Alzheimer’s Red Flag or False Alarm?
by Lisa Esposito for U'S News:When it comes to the possibility of Alzheimer's disease, there are certain signs nobody wants to recognize. On the other hand, older and not-so-old adults may overreact to routine mental slips that can happen to anyone. Reduced speed in completing writing tasks, for instance, or less ability to pay attention while multitasking are normal parts of aging. If you wonder about the difference between an occasional memory glitch or slight cognitive slowing and a potential dementia warning sign, Alzheimer's experts compare some indicators below.Self-insight vs. outsider concern. "If people are concerned about their memory, oftentimes that's a sign that they're not experiencing significant memory loss," says Dr. Donovan Maust, an assistant professor of psychiatry with Michigan Medicine. "If you have the insight and awareness to be worried about your memory, that's actually kind of a good sign." People with the wherewithal to visit a specialist on their own might instead really need support for depression or reassurance about temporary difficulties in concentrating. Generally, he says, people who truly have dementia-related memory loss are more likely to be brought in by concerned loved ones who want them to be evaluated.Misplacing and retracing. Routine information overload could make anyone momentarily forgetful, says Dr. Sharon Brangman a past president of the American Geriatrics Society."So if you lose your glasses, it's most likely because you weren't thinking about them when you put them down; and you weren't in a routine where you put your glasses in the same place all the time," she says. If you're able to retrace your steps and find missing items, it's no big deal. However, if you can't retrace your steps because your short-term memory is too impaired to re-create your last minutes or hours, that's a problem. Or, she says, "If when you do find your glasses they're in a really strange place, then I would be more concerned."Memory loss to the test. To make a dementia diagnosis, health providers need to see objective deficits or decline in thinking abilities, based on cognitive testing. "It's not just a subjective, 'I think I'm getting worse,'" Maust says. For definitive results, he says, "You test [patients'] memory and [see that] they are doing worse than other people their age." Knowing a person's baseline is important, he adds: "If you're concerned about your memory and you're going to see a doctor, take along a family member who knows you really well."Fading nuances. With dementia, "we start to notice that some people have trouble with abstract thinking," says Brangman, who oversees geriatrics at Upstate University Hospital in New York, and its Center of Excellence for Alzheimer's Disease. "They're very concrete in their language skills." Sarcasm and idioms become too difficult for the brain to process. In her office, patients are asked to explain the proverb: "People who live in glass houses shouldn't throw stones." For those with dementia: "You'll break the glass" might be their response.Language distinctions. At some point, everyone flubs that word on the tip of their tongue, only to have it pop up later. But dementia can truly leave people at a loss for words. "Sometimes there are language problems where people have trouble with word-finding, to the point where they start to become less fluent and use 'things' instead of naming a specific item," Brangman says. "Nouns become a little tricky."Functional bottom line. Memory or language problems alone don't equal dementia. "It has to be a memory loss that also interferes with function," Brangman says. "You have to have difficulty performing tasks that normally wouldn't have been a problem for you." Along those lines, Maust says that preparing meals, grocery shopping and navigating transportation whether by bus or driving are good examples of maintaining functions. "Those are actually pretty complicated things that most adults take being able to do for granted," he says. "So if you have an 80-year-old who's doing [them] without problem, that's a really good sign."Finances in order or chaos? When people can't keep up with their finances it could be a bad indication. Because it involves thought processes alone (unlike, say, filling your gas tank), trouble taking care of bills is often one of the first things people with dementia grapple with, Maust says. If a parent who'd been a meticulous bill-payer throughout his or her life began having bank-account overdrafts, he says, that would be a concern.Eating and sensory changes. Although it's not universal, a diminished sense of smell is sometimes tied to dementia. "We do know that many people with advanced dementia lose their interest in eating," Brangman says. "So much of what we eat is based on smell." A preference for very sweet or salty foods can appear as the sense of smell fades, she says, because the related taste buds are among the last to lose sensitivity.Driving challenges. Driving can become more difficult with age due to normal changes in vision and reaction time. If you can find workarounds such as driving only during the daytime, or making a series of right turns instead of turning left at a busy intersection, that's a positive sign, Maust says. However, getting lost while driving along a familiar route is more troubling.Personality U-turns. Family members, friends or co-workers may witness startling personality changes with evolving dementia. "Someone will become very aggressive, mean or nasty and quick to anger – or the opposite," Brangman says. "Someone who used to be grumpy and hard to get along with is suddenly nice and docile."From social to isolated. If an aging aunt no longer wants to have lunch with the girls or play her weekly bingo, she might be avoiding social activities she can no longer handle. With dementia, picking up on conversations or remembering names can become too much of a struggle. "People become more withdrawn and isolated," Brangman says. "Sometimes those symptoms that look like depression can be early signs of Alzheimer's disease, especially if they occur after the age of 65."If You Suspect DementiaIt takes time for family members to catch on as loved ones go through these changes. "They can usually compensate until you get to a critical point where they just can't anymore," Brangman says. "I had a patient whose adult daughter noticed her mother was reading the same book," she recalls. "She used to go through books in a couple of days. Not only was she reading the same book – she really seemed to be stuck on the first chapter. So that was another red flag."If you have a concern, it's important to talk with a health professional. "It's not one of those things where you want to wait and see," Brangman says. "It's better to get evaluated and reassured that everything's OK."If in fact dementia is present, she says, education is vital for patients and caregivers. "There are so many resources out there," she says. "So you don't have to reinvent the wheel and go this alone."