Should I be keep trying to get an Alzheimer's diagnosis for my mother?
My Mom's memory over the last couple of years has deteriorated noticeably. She asks the same question repeatedly during conversations. She tells the same stories over and over. She occasionally forgets how to get to places she has been to before, like a favorite restaurant or store. I took her to our family doctor and he asked a series of logic and memory type questions. She aced them. He said there's no way she can have Alzheimers. He said it's because she doesn't sleep very well and it's just her age, 70. She says she is sleeping better after learning breathing techniques (she won't take sleep meds). We don't see any improvement. Should we insist on a more thorough exam? Maybe with a neurologist? We are concerned it's dementia of some sort...
It can be hard not to lose your patience with a family member when she keeps repeating stories or questions, but once you learn the basics of dementia communication and approaches, together you can have the best of days with fun, laughter, and love.
As we get older it is common to forget a few things and we're probably also inclined toward telling our favorite stories repeatedly, so sometimes it can be difficult to distinguish normal aging memory loss from early dementia and getting an accurate diagnosis.
From your description, your mom is experiencing mild cognitive impairment, MCI for short. This could have been brought on by her sleep problems, but it could also be a precursor to one of the numerous known dementias, of which Alzheimer's is the most prevalent. Most doctors use the mini mental test so see if there's an indication of short-term memory loss, but as you say, your mom aced it.
In spite of aggressive research into all aspects of this disease, no doctor can state for certain whether or not a person will have Alzheimer's in the future. Your mom should probably see a specialist for a thorough physical, which usually includes an extensive cognitive exam as well.
Whereas Alzheimer's is incurable, several conditions that mimic the disease, are reversible. The sooner they are identified, the sooner they can be corrected. Among these are vitamin and other nutritional deficiencies, allergies, late onset diabetes, thyroid issues, dehydration, drug-interactions or reactions, low-grade infections and NPH, normal pressure hydrocephalus (fluid on the brain.)
When other dementias have been ruled out, the diagnosis will be "dementia, probably of the Alzheimer's type." There's some progress toward more accurate testing of Alzheimer's, such as blood tests and spinal taps, but so far, the only conclusive diagnosis is done only at autopsy.
Specialists urge people to get tested as early as possible, to give them the opportunity to put their affairs in order and in most cases, well-meaning physicians will routinely prescribe either Exelon (Rivastigmine) or Aricept (Donepezil), often in combination of Namenda (Memantine.) None of these medications bring back lost memory, but they do seem to help some people refocus. Of course, as with all medications that have positive effects, they may also have serious side-effects. In the case of Alzheimer's medications, they are not recommended for people with some heart and circulation conditions. People with low body weight are particularly at risk.
Even at best, these medications may only work for a percentage of patients. One of the most popular drugs, Aricept, has only a 30% success rate and then minimal improvement in those cases. In April, 2011, the Wall Street Journal reported that the Food and Drug Administration (FDA) recently chastised Pfizer for their two television commercials for Aricept, the most popular medication for Alzheimer's Disease, as "misleading," "deceptive," and "not supported by the available research data. The AlzForum.org website features short and clear charts of test results and efficacy of the Alzheimer's drugs currently available.
We experienced the physician using a short test on my husband and saying it was a simple case of short term memory loss caused by anxiety over a job loss. I believed that it was the other way around, that the memory and thinking gaps caused the job loss. I began to document my observations and we returned to the doctor with two pages of examples over a two week period along with a request for further testing. The testing was done by a neurologist and a psychologist who recognized the memory loss and cognitive impairment as likely to be Alzheimer's and started medication. They referred him to the Mayo clinic in Rochester, MN where the Alzheimer's diagnosis was concurred by a doctor specializing in the disease. The medication seems to have slowed the progress of the memory loss and the diagnosis puts us in a better position to plan for the future.
Good luck in your efforts and God bless you and yours.
By all means try for at least a second opinion. If your mom is cooperative, get to a neurologist as soon as possible. My mothers "doctor" thought she was malnourished and needed vitamins. She did not even catch on, when Mom would come for her b-12 shot, sit in the waiting room for a few minutes and then leave without seeing the doc or getting a shot. She would tell Dad(waiting in the car) that she was done. I found this out from the receptionist, NOT the doctor. By the time I was able to get a neurology appt. and MRI, there was significant brain damage. At least with a neurologist, you can find out if it is indeed something else, besides alzheimers, that might be treatable. If not then you will have time to plan where and how you will get care for your mom, when it becomes necessary.
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