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

MISDIAGNOSIS OF ALZHEIMER'S DISEASE CAN BE TRAGIC

Question: My grandfather got very senile in the last couple of years before he died. Now my mother, who is only 62, has me worried. She's been acting confused, nervous and forgetful lately, and sometimes at night she wanders around the house for no apparent reason. I'm worried that she might be getting Alzheimer's disease. What should I do?

Answer: The ability to learn, to remember and to handle complex mental tasks continues despite advancing age. Most older individuals notice that they don't think as fast as they once did, but that they still think as clearly. You can think of the slight slowing of thinking as the time it takes to find a piece of information in your filing cabinet. When you are young there aren't nearly as many papers in the cabinet as when you get older. Naturally, it takes a little longer to find any given bit of information in that bountiful collection.

Let me take a moment to explain about Alzheimer's disease for those who are not familiar with it. Alzheimer's disease is a progressive deterioration of the brain. The sufferer loses the most complex thinking abilities first: memory of recent events, the ability to handle complex matters like money management, and the ability to find his or her way around in unfamiliar places. As the deterioration progresses, the person frequently becomes confused, agitated and unrealistically suspicious of others. Roaming around without knowing where he or she is or what he or she is doing, particularly at night, is common. The ability to feed, clothe, and care for himself or herself eventually wains.

Individuals of any age can develop Alzheimer's, but it is more common in those over the age of 65 years. In individuals younger than 65, the disease tends to progress more rapidly, and there is definitely a hereditary tendency for this early onset form of the disease.

Your concern that your mother may have Alzheimer's is reasonable. Alzheimer's sufferers have a much shorter life expectancy than normal, and generally the deterioration is progressive ultimately requiring total 24-hour care before the end.

Question: What can be done for her?

Answer: The first step is to identify the cause of her problems. The symptoms of Alzheimer's are the same as those of other conditions which cause deterioration of the brain's functions. This is properly called "dementia," and Alzheimer's is actually called "primary degenerative dementia of the Alzheimer type." There is no test that proves Alzheimer's disease, so the diagnosis is made by excluding other possibilities. Even though it is time consuming and expensive to look for these other conditions, it is important because the other conditions require treatment that is different from that for Alzheimer's. Brain tumors, Huntington's Chorea, vitamin B12 deficiency, multi- infarct dementia and other conditions must be tested for. If no other cause is found for the dementia, the diagnosis of Alzheimer's disease is established beyond a reasonable doubt.

It's hard to stress too much just how important it is to test for diseases that can masquerade as Alzheimer's. Murray Goldstein, D.O., former director of the National Institute of Neurological Disorders and Stroke, put it this way, "The misdiagnosis of Alzheimer's disease is tragic, because we have treatments that can cure, or at least improve the outlook for, patients whose symptoms are due to one of these other conditions, but we have no such treatment for those suffering from Alzheimer's disease."

There are medications that may help with your mother's agitation and confusion, but they do not change the course of the disease. This demonstrates that medical science of 1996 is still incomplete. We have much to learn.

The care of a loved one with Alzheimer's is emotionally, physically and financially taxing. Talk with your doctor about support groups for you and agencies that can help you deal with this difficult situation.

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.