Dementia
People ask me a lot of questions about Alzheimer’s Disease and dementia. How, what, when, most people dealing with this are at a total loss, understandably so. It is a long, cruel disease that takes a loved one in bits and pieces over many years. It starts very subtlety, forgetting where you left the keys, can’t come up with names or objects, can progress to getting lost, forgetting where the bathroom is, to forgetting spouses, children, your own name. People can become agitated, paranoid, have hallucinations. Some people can become so agitated that they react violently, or curse, cry out, or are sexually inappropriate. I have seen the kindest, sweetest people turn into someone the family cannot recognize. This is agonizing ! I don’t have any answers about why this happens, but I can help with some of the navigation.
The subtle symptoms are the best time to start your investigation. Word finding, forgetting names, lost keys, putting strange thing into the refrigerator are some of the things I’ve heard over the years as early signs. The people with this disease are very good at hiding it and covering it up, and oddly, so is the family. “Oh, she’s just getting older”; “Some memory loss is normal”. It’s hard to admit there is something wrong, no matter what the problem may be.
The best way to start is to rule out any physical issues. Cognitive changes can be caused by something physical. A Vitamin B or folate deficiency can be ruled out with a simple blood test. An infection like a urinary tract infection or pneumonia can cause significant and sudden cognitive changes. A history of sexually transmitted diseases can cause dementia like symptoms, as can a history of alcohol use. Some providers will pursue a Ct scan of the head to rule out a tumor or stroke. Ruling out physical causes is the first step. Diseases like Parkinson’s disease can also be a cause of dementia.
People who have depression or anxiety can also show signs of dementia. Often, the symptoms of depression, anxiety and dementia can be very similar. People who are depressed can be forgetful, people with anxiety can be scattered and appear agitated.
If the physical causes are ruled out, the next step is to have a Neuro-Psychological exam. This is a comprehensive, often up to 3 hour evaluation to determine the possible cause of cognitive changes. This can result in a definitive diagnosis of either Alzheimer’s disease, vascular dementia, Lewey Body dementia, mild cognitive impairment, depression, or anxiety. The report will also provide recommendations to manage whatever the diagnosis may be.
The best advise I can give is to arm yourself with the truth. Knowledge is power. Figuring out what the problem is and how to navigate the symptoms and long term ramifications will be your best defense. It may not make it any easier, but you will be better prepared.
