Bob and Margaret have followed football since they were married nearly forty years ago. It is only recently that they stopped going. Margaret was having memory problems and couldn't remember the names of people they had been sitting with for years. And the last time they went she became lost on her way back from the toilet. The following week Bob and Margaret came to the surgery. "It's not just what happened at the football," said Bob. " There have been other things that have been worrying me." He explained how Margaret had become vague and almost completely disinterested in her appearance. " The last straw was over the weekend," said Bob. " I came home and the house was full of gas. Margaret had forgotten to turn off the stove." Throughout all this, Margaret nervously shrugged her shoulders. " Don't exaggerate Bob. You're making this up. What ever will the doctor think?"
The story sounded like a dementing illness such as Alzheimer's disease. Margaret laughed that she was not as young as she used be but I could sense that she also was a bit worried about what was happening. I saw Margaret the following week for a more extensive assessment. A full physical examination was normal. However, she performed poorly on tests of orientation and recent memory. She had no recollection of the date and year and was unable to answer any recent political, sport or current news questions. In all areas of testing there was a marked deficit. With Bob and Margaret's permission I spoke to their older daughter who confirmed these impressions. After a series of investigations Margaret was referred to an aged care specialist. The diagnosis of Alzheimer's disease was confirmed.
Alzheimer's disease is the most common type of dementia. It is a slowly progressive condition and, despite extensive research, its cause is not fully understood. Although several drugs are presently under trial, there is still no specific treatment. However, a few drugs have shown promise in delaying progression of the disease. If post-mortem brain tissue is examined there is a specific microscopic appearance. In practical terms, Alzheimer's disease is dementia after other causes have been excluded.
Alzheimer's disease is characterized by a gradual deterioration of memory and personality. Insight, judgment, reasoning, language and other skills are also affected, to varying degrees. Over a period of several years the person usually becomes dependent, and requires full nursing care.
In Australia there are about 150,000 people with moderate to severe dementia, about a half of whom have Alzheimer's disease. Although many older people have a dread of losing their memory, it is worth noting that only one person in six eventually develops dementia. Alzheimer's disease does occur mainly in the elderly. However, it can also affect people in middle-age, and the incidence appears to be increasing.
There are many ways that Alzheimer's disease may present in general practice. Frequently it is a combination of memory loss, lack of care in appearance, and difficulties with concentration and understanding. Often it is an overall picture rather than one isolated feature. It is unusual for the actual person to complain of symptoms. More often it is another family member who contacts the doctor about some worrying signs that have occurred.
Dementia can also be caused by multiple small strokes and alcoholism. A very similar appearance can also be seen with severe depression, underactive thyroid gland and certain vitamin deficiencies. It is extremely important that all these other causes be kept in mind because they may be treatable, even reversible, if the condition is recognized early. After a careful history and examination a series of blood tests and a CT brain scan are usually arranged.
Most patients with Alzheimer's disease are referred for specialist assessment. In some cases a course of medication might be suggested. The main aim is to retain the person's capabilities in all areas for as long as possible. It is better if other members of the family are involved as well. They need to learn how to best communicate with someone who has Alzheimer's disease. There is also a lot to learn about activities, exercises, home safety, continence problems, supervision and legal matters.
It is often overlooked that an intact memory is not a prerequisite for enjoying simple pleasures. People with Alzheimer's disease can often enjoy experiences such as music or going to a movie, even if they have no recollection afterwards. They can also enjoy household pets, visits from old friends, and trips to familiar places.
Alzheimer's disease does have a profound effect on the person's family. The carer of the person with Alzheimer's disease is often under considerable strain and should always be kept in mind. Day-centre attendance for one or two mornings a week can often be arranged. Likewise, a period of respite care for a few weeks in a nursing home can also help to give the carer a well-needed break.