The usual way of arriving at a tentative diagnosis of "probable" Alzheimer's is by ruling out other dementia-causing conditions that can be spotted (and, in some cases, treated) - by lab tests, brain scans, and other diagnostic procedures. When all the tests and scans come back negative (i.e., no tumors, strokes, vitamin deficiencies, medication overdoses, depression, alcohol or drug abuse, thyroid problems, Parkinson's Disease, Huntington's Disease), what's left is called "probable" or "possible" Alzheimer's if the person's symptoms appear gradually, the behavior pattern and loss of abilities are consistent with known Alzheimer's Disease behavior, and the condition gets progressively worse over time.
Should you worry about Alzheimer's if you misplace your keys, can't find your car in a parking lot, or forget to turn the oven off? If you're over 60, as I am, you probably will worry, though a man or woman of 30 would attribute these memory lapses to being absent-minded, busy, or stressed. Most people forget and lose things all the time. When should you start worrying? The rule of thumb is that when the forgetting and losing things begin to interfere with the competent and independent handling of your life tasks - job, family and household duties, financial responsibilities, community and social obligations - it might be a good time to schedule a diagnostic evaluation.
Here are some scenarios based on the experiences of real people who did end up with a diagnosis of probable Alzheimer's:
- A 55 year-old man, formerly a top-performing sales manager of a car dealership, has recently missed a number of appointments and has fallen behind in his paperwork. His company referred him to counseling for suspected depression and for stress management training, but his work performance has not improved. Diagnosis: probable Alzheimer's.
- A neighbor of an 85-year-old woman who lives alone and still drives her car, telephoned the woman's daughter to report that she saw the woman's mother leave for the grocery store four or five hours ago and that she hadn't returned. The daughter quickly drove to her mother's favorite supermarket and found her wandering around in the parking lot in a confused and agitated state. The frozen food items in her grocery bags were thawed and dripping, indicating she'd been out there for several hours. When the daughter brought her home, she found the refrigerator empty, stacks of unwashed dishes in the sink, and dirty laundry strewn about. Her mother had always been a meticulous housekeeper. Diagnosis: probable Alzheimer's.
- A retired dietitian and homemaker, known for the originality and variety of her gourmet meals, has served chicken and potatoes, baked in the toaster oven, and canned green beans, three or four times a week for the past several weeks. When asked about it, she snaps at her husband and claims that she has been very busy, and suggests that he take over the cooking. Diagnosis: probable Alzheimer's Disease.
The above scenarios illustrate some early-stage symptoms and behaviors. Other common symptoms are forgetting the names of things, trouble remembering recent events and the names of people - even old friends - and learning new information, such as a change of address or phone number or the name of a new doctor. Most early stage patients cannot keep track of the current date and year or the date and time of appointments. They may get lost or disoriented when away from home. The ability to read is preserved, but the rapid forgetting that occurs makes the activity generally unsatisfying. Most can carry on a coherent one-to-one conversation, but will get lost in a complex discussion, particularly if several people are involved. The net result of this constellation of symptoms is a loss of confidence and a withdrawal from former activities and relationships. Persons at this early stage will most certainly benefit from an exercise program from the standpoint of enhancing social stimulation, particularly if provided one-on-one or in a small, supportive group setting.
Persons in the moderate stage of Alzheimer's Disease will experience a worsening of the above-mentioned symptoms. In addition, they may no longer be able to comprehend or respond appropriately to conversation directed at them. They may no longer consistently identify their spouse or children, though they will recognize them as someone close to and loved by them. Confusing spouses with long-deceased parents, or children with siblings is very common. They may become suspicious, accusing a son or daughter-in-law, or long-trusted household worker of stealing their belongings or their spouse of being unfaithful. Frustration engendered by their failing abilities may trigger outbreaks of aggressive behavior. Wandering and sleep disturbances may occur and ability to dress, bathe, shampoo, and brush teeth independently may be lost. There may be occasional incontinence, made more difficult to manage by patient resistance to wearing absorbent products.
Many persons with moderate and moderate-to-severe symptoms remain at home with help from hired part-time caregivers and the use of adult day care centers. Patients at this level are excellent candidates for an exercise program. If your care recipient attends a day care center, insist that he or she include regular exercise in their daily programming. If you have hired help in the home, ask them to take the person for brisk walks and engage them in regular exercise.
Persons in the severe stage of dementia are unable to communicate or recognize family members, may have difficulty swallowing, are incontinent and incapable of any self-care activities, and may be bedridden much of the time. They typically do respond to music, touch, a doll or stuffed animal, the affection of a dog or cat. Any movement they can be encouraged to make will be beneficial to their cardiorespiratory systems and reduce the likelihood of pressure sores and other infections.