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Early
Diagnosis Key Weapon in Anti-Alzheimer's Arsenal
November is Alzheimer's Awareness Month
Alzheimer's disease, a progressive degenerative disease of the
brain for which there is currently no cure, affects approximately
4 million Americans. Experts predict that by the year 2050,
more than 14 million people nationwide will suffer from the
disease. In Massachusetts, there are an estimated 130,000 people
with Alzheimer's disease or a related neurological impairment,
and 1 in 10 people has a family member with the disease or a
related disorder.
Detecting Alzheimer's
"While not all forms of dementia are Alzheimer's disease, physicians
should be aware of the 10 warning signs that may indicate onset
of the disease," said Janet Jankowiak, M.D., a geriatric neurologist
at the Jewish Memorial Hospital in Boston and vice chair of
the MMS Committee on Geriatric Medicine. Symptoms include
- Memory loss that affects job skills
- Difficulty performing familiar tasks
- Disorientation to time and place
- Poor or decreased judgment
- Problems with abstract thinking
- Changes in mood or behavior
According to the recent evidence-based guidelines for the detection,
diagnosis, and management of dementia published by the American
Academy of Neurology, routine evaluation of demented patients
should include a screening for depression, thyroid function,
and serum B12.
If cognitive impairment is suspected, patients should be screened
for dementia by a Mini-Mental State Exam, adjusted for age and
education, a Memory Impairment Screen, and/or formal neuropsychological
batteries. Structural neuroimaging with either a noncontrast
CT or MRI is also appropriate in the initial evaluation.
Patients should see a neurologist if they have an atypical presentation
or any neurological signs or symptoms such as gait or eye movement
abnormalities or focal neurological findings.
"Early diagnosis remains one of the strongest weapons against
Alzheimer's disease," said Dr. Jankowiak.
Starting early treatment with cholinesterase inhibitors may
improve cognitive functions, such as memory and reasoning, as
well as overall quality of life. Vitamin E may also slow the
progression of the disease. Strategies to improve functional
performance and reduce behavioral problems include behavior
management, scheduled toileting, playing soothing music, and
walking.
Support for Patients and Families
Once a patient is diagnosed with Alzheimer's, it is important
that both the patient and the family be referred to appropriate
support, because the disease affects not only the patient, but
those who care for him or her as well.
Primary caregivers should be encouraged to find out more about
the disease, avoid isolation, and seek support from family,
friends, and professionals. The Massachusetts Chapter of the
Alzheimer's Association offers an array of services, including
educational programs for patients, family, and professional
care providers; support groups for family members and groups
for early-stage patients; and a program to prevent and search
for "wanderers."
A telephone helpline, (800) 548-2111, provides counseling and
referrals to community services.
"Recent studies have shown that when family members learn the
techniques of rehabilitative care and are emotionally supported
in these efforts, patients have fewer psychiatric symptoms and
remain in the community longer," says Paul Raia, Ph.D., director
of Patient Care and Family Support for the Alzheimer's Association,
Massachusetts Chapter.
– Eileen Mongeau
For more information and the evidence-
based guidelines, visit the American Academy of Neurology's
website at www.aan.com. The
Alzheimer's Association, Massachusetts Chapter, can be reached
at www.alzmass.org or (800) 548-2111.
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