogram (EKG). In addition, other tests may be ordered.

The last category of tests is used to exclude such causes of dementia as vitamin deficiency, thyroid disease, and chronic infections, such as syphilis, depressive syndrome, brain tumors, circulatory disease, hydrocephalus, subdural hematoma, and multi-infarct dementia.

None of these tests alone can make a diagnosis of AD. They are useful only when their findings are considered together and they can be used to identify or eliminate other potential causes of dementia.

The only way to confirm a diagnosis of Alzheimer's Disease is to examine brain tissue under a microscope, such as in an autopsy.

Obtaining A Medical Assessment

A good place to start is with the family doctor. A geriatrician or an internist also can begin the diagnostic process. Any of those doctors may then consult with or refer to a neurologist, psychiatrist, or specialized Alzheimer diagnostic center.

Because of the seriousness of Alzheimer's Disease, a second opinion is appropriate if there are any doubts about the diagnosis. In some patients it is difficult to tell from a single testing whether there has been any decline. Re-testing is then recommended to provide comparisons that will show if there has been decline of memory and other skills and abilities. Re-testing is also recommended in cases where the patient experiences symptoms that are not clearly defined.

Looking Ahead

You probably have many questions about what can be done to protect the future security of an Alzheimer patient and his/her family. You should feel reassured knowing that, before the full decline of mental capacity, the Alzheimer patient will be able to make decisions about the future management of his/her life and assets through careful ncial and legal planning.

It is beneficial for the Alzheimer patient and his/her family to devise a plan that meets their needs and desires as soon as possible. Whether the patient him/herself or his/her concerned caregiver(s) are to assume this task, professional financial and/or legal advice will be required. If your elder is diagnosed with AD, you'll need to find a competent, concerned professional to answer any questions to your satisfaction. Remember, laws vary from state to state as do the needs of each person and family. With help and proper guidance, you should be able to make the choices that will best protect your circumstances.

You are probably wondering where to start. You should begin by collecting any legal and financial documents that are the property or concern of the Alzheimer patient. This includes prior tax returns, information on insurance policies, mortgages, bank accounts, and other financial investments, as well as previously executed wills and trusts. Descriptions of employee benefits to which the patient may be eligible will also be important when planning an estate. With these documents in hand, you are now ready to seek professional legal or financial advice.

Patient And Family Relationships

Planning the future for a patient with AD can be a disturbing process for the individual and his loved ones. While it is important to designate an appropriate person early to assume legal responsibilities, it should be understood by all that the patient will only need to give up those responsibilities that he can no longer effectively handle. Even after there has been significant impairment, keeping the patient abreast of important decisions will help to ease his mind that things are being done the way he would have chosen. Very often a family meeting with the patient's physician, counselor, clergyman, or legal advisor can help to open communications among family members.

Finding Legal Help

  • You may want to start by calling your family lawyer. Keep in mind, however, that he may want to consult a specialist or may refer you to someone whom he feels would be better qualified to help you.
  • The state bar association will also be able to provide you with the names of attorneys practicing in your area. Of course, don't overlook your friends, family, coworkers, and support group members. Personal references are very often an excellent source of locating caring professionals.
  • The Legal Aid Society or the local Office on Aging will be able to help you find legal aid free or at a low cost.

Resources For More Information

For more information about Alzheimer's Disease, write the Alzheimer's Disease and Related Disorders Association, 70 E. Lake Street, Chicago, IL 60601-5997. Or, call 312-853-3060 or 1-800-621-0379.

Feil, Naomi.
The Validation Breakthrough: Simple Techniques for Communicating With People With "Alzheimer's Type Dementia.".
Baltimore, MD: Health Professions Press, 1993.

Mace, Nancy, and Peter Rabins, M.D.
The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer's Disease, Related Dementing Illness, and Memory Loss in Later Life.
Baltimore, MD: John Hopkins University Press, 1991.

O'Connor, Kathleen, and Joyce Prothero.
The Alzheimer's Caregiver: Strategies for Support.
Seattle, WA: University of Washington, 1987.

Ronch, Judah L.
Alzheimer's Disease: A Practical Guide for Families and Other Caregivers.
New York: Continuum, 1991.

For more information or a list of other Heritage Planning educational materials on helping your parents, contact:

Richard Smith or Roger Erickson
Professional Educators Benefits Company
Post Office Box 37102
Tallahassee, Florida 32315-7102

Telephone: Richard Smith: 850-385-2627, Roger Erickson
In Florida, outside Leon County call: 1-800-260-6573