At what age do the symptoms (of Alzheimer’s disease) start? Is there some type of test a doctor can do to see if a person has this disease? I have a family history of Alzheimer’s (1 aunt, 1 uncle, 2 great-aunts). I am almost 49 years old and find myself getting very confused at times, forgetting words, saying odd things, losing my train of thought, etc. I have a very stressful job, and never seem to get enough rest. I don’t know if these symptoms are from having too much to do and not enough rest, or is there really something wrong?
Dementia of the Alzheimer’s type, also known as Alzheimer’s disease, is a neurodegenerative disorder where normal functions of the brain start to deteriorate. The onset is gradual and involves an ongoing decline in the normal thinking, memory, and action-control abilities of the brain.
One of the most striking findings in Alzheimer’s disease regards memory problems — mainly, an impaired ability to learn new information or to recall recently learned information, especially when the information is brand-new (as opposed to older memories from earlier in the person’s life). This is why your grandmother, for example, who has some signs of early Alzheimer’s disease, can’t remember that you spoke to her yesterday on the telephone, but can tell you in beautiful detail what your mother wore on her wedding day thirty years ago. Other findings include language difficulties, usually word-finding problems; impaired ability to carry out purposeful movements and activities; failure to recognize objects; and disturbances in planning, sequencing, organization, and abstraction.
Dementia of the Alzheimer’s type can have an early onset (younger than age 65) or a later onset (after age 65). Some forms of the disorder have a genetic component, and some of these appear to be associated with a younger age at onset and a more severe course of the disease. Although we do not know exactly what “causes” the disease, it is probable that there are multiple causative agents and pathways involved. Some factors include genetic components (the genetic marker called the apolipoprotein E-epsilon 4 allele represents a significant risk factor for the disease) as well as abnormalities or modifications in certain proteins found in the brain (beta-amyloid protein and tau protein).
Treatment currently is aimed at making sure that people who have signs of the disease stay in top-notch medical health, since complications from a medical illness or from too many medications can make the thinking and memory problems of a person with early Alzheimer’s disease much worse. Psychosocial stimulation — keeping the brain active with friends, family, activities, and socializing — is very important also, and may slow down the progression of the cognitive decline (the “use it or lose it” principle). Some medications which stimulate the neurochemicals in the brain can help with the early signs of memory and attention problems, but will not change the progression of the disease (e.g., Aricept or donepezil).
If you have a strong family history of Alzheimer’s disease and you are concerned about your memory and thinking functions, then by all means seek out knowledgeable evaluation and advice, starting with your family doctor. She can listen to your observations, ask you detailed questions, perform a detailed physical examination and check some basic blood tests. As I mentioned earlier, it is critical that your physical health be stable, since many health problems can affect memory and thinking, especially as we get older (reactions to over-the-counter and prescription medications, untreated diabetes or hypertension, thyroid problems, etc.)
Next, depending on those findings, you and your doctor can discuss getting a more detailed and specialized examination from a neurologist or a psychiatrist specializing in dementia. This specialist will go into even more detail about your mental and physical functioning, will perform a detailed neurological examination to see how your brain and nervous system are working, and may order some additional lab tests to make sure there are not other factors present that could be causing your symptoms.
The neurologist or psychiatrist may also request that you get neuropsychological testing by a specialist called a neuropsychologist, who is trained to administer special tests for memory, attention, concentration, and other functions of the brain. Put all together, this information will allow the specialist to determine if your findings are consistent with an early Alzheimer’s disease or with some other process.
A thorough expert is important because there are medical disorders that can affect brain functioning and psychiatric disorders that can affect memory and thinking functions. Severe, untreateddepression, for example, can cause memory, attention, and concentration problems. When the depression is treated, the memory and attention problems get better. Furthermore, people who have Alzheimers’ dementia can also have complicated additional symptoms, including depression, agitation, paranoia, and hallucinations. These additional symptoms can often be ameliorated if the person receives psychiatric treatment; and then one often sees that the Alzheimer’s symptoms improve somewhat also.
There are some current very exciting areas of research that are looking into activities that can slow down the progression of the cognitive decline in dementias. Preliminary findings indicate that exercise may be very useful, as well as healthy lifestyle changes.