Alzheimer’s Diagnosis Should Be Made After Considering Other Causes for Memory Problems
A colleague of mine has, from time to time, stopped in my office to chat about her father. I'm the "office expert," when it comes to caregiving woes. As I've listened to her talk about her experiences with her father, a couple of times I've said, "Are you sure he has Alzheimer's disease?"
She'd say, "That's what the doctor says."
I've written before about the fact that I think too many general physicians just assign the word Alzheimer's to someone who shows signs of dementia. I always tell people who ask for my thoughts that they need to see a specialist who understands the difference between Alzheimer's, other dementias, and other possible causes for the symptoms.
It's possible that medications are the problem - either the wrong medications, too many medications or drug interactions. The memory problems could be from alcohol or prescription drug abuse, vitamin B12 deficiency, depression or any number of other things. It's also possible, as in my friend's case, that it's a form of dementia other than Alzheimer's and may need different treatment.
A video report on channel3000.com titled," Alzheimer's Disease Can Be Difficult To Diagnose: Symptoms Can Mimic Other Problems," reminded me of my friend's situation. The article accompanying the video concentrates on the overlapping symptoms of Alzheimer's and depression.
The video shows how new brain imaging techniques are helping in the diagnosis, so progress is being made. Not too long ago, an autopsy was the only thing considered definitive, when it came to diagnosis.
There's much in the article that focuses on depression as a jumping off point for questions. Many depressed elders can show symptoms that mimic early Alzheimer's. According to the article, some doctors treat depression first to see if that alone helps. If not, they will look farther into Alzheimer's testing.
Research, at this time, shows that people with depression might be at a greater risk for Alzheimer's as they age. So, treating depression early could be viewed as a preventative measure.
The article suggests that depression can be resolved completely, which is something I have trouble with. I'm not sure it's that simple, as I've known many people with depression that have needed to try several drugs, each of which has taken weeks to take effect, and still the relief is not complete. If someone has Alzheimer's, it would be hard for the person to tell if a medication is making him or her worse, and the wrong antidepressant can do that.
However, I don't know any alternative but to try. Certainly depression and Alzheimer's can go hand in hand. Certainly, antidepressants would be a good option to try, for many patients, before diagnosing full blown Alzheimer's. But a couple of months on one antidepressant many not be totally conclusive.
Anyone starting an antidepressant should be closely observed, and should they worsen, the doctor needs to be contacted immediately. But, if they do improve; if their memory gets better; if their other symptoms lessen; well, maybe a diagnosis of depression is right, and there is no dementia.
It does seem that an important part of diagnosing Alzheimer's or any dementia is ruling out other factors that may mimic the disease. Then some of the early Alzheimer's drugs can be tried, if that seems wise.
As far as my friend's dad goes, they kept him on Aricept, as it improves blood flow, so they felt it was still a good choice for his vascular dementia. Still, his behavior (and lack of other behaviors) made much more sense, once the correct disease was diagnosed.
It will likely be a long time (if ever) before a simple blood test, or even a scan, can definitively detect early Alzheimer's. So, it's good to have open minded doctors who will take the time to test for depression, medication interactions and other causes before just throwing out an Alzheimer's diagnosis. We want the best treatment for our loved ones. And good treatment starts with a good diagnosis.