Beth Witrogen McLeod
CONSUMER HEALTH INTERACTIVE

Note: This article has been localised for an Irish audience.

Alzheimer's disease (AD) is the leading cause of brain damage in old age, affecting 6 percent of the population over 65, and 20 percent of those 85 and older. Warning signs include poor judgement, loss of initiative, a tendency to misplace things, recent memory loss that affects job performance, problems with abstract thinking, a declining ability to perform routine tasks, and unusual changes in mood or behaviour. While these signs alone do not indicate AD, early diagnosis is important to determine if these symptoms indicate a diagnosis of AD, another dementia, or a treatable condition. The time from onset of symptoms until death ranges from three to 20 years. Yet most programmes for people with the disease and their caregivers and families focus on later stages, when cognitive and physical impairments are pronounced and often agonising, and the person with the disease can no longer discuss his or her condition.

A new awareness of early-stage possibilities has also spurred new research and treatments. According to some experts, the most radical change on the horizon may be diagnosing Alzheimer's before symptoms appear or when a patient has mild cognitive impairment, considered to be a precursor to the disease. Because no pharmaceutical treatments are effective for the disease's late stages, early diagnosis soon after the first appearance of symptoms is especially important.

The key to discovering and diagnosing early-stage AD is for family members to be observant -- but not to overreact and jump to the inappropriate conclusion that any significant change in a loved one's behaviour is a sign of the disease. There are many steps in the process of diagnosing Alzheimer's, including reviewing the family medical history, doing a physical exam to asses nutrition, vital signs, and organ disorders, running laboratory tests to rule out other disorders, and doing an in-depth psychiatric exam to rule out other causes of dementia. A GP will also evaluate the patient's mental status (testing for a sense of time and place as well as the ability to remember and to do simple calculations or spelling) and do a neurological exam for evidence of strokes, tumour, coordination and muscle tone. Many other illnesses, including depression, can resemble Alzheimer's, as can symptoms caused by harmful drug interactions.

Early diagnosis may lead to early treatment with some of the first moderately effective drugs (all prescription-only) such as donepezil (Aricept), rivastigmine (Exelon), and tacrine (Cognex), which are not cures, but may slow the progression of memory loss in some people. Focusing on the special needs of people with early-stage AD has also opened a world of possibilities for families. Early on, when impairment is mild, it's best to concentrate less on incapacity and more on what people can still do. People in the early stages of the disease can take advantage of recreational, social, educational, and vocational programmes. And support groups for both caregivers and care receivers go a long way toward keeping families functioning and intact.

Here are the most important steps experts recommend for coping with a diagnosis of early-stage AD:

•join a group -- in person or online -- for education and support.

•Help the person involved get his legal and financial affairs in order, including making a living will and granting power of attorney for health care and for finances. Talk with them about their health care wishes while they can still understand and reason, and use these discussions to guide future decisions. Organise financial documents such as birth certificates, insurance policies, retirement accounts, and social welfare information, and keep them all in one place.

•If she is still driving but you have concerns, talk with her doctor, who can order a regular driving test. This is especially difficult in the very early stages of the disease, when things are not black and white. If nothing else, place limits on driving distance, driving alone and at night, and so on.

•If he manages his own medications, count doses to see if proper amounts are being taken. A segmented pillbox will help monitor medication use. Make sure each medicine is necessary and that none are considered dangerous for persons with dementia (in particular, ask your GP about anticholinergics, insulin, or sedative-hypnotics).

•Automate as many functions as you can, such as cheque deposits and bill paying, but keep the person involved.

•Consider Meals-on-Wheels if the person with Alzheimer's is living alone and you are concerned about adequate nutrition.

•Try to talk to the person involved about long-term care plans, such as who she wants to manage her affairs and health decisions.

•Talk to the person's GP about clinical trials and discuss what range of early-stage programmes are available in your area.

•Help the person to continue pursuing friendships and interests and to participate in everyday activities as much as possible, or modifying those activities as needed.

-- Beth Witrogen McLeod is the author of Caregiving: The Spiritual Journey of Love, Loss, and Renewal (John Wiley &Sons, 1999), which was nominated for a Pulitzer Prize.

This article has been revised by Vhihealthe for its audience and may contain, among other things, information or medical practices that are unique to Ireland. Neither Consumer Health Interactive nor the original author make any warranty as to the accuracy of the article as revised, and assume no responsibility for modified content.

Further Resources

The Alzheimer Society of Ireland. Tel. 01 284 6030. Email: alzheim@iol.ie

First published April 3, 2002
Copyright © 2002 Consumer Health Interactive

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