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...
Expert Answer
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.