June is Alzheimer’s and Brain Awareness Month, a fitting time to consider the complexities of having, diagnosing and treating cognitive disorders. Dementia has different causes, the most common being Alzheimer's disease, a progressive condition in which neurons stop functioning appropriately, causing lapses in memory and changes in the way a person thinks, makes judgements, communicates and behaves. In the early stages of Alzheimer’s, the main symptom is typically forgetfulness. Of course, a certain amount of forgetfulness is associated with the normal process of aging, but with Alzheimer’s, it may accompany other problems, such as changes in understanding, communicating and behaving, even shifts in personality. It can wreak havoc on a person’s mood, sleep patterns, capacity to manage normal tasks, properly assess risk and make sound judgements. It can also disable one’s motor functions. In advanced stages, Alzheimer’s can render a person unable to care for themselves.
There is no cure for Alzheimer’s, but in many cases prescription medication and interventional treatments can delay its progression and help manage symptoms. However, not all cognitive decline is Alzheimer’s disease, and not all cases can be treated using the same medication and therapies. In some cases, minor impairment may be owed to something as commonplace as a thyroid disorder or vitamin B-12 deficiency. In others, it may be caused by a vascular or frontotemporal disease. Therefore, the best possible treatment and management of cognitive decline begins with discovering the correct cause so the right treatment can be devised and implemented.
Diagnosing Alzheimer’s Disease
Unfortunately, there is no single designated test to diagnose Alzheimer's, but there are state-of-the-art imaging tests that can be used to rule out other causes of dementia. This is important, because an estimated 20% of people diagnosed with Alzheimer’s actually have another form of dementia, whose causes can include stroke and ischemia, brain tumor, subdural hematoma (bleeding near the surface of the brain), cortical atrophy (degeneration of the brain's cortex), changes to blood vessels or hydrocephalus (excess fluid in the brain). When the cause of dementia is incorrectly diagnosed, it can lead to ineffective treatment, sometimes allowing the disease to progress further than it might if properly addressed. Combined with a detailed accounting of one’s medical history and a physical and neurological exam, brain imaging tests can be used to assess other possible causes. Radiology Associates’ team of board-certified neuroradiologists subspecialize in interpreting highly sophisticated imaging techniques used to examine the brain, including:
Computed tomography (CT) – this quick, painless scan combines advanced x-ray technology to produce multiple images that are sent to a computer to form a nearly 3-D image of the brain. CT can discover other causes of dementia and rule out Alzheimer’s.
Magnetic resonance imaging (MRI) – head MRI uses a powerful magnetic field, radio waves and a computer to create detailed pictures of brain abnormalities associated with mild cognitive impairment. MRI can be used to assess whether or not this mild impairment may progress into Alzheimer's disease, and monitor its development.
PET/CT - Combining positron emission tomography (PET) and computed tomography (CT) provides information about both the function and anatomy of the brain in a single scan. PET/CT imaging can help differentiate Alzheimer's disease from other types of dementia.
Knowing the cause of cognitive decline promotes the best chance for the right treatment. And although Alzheimer’s disease can be a rather dire diagnosis, when caught in the early stages, its effects can often be delayed and managed, improving quality of life. “So often, a fear of knowing causes patients to delay seeing their doctor,” says diagnostic and interventional neuroradiology subspecialist Dr. David B. Turetsky. “But discovering the cause of impairment before it advances offers the best chance of effective treatment, which can make a big difference in one’s life going forward.”
Don’t Delay Reporting Symptoms to Your Doctor
Sure, memory issues are a common part of aging, and few among us want to admit that we’re not thinking as clearly as we once did. These sentiments tend to cause people to underreport their own or a loved one’s cognitive decline. Symptoms are often so gradual that they go unnoticed, and extensive efforts are often made to conceal lapses in memory or judgement. This can leave dementia undiagnosed for too long, leaving people more vulnerable to its effects. Figuring out the cause and type of dementia early in its course can lead to the proper medication and other therapies that can reduce the problems associated with it, so see your doctor as soon as you or a loved one begins to show signs of memory loss, behavioral changes, noticeable shifts in mood, or other symptoms of changes in brain function.
Signs of Alzheimer’s Disease
Who hasn’t walked into a room only to realize they didn’t remember what they intended to do there? Some brain lapses can be caused by simple distraction, but as we age, this type of thing can become more and more common. Certain warning signs, in you or in a loved one, should have you making an appointment with your physician sooner rather than later:
Noticeable memory loss. Short-term memory issues are often dismissed as just plain “old age,” but when short-term memory loss becomes commonplace, it should be taken seriously. If you or a loved one are repeatedly losing or misplacing things, forgetting important names, or forgetting big things, like to unload groceries from the car, don’t dismiss it as nothing. As with nearly all health issues, early detection is the key to optimal treatment.
Diminished reasoning. People with Alzheimer’s often see a decline in their ability to judge things appropriately, make shrewd decisions, solve problems and perform as they once did. They may lose track of time, or inaccurately assess how much time has passed. This change in ability to reason can leave people more vulnerable to accidents, rash decisions and scams.
Personality shifts. Apathy, depression, irritability, pronounced stubbornness, hostility, even aggression, are common signs of Alzheimer’s. So, too, are changes in sleep patterns, weight gain or loss, and chronic fatigue. Of course, these can be signs of other problems, too – which is why medical attention is so important. Unexplained changes in mood, habits or personality should be checked out by your doctor.
Changes in understanding. As it advances, Alzheimer’s can cause a string of disabilities, including changes in one’s ability to speak, write, read or understand what people are saying. It can affect only one type of understanding or several. It can affect perception, causing people to become clumsy, or to have trouble correctly identifying everyday noises or conditions. In advanced cases, people may not recognize the faces of loved ones – or even their own reflection in the mirror. Motor function is often affected, rendering people unable to perform everyday hand movements, walk, even chew.
Changes in behavior – Alzheimer’s can include sometimes dramatic changes in one’s behavior, inviting uncharacteristic anger, use of foul language, getting lost in familiar surroundings, engaging in inappropriate or risky behaviors, refusing assistance, eating strange things, and other problems. It may cause a strong overreaction to minor issues: crying, shouting, even lashing out, over something relatively unimportant. Some people go on to develop psychosis, which invites sporadic and recurrent delusions and visual and/or auditory hallucinations.
Sundowning – For reasons yet undetermined, many behavioral issues caused by Alzheimer’s disease tend to get worse in the late afternoon/evening. It may be due to increased weariness as the day goes on, which may enhance the severity of symptoms.
Imaging tests can identify changes in the brain's structure and function, including atrophy, stroke damage, ischemia, metabolic changes, oxygen metabolism, blood flow, neuronal activity, the presence of amyloid proteins and other elements that signify specific reasons for cognitive decline.
When warning signs of cognitive decline appear, it's important to get a quick and accurate diagnosis to rule out other possible causes, distinguish between the different types of brain disease and disorder, and establish a baseline so further degeneration can be measured and the effectiveness of treatment can be monitored.
Medication and specific interventions can help ease the symptoms and progression of Alzheimer’s and other causes of cognitive decline, so don’t wait. If you or a loved one has symptoms of cognitive impairment, no matter how subtle, talk to your doctor. With the proper diagnosis and treatment, the future could look a whole lot more promising.