By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SOME FORMS OF DEMENTIA CAN BE REVERSED -- ALZHEIMER’S CANNOT

Question: My mother, who is 80, has just been diagnosed with early Alzheimer’s disease. I have noticed that she has been more forgetful over the last year or so, but I thought this was normal as you get older. The doctor wants to do some tests, and start her on some medicine. Can you tell me more about Alzheimer’s, the medications, and anything else that might help?

Answer: Alzheimer’s disease is one of several types of dementia. Dementia is defined in the Merck Manual as “a deterioration of intellectual function and other cognitive skills, leading to a decline in the ability to perform activities of daily living.” There are many causes of dementia; some are reversible and some -- like Alzheimer’s -- are not.

The two most common types of dementia are Alzheimer’s type and vascular dementia. Vascular dementia can be diagnosed frequently by brain imagining such as CT scan.

There are tests that can be used to rule out some of the possible causes of dementia. For instance, depression -- especially in the elderly -- can have symptoms similar to dementia. This condition, which doctors call “pseudodementia,” can be distinguished from real dementia by psychological and neurological testing. These tests tell us if there is cognitive impairment and, if so, to what extent. However, there is not yet a generally available test to diagnose specifically for the Alzheimer’s form of dementia.

Tests for Alzheimer’s are being studied by researchers. One such test is an experimental procedure in which patients are injected with a compound called Pittsburg Compound-B, or PIB, and then given a PET scan of the brain. Patients with Alzheimer’s retain more of the PIB chemical marker in certain regions of the brain than normal subjects. These regions are exactly the same areas where, on autopsy, doctors find a specific kind of plaque in deceased Alzheimer’s patients. At this point the test and the interpretation of its results need to be refined before it can be released for general use.

There is also a urine test available, but it’s reliability has not been scientifically proven.

This means that for now, Alzheimer’s disease is still a “diagnosis of exclusion” that requires examination and testing to rule out all of the other possible causes of the dementia. Only then can your doctor conclude that Alzheimer’s disease is the real cause.

As Alzheimer’s progresses, patients increasingly lose the ability to recall and use previously acquired knowledge. This progressive loss of memory leads to behavioral changes and loss of decision-making abilities. Alzheimer’s disease is more common in women, and the incidence increases with age.

While Alzheimer’s is a non-reversible, progressive disease, there are many things that can be done. Treatment with one of the newer Alzheimer’s drugs can slow the progression. A healthy diet and using other medications, if there are behavioral problems, can benefit the patient.

You can help your mother maintain cognitive function as long as possible by providing routines for her. Also, keep calendars and clocks visible, and make lists and written instructions for using household items. Stress and anxiety can make memory worse, so work to minimize those aspects of her life. I’d also recommend having a family meeting with your mother now, to discuss her wishes for care in the future. That will make the road ahead much easier for everyone to navigate.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.