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Alzheimer's Disease: When Is Memory Loss or Mental Confusion Cause for Concern?

November 06, 2012

Have you ever forgotten where you left your reading glasses? Do you sometimes have trouble remembering where you parked the car at the airport or shopping mall? When your credit card company representative asks for the last four digits of your Social Security number, do you ever have to recount the entire nine-digit sequence in your head before responding with the appropriate four numbers?

With normal aging, everyone's thinking processes slow down a bit. Increasingly frequent memory lapses, difficulty in concentrating on daily tasks or trouble in following conversations, however, may be signs of Alzheimer's disease.

"Alzheimer's disease is a type of dementia, which includes a broad range of disorders caused by damage to the nerve cells in the brain," says Dr. Charan Singh, a board-certified neurologist on the medical staff at Washington Hospital specializing in Alzheimer's, dementia, Parkinson's disease, stroke and headaches.

"The damage interferes with the nerve cells' ability to communicate with each other, causing problems with learning and memory that can have a serious impact on the person's everyday life," she explains. "There are other causes of dementia, and in the early stages it is hard to distinguish Alzheimer's from other forms of dementia. Alzheimer's is the most common type of dementia, though, and it is more rapidly progressive than other forms."

In recognition of National Alzheimer's Disease Awareness Month in November, Washington Hospital is sponsoring a free seminar featuring Dr. Singh to help people in the community learn more about the disease. The seminar is scheduled for Tuesday, November 13 from 1 to 3 p.m. in the Conrad E. Anderson, M.D. Auditorium at 2500 Mowry Avenue in Fremont.

Early signs of Alzheimer's can include trouble remembering newly learned information and carrying on coherent conversations. As the disease progresses, the person may become disoriented - even in familiar settings - and might lose interest in social activities and experience personality and behavioral changes such as anxiety, suspiciousness, agitation, delusions or hallucinations. People in late stages of the disease may need help with basic functions of daily living such as dressing, eating and personal hygiene.

Risk Factors for Alzheimer's

The main risk factor for developing Alzheimer's is aging. According to the Alzheimer's Association, of the 5.4 million Americans living with the disease, 5.2 million are over the age of 65. Nearly half of Americans over age 85 have the disease.

"With aging, people begin accumulating protein deposits - called plaques - between the nerve cells in the brain," says Dr. Singh. "We also develop 'tangles' within the nerve cells. Those plaques and tangles are believed to play a role in blocking communication among the nerve cells. People with Alzheimer's tend to develop far more plaques and tangles, beginning in specific areas of the brain related to memory before spreading to other parts of the brain."

A family history of Alzheimer's increases a person's risk for developing the disease. People who have a first-degree relative - parent, brother, sister or child - with Alzheimer's are more likely to develop the disease. Having more than one family member with the disease further increases the risk.

Other factors that may contribute to developing Alzheimer's include serious head injury, high blood pressure, high cholesterol, smoking, diabetes and obesity. Physical and mental inactivity also may play a role.

"There's an old saying that goes, 'If you don't use it, you lose it,' and that applies to the brain as well as the body," Dr. Singh says. "That's why we try to educate patients and their families on the importance of keeping mentally and socially active, as well as the importance of exercise and a healthy diet."

Evaluation and Treatment

Anyone experiencing signs of Alzheimer's should seek an evaluation. That includes people under age 65, since nearly 4 percent of Americans with Alzheimer's experienced early onset of the disease in their 40s, 50s or early 60s.
Diagnosis usually involves taking a complete medical and family history, performing a thorough medical examination and conducting cognitive screening tests to assess memory and brain function.

"Unfortunately, the only definitive way to see the plaques and tangles in the brain that would confirm a diagnosis of Alzheimer's is through an autopsy, which obviously is not possible," Dr. Singh notes. "Nevertheless, imaging tests of the brain with MRI or CT scans, along with blood tests, may provide additional information to help with diagnosis."

While there currently is no cure for Alzheimer's disease, medications called cholinesterase inhibitors may help slow the breakdown of chemicals in the brain that are necessary for transmission of information between nerve cells.

"There are several medications that have been shown to delay the progression of dementia by up to 30 percent and have helped delay patients' placement in nursing homes by two to three years," says Dr. Singh. "These medications also can help with changes in behavior. Certain drugs used to treat other illnesses such as depression may sometimes help with emotional and behavioral symptoms of Alzheimer's."

Another important aspect of treatment is providing supportive care to help patients and their families deal with the often-devastating effects of Alzheimer's disease. Many people with Alzheimer's live at home, with care provided by family and friends. The Alzheimer's Association reports that in 2011, 15.2 million family members and friends provided care to people with Alzheimer's and other dementias. More than 60 percent of those caregivers rated the emotional stress of caregiving as high or very high.

Washington Hospital offers the Alzheimer's/Caregivers Support Group for family members and other caretakers of people with Alzheimer's. The group, which is always open to new members, meets the last Wednesday of each month from 7 to 9 p.m. in the Conrad E. Anderson M.D. Auditorium. The next meeting is November 28. Another resource is the Family Caregiver Alliance, which offers referrals to community resources such as daycare, support groups and homecare services.

"I strongly believe that caregivers need more help and support," Dr. Singh emphasizes. "Alzheimer's disease actually doesn't shorten the patient's lifespan by a substantial amount, so it can be a heavy and lengthy burden on caregivers."

To register for the seminar on November 13, visit www.whhs.com and click on "Upcoming Seminars." For more information about Washington Hospital's Alzheimer's/Caregiver's Support Group, call HealthConnection at 800-963-7070. Information about the Family Caregiver Alliance is available at www.caregiver.org. For additional information on Alzheimer's disease, visit the Web site for the Alzheimer's Association at www.alz.org.

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