Alzheimer's Disease

By Dr. David Lipschitz

June 12, 2013 5 min read

As America grows older, the prevalence of Alzheimer's disease will increase significantly. According to the Alzheimer's Association, the disease is currently the sixth-leading cause of death, afflicting 1 in 8 Americans and costing our health care system $200 billion annually.

The disease is slowly progressive, and in the early stages, it is no more than a mild disability. Though short-term memory may be lost, other intellectual functions are retained, and with protection and support from family members and the community, a person with the disease can have many years of productive, high-quality life. This requires making the diagnosis as soon as possible.

Sadly, too many patients receive no more than a pill as treatment; an accurate diagnosis is often not made; and potentially treatable causes of dementia are missed. To ensure the best quality of life, it is essential, if memory loss is suspected, that the patient be evaluated and treated by specialists who are skilled at making a diagnosis. A skilled team -- including neuropsychologists, social workers and pharmacists -- is needed to provide day-to-day care and education. Community resources are needed to ensure the best possible quality of life for the patient and family members who bear the burden of caregiving, which gets progressively more difficult.

The initial step in care is an evaluation by a physician who performs a detailed history and examination and then develops a plan of care, the least important component of which is the prescription of medications currently approved to help treat Alzheimer's and other conditions leading to memory loss.

The first step is to determine whether the patient does indeed have significant loss of intellectual function.

As people grow older, many experience difficulty remembering names, seem less astute at math and become concerned that their memory is failing.

Unless the patient has an impaired ability to function in the community (work, shop, manage finances) or interact with others, the problem is nothing more than benign forgetfulness. Memory loss is likely if the patient repeats himself frequently, gets lost while driving and forgets appointments.

Usually, talking to the patient and family members will strongly suggest a problem. This is confirmed by screening memory testing and more extensive testing of every aspect of intellectual function by a trained neuropsychologist.

Once memory loss has been identified, an accurate diagnosis must be made. Though Alzheimer's is the most common cause, other diseases, some of which are correctable, also affect memory. In addition to memory testing, blood tests and imaging studies of the brain are frequently required.

Memory loss can be caused by mini-strokes and other degenerative diseases of the brain. In 12 percent of cases, a potentially correctable cause is identified. These include depression, vitamin B-12 deficiency, elevations in serum calcium and a condition called normal pressure hydrocephalus. In this disease, swelling of the brain results in memory loss, problems with gait and balance, and loss of bowel and bladder continence. This diagnosis should never be missed, as surgery often leads to cure.

Once Alzheimer's has been diagnosed, every coexisting medical problem must be treated relentlessly, as they all can make symptoms worse. Examples include depression, high blood pressure and diabetes.

An assessment of the health and welfare of the caregiver is essential. Most are stressed, prone to illness and unaware of the resources available to provide needed help. Here support groups, counseling and education about the disease are invaluable and help ensure the best quality of life for the patient and his family.

Though the benefits are small, medications are available that may slow the rate of progression of memory loss and provide a few additional years of independent life. Sadly, the hope of a cure is nothing more than a distant dream. However, ongoing research will almost certainly lead to breakthroughs that hold the promise of eradication of the disease, if not in our lifetime then in our children's.

As with children, "it takes a village" to care for a patient with memory loss. A highly trained team of health care professionals and community support groups are needed to provide the care and support for the patient and the family dealing with this difficult illness.

Dr. David Lipschitz's weekly column, "Lifelong Health," can be found at http://TheCoralMag.com.

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