STORY BY

Liz Bennett

The 79-year-old professional woman sitting in the doctor’s office was deeply concerned. For the previous six to eight months she’d been forgetting meetings and appointments and felt—for the first time in her life—that she needed to write everything down. Now she was about to go through an extensive neurological evaluation to determine if she had what she feared most: Alzheimer’s disease (AD).

There was reason to be concerned.

Every 70 seconds, someone in this country develops AD, according to the Alzheimer Association and more women than men have it—the downside of outliving their male counterparts. New statistics from the association’s “2009 Alzheimer’s Disease Facts and Figures” show that more than five million people in the US live with the disease. One in eight people 65 or older is affected, and the risk is higher for those over 85.

Alzheimer’s disease is the most common form of dementia and accounts for 60 to 80 percent of cases, but diagnosing it is difficult. Even specialists can’t always distinguish between mild memory problems and early stages of dementia. It requires extensive testing and consultations with experts, says James A. Ferrendelli, MD, professor in the Department of Neurology at The University of Texas Medical School at Houston.

How is the disease diagnosed, and what is involved in the testing? What kind of doctors do the testing and make the diagnosis, and why is early diagnosis important?

The first step in the process is to consult “someone knowledgeable,” advises Ferrendelli. “If you think you’re ‘losing it,’ ask your doctor to refer you to a neurologist or specialist in memory.”

Memory screening is part of every evaluation in geriatric medicine, explains Carmel Dyer, MD, director of Geriatric and Palliative Medicine at UT Medical School at Houston. It can be as simple as a “clock test,” which takes about five minutes and assesses recall, planning and task execution, or a “mental status exam,” which takes a little more time and includes from 10-30 simple questions such as spelling words backward.

“Many people come to us (at the UT Medical School) with concerns about their memory because we’re geriatricians,” says Dyer. “Dementia is a clinical diagnosis, so what’s involved is taking a very detailed history from the patient. You may need more history from a family member or someone close to them. If it’s borderline—if it’s not clear—we do more extensive testing.”

That may involve blood, urine and spinal fluid tests as well as brain scans, such as computer tomography (CT) scan or magnetic resonance imaging (MRI) test.

Earlier diagnosed, the better

Early diagnosis is beneficial for several reasons. Although there is no cure, starting treatment in the early stages of AD can help preserve function for months to come. Alzheimer’s can be treated with a combination of drugs and therapy, although the effectiveness of the former is being researched. The best-known drug is Aricept, which some specialists believe prevents the progression of AD for a period of time and is generally prescribed only after the diagnosis. It’s also expensive and can cost a patient as much as $120 a month.

Early diagnosis also helps patients and their families plan for the future, make living arrangements and take care of financial matters, Dyer points out.

While research on the causes and treatment of the disease continues, the best way to stave it off is daily exercise, and not just crossword puzzles to keep the mind agile. “Physical exercise,” says Ferrendelli, who at age 72 tries to work out between 30 and 90 minutes each day. Exercise helps to maintain the health of blood vessels in the brain, helping to ensure a steady flow of oxygen and nutrients to areas of the brain critical for thinking and memory. Exercise also lowers stress and levels of stress hormones that can damage brain cells.

Ferrendelli’s daily workouts include cardiovascular exercises on an elliptical trainer, a stationary exercise machine to simulate walking or running without causing excessive pressure to the joints. He also does weight-resistant exercises.

Dyer agrees with Ferrendelli that exercise is the best medicine to ward off AD, along with getting a good night’s sleep. “Most of us are not at our optimum functioning if we get less than seven or eight hours,” she says.

Meanwhile, if you or someone you know is concerned about having the disease, it could be worthwhile to get tested. (It’s expensive, but it’s covered by Medicare.)

After an MRI and a full neurological evaluation, the 79-year-old professional woman received her results. The diagnosis: “Mild cognitive impairment,” but no significant abnormality. “I felt relieved,” she says.

 

 

Last Updated: 10-14-2009

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