It may seem to you that I spend an inordinate amount of time talking about Alzheimer’s disease.  That could be true but it is still one of the most misunderstood conditions associated with aging.  In June I told you about the Alzheimer’s Association initiative to educate people about the 10 Warning Signs of Alzheimer’s.  Here is just a quick review of those 10 Signs:

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems.
3. Difficulty completing familiar tasks at home, at work or at leisure.
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps.
8. Decreased or poor judgment.
9. Withdrawal from work or social activities.
10. Changes in mood or personality.

While it is true that the incidence of the disease increases with age, it is not normal to experience these changes just because you get older.  I also mentioned previously that the Alzheimer’s Association has a checklist to fill out and take with you if you are concerned about memory loss for yourself or a loved one.  As a lay person you might assume that all doctors have the same level of knowledge about Alzheimer’s disease and feel the same level of comfort in making the diagnosis.  That’s not true at all.  Some younger doctors have had this information included in their schooling and some haven’t.  Some older doctors have taken the trouble to educate themselves about causes of memory loss and some haven’t.  Some neurologists have expertise in making the diagnosis and the patience to work with patients and families who receive the diagnosis; and some don’t.  Geriatricians probably have the most experience in diagnosing and treating Alzheimer’s patients but they tend to be few and far between.  Family Practitioners, General Internists, Neurologists, Psychiatrists and Psychologists will be called upon most often to address the symptoms associated with the disease.  A diagnosis of Alzheimer’s must be done in a systematic fashion and other medical conditions ruled out that could be causing symptoms that mimic the disease.  These days most doctors are under pressure to see a large volume of patients and don’t have a lot of time to devote to focusing on memory loss complaints.  Sorting out all the information needed to make an accurate diagnosis is time consuming and can be very frustrating for the doctor, the patient and the caregivers.  There also tends to be a lot of emotional turmoil surrounding this kind of symptom complex and all the parties involved may feel shortchanged by the typical office visit.  Additionally, the person with Alzheimer’s may have adequate social skills to mask the true depth of their memory and functional problems in a 15 minute encounter.  Just as commonly, the patient’s spouse or caregiver may have learned to compensate for their lapses in memory and judgment and be unwilling or unable to see what’s happening. 

I’ll not try to reproduce the entire list that you need to fill out before seeing your doctor but I would strongly encourage you click on this link  http://www.alz.org/national/documents/ED_doc_checklist-030609.pdf  to view and print the list or visit your local Alzheimer’s Association office to obtain the form.  You can also call 1 800 272 3900 you don’t use a computer or have a local branch of the organization.  Although it’s not mentioned in the Alzheimer’s Association website, I’d encourage you to make an appointment that specifies you want the doctor to evaluate memory problems.  Don’t bring it up just casually during a visit for something else and expect it to get the kind of time and attention it needs.  And please don’t ask your doctor not to share their conclusions with the patient.  It violates ethical standards and places a “secrecy burden” on all the parties involved.  Whether you use the form the Alzheimer’s Association recommends or create your own, here’s the essence of what the doctor needs to know:

• Has health, memory or mood changed?  If so, how has it changed?  How long has it been noticeable?  How frequent is it?  Is there a pattern to it (a particular place, time of day, etc.)?
• What behaviors have changed and how do you respond to the changes?
• Do you have problems with
  • Repeating the same thing over and over
  • Remembering appointments, family occasions, holidays
  • Writing checks, paying bills, handling finances
  • Shopping independently
  • Taking medications according to instruction
  • Getting lost while walking or driving in familiar places
• Make a list of your medical conditions/surgeries, medications and over the counter products if you don’t think your doctor already has that information in your chart.
• You may also want to inquire whether your doctor will make the diagnosis or will be referring you to a specialist; what other conditions could explain your symptoms, if your medications could be a factor and, if there is a diagnosis of Alzheimer’s, how you or your family can best educate themselves about the typical course of the illness, available treatments and how to plan for your future.