Tuesday, March 25, 2014

Alzheimer's Disease: Differentiating Dementia From Normal Memory Loss

As we age we are susceptible to increasing illness and eventually death. Perhaps the most feared illness is descending into Alzheimers's disease. By the age of 85 it is estimated that half of all Americans would have evidence of this condition. Fears have increased as news of the disorder spreads. The death of Ronald Reagan with Alzheimer's Disease emphasized our vulnerability and helped bring the disorder into greater public view.

Cliff, a spry 67 year-old man, was referred to me to help him overcome a belief that he was developing a rapid and early onset of Alzheimer's disease. He first noticed his condition about six months ago and it had progressed to its current more "advanced" stage. He had become depressed as he perceived that his memory was rapidly declining despite psychological tests and a neurological clinical evaluation that said he was normal for his age. He had become obsessed with the fear of his descent into the Alzheimer abyss, as he put it. "My memory is so bad, I know that it is the beginning of Alzheimer's, no matter what anyone has told me to the contrary."

He was afraid that losing his memory would cause him to lose control of his life. He worried about his declining memory's impact on his day's activities, the effect on his family, especially his wife and his fear of having a shortened life span. He gave me many examples of things he forgets to do, how he continued to misplace objects and forget appointments. "No matter what tricks I use I always forget where I put my keys."

I performed a few clinical tests that clarified that his memory was fully intact, which I immediately told Cliff. Such tests are simple to perform as illustrated:

• I asked Cliff to elaborate on something I had told him ten minutes earlier to determine if he remembered the subject and our previous discussion.

• I asked him to see if my memory was intact by seeing if I could repeat five to seven digits that he would give me. I deliberately made one mistake to see if he caught it. It would immediately be apparent if he knew my error since he would have had to also recall the numbers.

• I reversed the procedure and asked him to repeat a different series of numbers that I gave him.

• I gave him a series of nouns and told him to remember them since I would ask him to recall them later.

Advanced testing:

If anxiety interfered with the testing and if further reassurance was needed that he was not becoming senile, I performed an additional test to show him the intactness of his memory.

I gave Cliff a list of commonly known numbers, such as Social Security, license plate, telephone number, driver's license, telephone number of best friend, business telephone, etc and asked him to select one so I could check his memory of the numbers backwards. That tested both his recall of the list and also his selection of a memorized number that he should know perfectly. Whatever he picked out I knew his memory had to be fairly intact, otherwise he would not have remembered the list.

Also, repeating a well-known number backwards is normally not difficult, but it does require an intact memory. I again reassured him that my objective appraisal indicated that his memory was normal.

If the testing indicated a real possibility of mental decline there would have been a need of further testing of brain function, either performed by a neurologist or geriatric specialist.

You can use these tests to evaluate your own fears of losing your memory. Although Alzheimer's disease becomes fairly common when we reach our eighties many people live into their nineties and beyond with intact brain functions. Your objective is to live as well as possible based on your actual mental state.

No comments:

Post a Comment