ALZHEIMER’S DISEASE: GETTING AN ACCURATE DIAGNOSIS

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
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Posted on Tuesday, June 1st, 2010 at 11:46 am and is filed under General health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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