10 Warning Signs of Alzheimer's

When I started my medical career, you couldn't get 10 people together in a room to talk about Alzheimer's Disease.  Most people didn't know what it was.  The term "senility" was still in common use and poorly understood.  Now, the term "Alzheimer's" is almost thrown about casually and used anytime someone has a "Senior Moment".  Do you know what the real symptoms are?  It is now one of the most commonly made diagnoses for older adults, but it's not always made using a systematic method and other causes of memory loss and behavior problems are often overlooked.  The Alzheimer's Association (www.alz.org) has a new initiative to educate people about the 10 Warning Signs of Alzheimer's along with a checklist for people to fill out and take with them to the doctor.  Since there is no laboratory or X-ray test that confirms the diagnosis of Alzheimer's Disease, the history of symptoms becomes one of the most important diagnostic tools for the doctor.  Although the doctor will probably order a panel of lab work and perhaps brain imaging, the primary purpose behind the testing will be to eliminate other causes of disease that could explain the symptoms.  Examples of some other conditions that can mimic Alzheimer's Disease are multiple, small strokes, serious depression, normal pressure hydrocephalus (an accumulation of fluid in the brain), malnutrition and certain other degenerative brain diseases.  Here are the 10 Warning Signs along with some of my own comments regarding clinical aspects of the disease.

1. Memory changes that disrupt daily life.  That's not just forgetting why you went in a room.  It's increasing reliance on memory aids or other people to remember things for you.  It's typical to forget names and appointments but remember them later.
2. Challenges in planning or solving problems.  This is sometimes referred to as executive function; making decisions, paying bills and other number related tasks, making and following plans.  It's typical to make errors in math and organization skills; most of us have done that most of our lives.  However, the errors become more prominent and eventually debilitating.
3. Difficulty completing familiar tasks at home,at work or at leisure.  Even familiar tasks with a sequence of steps can become baffling and overwhelming, sometimes causing people to withdraw from family, friends and familiar settings.  It's typical to need help with some of the newer technological challenges like microwave ovens, cell phones and computers.
4. Confusion with time or place.  Losing track of dates, seasons and even the current year may become a problem.  People afflicted with the disease live very much in the moment and may not realize where they are or how they got there.  It's typical to get confused momentarily but figure things out later.  Even though it's typical, it's frightening and may start a cascade of events that cause a loss of self-confidence and depression.
5. Trouble understanding visual images and spatial relationships.  This could include difficulty reading and even a loss of interest in reading.  It may also cause problems with judging distance, determining color or contrast or recognizing their own reflection in a mirror.  It's typical to have visual changes related to cataracts, macular degeneration and other age related eye conditions.
6.  New problems with words in speaking or writing.  There may be trouble following or joining a conversation, getting lost in a conversation or repeating themselves.  Familiar vocabulary may be hard to produce and they may call objects by the wrong name.  Writing may become scrawling and disorganized.  It's typical to have some word finding difficulty, but the word can usually be retrieved after awhile.
7. Misplacing things and losing the ability to retrace steps.  Losing objects or placing them in unusual places (clothing in the refrigerator for example) may occur along with the inability to think back about what actually happened.  It's common to accuse other people of stealing when they can't find objects and gradually they become more "absent-minded".  It's typical to misplace things and then find them when you retrace your steps.
8. Decreased or poor judgment.  Those with Alzheimer's may develop poor judgment when dealing with money and personal relationships.  Being an easy mark for con artists, telemarketers and sweepstakes offers  happens frequently.  Also, becoming calloused, angry or indifferent toward people they have been close to may also occur.  It's typical to make bad decisions that you may regret.
9. Withdrawal from work or social activities.  Because of some of the changes described above, Alzheimer's patients may withdraw from hobbies, social activities, work or sports.  Remembering how to compete or carry out the steps of a hobby can become daunting.  It's typical to become weary of work, family and social obligations and feel that you need to scale back.
10. Changes in mood and personality.  Personality change is one of the true hallmarks of a dementing illness.  Classic changes include ongoing confusion, being suspicious or paranoid, becoming depressed, fearful or anxious. They may strike out at those close to them and develop misperceptions about things going on around them.  It's typical to have specific ways of doing things and becoming irritable when a routine is disrupted.  For more information, go to www.alz.org/10signs or call 877-IS IT ALZ (877-474-8259).