Alzheimer’s disease is the most common form of dementia. Older adults often live in fear of the diagnosis. One of the most difficult duties of a psychologist is to inform family members a loved one has Alzheimer’s disease. It is a death sentence without any firm termination. The condemned is blithely unaware, while the caretakers assume a huge burden.
There are many facets of this disease, and likely even more misconceptions. In my opinion, to call Alzheimer’s a “disease” is a misnomer. Normal aging includes erosion of the neocortex and hippocampal areas of the brain. Once the degree of cortical damage reaches roughly thirty percent, then the unlucky person exhibits symptoms of a senile dementia of the Alzheimer’s type. The professional literature abbreviates this as SDAT. The neurodegenerative changes are not unusual or pathological. If one lives to 80 years of age, without any cognitive impairment, they will still possess neuritic plaques and neurofibrillary tangles. This is an aspect of normal age-related cognitive decline. The presence of a pathological memory impairment is associated with the degree of cortical atrophy, not with some exogenous disease process.
By the age of 50, we all begin to have a reduced ability to find names for things, and difficulty recalling verbal information without some prompt or context. Many people call this the CRS Syndrome; alternately entitled “can’t remember sh–.” The differential diagnosis is the recognition memory of the person. Utilizing memory tests with a recognition component reduces the gulf between a 20 and a 90 year old. Another difference is called “source amnesia.” Your 85 year old father may forget to do a task, or forget that they had learned something, but will recall when prompted. In the early stages of a SDAT, the patient will sometimes remember verbal or visual information with a cue, yet be completely baffled as to where they acquired the information. In more advanced stages of a SDAT, one can teach these patients procedure rules. They can be taught a card game, for example, yet be totally amnestic as to who taught them the game, and will even deny they know anything about how to play the game.
Two early symptoms of SDAT that goes unnoticed is decreased social interest and poor planning ability. As the disease begins to take hold, the spouse of a dementia victim will almost always notice a decrease in their willingness to visit with friends and family. It is often misdiagnosed as a clinical depression or chronic fatigue. Even more subtle are deficits of planning. The sequencing of new behaviors to accomplish a goal is impaired even in the early stages. Many people confuse this with old routines acquired over a lifetime, which are extremely resistant to the disease. It is very apparent when on tries to have them plan something new, something they have not done before. While in training, a patient of mine was due to go home to live independently by themselves. I noticed his helplessness when trying to take apart and put together a broken electric shaver. He ignored all discharge planning to the exclusion of the shaver, which he could not put together after disassembling. This patient would have returned to the hospital within a month or two, dehydrated and malnourished. He did well at an ALF for many years.
The last subtle symptom of early SDAT is a lack of self-awareness. People who suffer with SDAT are not aware of their memory impairment, diminished social interest and poor planning. They always answer “fine” when questioned regarding their memory. Nearly all normal aging persons remark that their memory is terrible! I consider this to be an extremely important diagnostic indicator of a SDAT. If your 80 year old husband or wife maintains their memory is normal, and you notice some of the symptoms I’ve mentioned, then I would consider a consult with a neuropsychologist. Please leave your comments in the space provided below.