CHAPTER 13 Alzheimer’s Disease and Other Dementias
SOME OF YOU MAY FEAR GETTING Alzheimer’s disease, and it is useful to know the basic facts about this illness. Also, understanding the boundaries between mild memory loss and Alzheimer’s disease can help in developing your strategy to prevent memory loss.
Does Everyone Eventually Get Alzheimer’s Disease?
Several years ago, Denis Evans’s research group at Harvard conducted a survey in East Boston and found that literally half the people above the age of eighty met diagnostic criteria for Alzheimer’s disease. Their results suggested that Alzheimer’s disease, not memory loss due to aging, was the normal clinical course for people as they grew older. However, other investigators have since reported much lower rates of Alzheimer’s disease in octogenarians. As I discussed in an earlier chapter, if performance on cognitive tests is corrected for age and education, then few people meet criteria for dementia, or Alzheimer’s disease more specifically. But if absolute cutoff scores on cognitive tests are used to make the diagnosis without accounting for the impact of age or education, then a large proportion of elderly people will meet the diagnostic criteria for dementia, primarily Alzheimer’s disease.
When Did Ronald Reagan’s Alzheimer’s Begin?
During a deposition in 1990, President Ronald Reagan could not recall the name of the chairman of the Joint Chiefs of Staff. We now know that he went on to develop Alzheimer’s disease. Did he already have the disease at that time, or perhaps even earlier? While we will never know the answer definitively, his experience illustrates how Alzheimer’s disease often starts. In Reagan’s case it began with forgetting names, a common symptom of age-related memory loss. This is classic for
Alzheimer’s disease: in its very early phases, it is nearly impossible to distinguish it from memory loss solely due to the aging process, but over time, other symptoms develop. (Recall the case of Frieda Kohlberg, the seventy-four-year-old Holocaust survivor with a genius-level IQ whose only neuropsychological abnormality was a subtle deficit in recent memory; this was the first sign of Alzheimer’s disease.) But with all the new technology now at our disposal, isnt there a better, more accurate way to make an early diagnosis of Alzheimer’s disease?
Making an Early Diagnosis
The short answer is that no diagnostic test has been consistently proven to be better than a comprehensive neurological and psychiatric evaluation with careful history taking (increased age, low education are known risk factors), supplemented by a neuropsychological test battery, in making the diagnosis of Alzheimer’s disease. The long answer is that there are many promising tests, each of which may have some clinical utility.
Taken From: The Memory Program How to Prevent Memory Loss
and Enhance Memory Power
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