Pills for Cheap

Because no technological advance has enabled us to see into the brain to prove that Alzheimer’s disease (or multi-infarct dementia) is there, experts estimate that an alarming 20 to 30 percent of the time people are wrongly diagnosed as having dementia when they actually have a treatable disease. Doctors may leap to a diagnosis of dementia in an older patient because they are conditioned to think that old age equals senility and are not skilled enough (or willing) to do the fine-grained testing needed to judge whether a dementing illness really does exist. The diagnosis of Alzheimer’s disease is made by exclusion, after a full medical and psychological evaluation has been done and when every other explanation for mental changes has been ruled out. Proof can be obtained only by autopsy, when the brain is examined directly. A surprising number of reversible conditions can look like Alzheimer’s disease.

Depression. On the surface, depression seems to have nothing in common with dementia. How can an emotional disorder look like pathology of the intellect? The reason is that a cardinal symptom of depression is intellectual change – cloudy thinking, problems in focusing, trouble in remembering what is going on. Unfortunately, these intellectual changes often appear in depressed older people without the gloomy attitude that cues doctors to depression – making the two illnesses sometimes very difficult to distinguish.

Physical illnesses. Because being sick almost always clouds our thinking, practically any illness can potentially be mistaken for dementia – the flu, an earache, even a bad cold. However, these illnesses in particular can produce the chronic mental confusion that makes a false diagnosis a special risk: metabolic problems such as thyroid dysfunction, kidney failure, Addison’s disease, hypoglycemia; cancer of the lung, breast, or other tissues; neurological disorders such as brain tumors, Parkinsonism, meningitis; and kidney and bladder infections.

Memory problems mislabeled dementia may occur after surgery, following an accident, or even from lying in bed for a few weeks. A person who is profoundly deaf may appear demented. If you ask your ninety-year-old mother a question and she stares blankly at you, it is surprisingly hard to tell whether the problem is her ears or her mind. A heart attack can be misdiagnosed as dementia too. Among the elderly, about 13 percent of the time mental confusion is its main or only symptom.

Medications. Medicines can impair thinking in people of any age. But drug-induced mental confusion is much more likely in later life, because our body metabolizes medications less effectively and we are more likely to be taking several types of drugs regularly.

People who take L-dopa, steroids, gentamicin, digitalis, antihypertensive medications, or tranquilizers are at special risk of being misdiagnosed as demented, because high doses of these drugs in particular produce symptoms that can look very much like Alzheimer’s disease. A poignant 1985 study involving the tranquilizer Valium amply demonstrates this. When researchers gave normal older people ten milligrams of Valium – a dose that, while large, is within the range a doctor might prescribe – they had problems on a memory test that were very similar to those of a comparison group suffering from Alzheimer’s disease.

Delirium is the medical term for the mental confusion many drugs and diseases cause. A person who rapidly becomes very confused and disoriented – within a few hours or days – is usually suffering from delirium. The hallmark of dementia is slow progression. Although people with dementia do vary in how well they can think on different days, when someone becomes delirious the shifts are dramatic – a rational human being is there one hour, the next a madman appears. And the delirious person may really look mad – perhaps seeing things on the wall or babbling incoherently. If you witness this type of transformation, get medical help immediately. The person may have a life-threatening problem or one that can cause permanent brain damage if not treated right away.

*125/159/5*

GENERAL HEALTH

Finding a genetic marker for Alzheimer’s disease brings us a step closer to developing a test to tell what a person’s chances are of getting this terrible disease. However, because scientists are just beginning to unravel the genetic determinants of the illness, this test may be years away. Statistics must suffice to answer that anxious question, ”How likely am I to get Alzheimer’s disease?”

If you have a strong family history – if several close family members developed the disease unusually early, before sixty or so – you do run a real risk. Otherwise the statistics are very comforting. Your chance of developing Alzheimer’s disease (or any other form of dementia) is small, at least until advanced old age. Alzheimer’s disease (and other old-age dementias) is illness of very late life – extremely rare before age sixty, uncommon but rising gradually in prevalence over the next two decades. Real vulnerability begins in the mid-eighties, when a significant minority of people does have serious memory problems. However, even among people hardy enough in body to live to one hundred, many survive sound in mind.

Interpret these statistics cautiously; the proportion of people with memory problems at each age varies greatly depending on the study we pick. The reason is not necessarily that older people in Japan are less (or more) prone to senility than residents of New York State but that the criteria for judging problems differ from survey to survey. And even some people diagnosed as having severe memory problems do not have dementia. They may have a treatable condition or even no intellectual deficit at all.

*124/159/5*

GENERAL HEALTH