FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER ASKS, "IS IT DRUGS OR IS IT ALZHEIMER'S?" ]

Question: My mother, who is in a nursing home, has become quite confused lately. Her doctor says that she has Alzheimer's, a condition that can't be treated. I am concerned that her mental deterioration is a result of her new medicine for high blood pressure and heart trouble and not due to Alzheimer's. The doctor doesn't think so. How can we tell? Isn't there anything we can do for her dementia?

Answer: It is physically and emotionally very difficult to care for a loved one who can't think and reason as they used to. That is why most individuals with these problems are in hospitals or nursing homes. Your concern about medicine contributing to your mother's intellectual decline is certainly a valid one, but so is the doctor's diagnosis of Alzheimer's.

Alzheimer's disease is a specific type of dementia. Dementia is defined in my American Heritage Dictionary as: Deterioration of intellectual faculties, such as memory, concentration, and judgment, resulting from an organic disease or a disorder of the brain. It is often accompanied by emotional disturbance and personality changes. There are many causes for this malady, such as stroke, HIV disease, head trauma, Parkinson's disease, Creutzfeldt-Jakob disease, normal-pressure hydrocephalus, hypothyroidism, syphilis, brain tumor, vitamin B12 deficiency, and of course, Alzheimer's disease.

Alzheimer's disease, which is also referred to as dementia of the Alzheimer's type, can't positively be identified until after death. However, during life the diagnosis can be established with reasonable accuracy by ruling out other causes of dementia. I assume that this has been done in your mother's case.

Medicine can certainly cause confusion and an alteration in the ability to reason. This type of problem is called delirium and is very similar to dementia. In delirium the symptoms have an abrupt beginning, hallucinations may be present, and the condition be treatable. Common examples of conditions that cause delirium are fever, concussion, heavy metal poisoning, and the use of certain drugs.

There are many drugs that can cause delirium. Blood pressure and heart medicine are occasional culprits, but alcohol, sedatives, cortisone, pain medicine, Tagamet and Zantac are more frequent causes. Of course, the illegal drugs like cocaine, LSD, heroine and others are taken for the expressed purpose of bringing on delirium.

I doubt that your mother has been secretly taking any illegal drugs, but it is possible that her new blood pressure and heart medicines are causing the change in mental status you've noticed. It is fairly easy to determine that the new medicine is the culprit if the mental changes begin within the first few days after starting the drug. Occasionally, however, the delirium doesn't start until weeks or months later. Then the process of establishing the correct diagnosis involves ruling out all of the possible causes of both delirium and dementia. This requires quite a number of tests.

Some loved ones are uncomfortable approving a large battery of tests because the end result may be no more than just a new label that represents another condition that medical science can't help. However, I strongly encourage you to avoid this mindset what if the dementia or delirium is one of those conditions we can treat? I think you owe it to yourself and your loved one to make sure the diagnosis of Alzheimer's is correct.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.