Memory Loss, Alzheimer’s Disease, and Dementia: A Practical Guide for Clinicians
By John Wisniewski
Why did you write this book? Would patients or family members be able to read it?
My co-author and I wrote this book to help frontline clinicians in the community—including the neurologist, psychiatrist, geriatrician, and primary care provider—be able to diagnose and treat patients with memory disorders easily and effectively. We worked hard to make the book accessible to healthcare providers of any profession with any background. To accomplish this task we incorporated many color figures, tables, boxes, and even videos, while eliminating confusing jargon and abbreviations. We ended up with a book that is easily accessible to anyone—even without a healthcare background. Many family members and even a few patients have read the book and found no difficulty understanding it.
You mentioned videos; how do you have videos in a paperback book?
Each book comes with a unique code on the inside cover that allows you to read the electronic version of the book on your computer, tablet, or phone. There are about 30 videos in the electronic version of the book.
How would you know if a patient was afflicted with dementia or Alzheimer’s disease? What would you check for first?
Dementia is a general term that simply means someone has trouble with their daily functioning because their thinking and/or memory is impaired. Alzheimer’s disease is the most common cause of dementia. The hallmark of Alzheimer’s disease is “rapid forgetting”—that is, even when someone is paying attention they cannot remember information. When I’m seeing an older person whose family tells me that she or he is asking the same questions several times a day, I become concerned about the possibility of Alzheimer’s disease, because asking the same question again and again is a sign of rapid forgetting. The first thing I typically do is to ask for other examples of memory difficulties. I will often hear problems with getting lost (even when traveling on familiar routes), leaving the stove on or the water running, and losing important items such as keys, glasses, pocketbook, or wallet. Other problems that are common in Alzheimer’s disease include trouble finding words and difficulty planning and organizing. After getting thorough history, I will do a physical and neurological examination (listening to the heart and lungs, examining strength, sensation, and reflexes, etc.), and perform some brief tests of thinking and memory. Finally I will order blood work to look for metabolic or hormonal disorders, vitamin deficiencies, and infections, along with an MRI or CT scan of the brain to look for tumors, strokes, and other brain problems. More on this topic can be found in Chapters 2, 3, and 4
Has there been any new developments in the treatment of dementia or Alzheimer’s?
One of the most exciting things that has happened recently is that there are now special amyloid scans that can detect the pathology of Alzheimer’s disease in living people. The United States Food and Drug Administration (FDA) has approved three agents to detect the amyloid plaques in Alzheimer’s disease using positron emission tomography (PET) scans. So we can now know with certainty whether or not someone has Alzheimer’s disease. The only problem is that insurance companies—including Medicare—aren’t paying for the scans. There is currently a study underway to see if Medicare should pay for them. The bottom line is that if you would like to get such a scan free of charge for yourself or your loved one you can participate in the study at one of these sites: http://www.ideas-study.org/list-of-active-sites/. More on this topic can be found in Chapter 2.
The other exciting developments are that there are more new medications for Alzheimer’s disease in clinical trials than ever before. There are medications that are being developed to improve thinking and memory, behavior, and mood. Even more exciting are the medications being developed to slow the progression of Alzheimer’s disease by stopping the formation of the amyloid plaques or even removing the plaques from the brain using special antibodies. More on this topic can be found in Chapter 19.
If you were checking for signs of Dementia in a patient or Alzheimer Disease, what would you be looking for , especially concerning the brain scans?
As mentioned, Alzheimer’s disease is one type of dementia. There are other types of dementia as well, such as frontotemporal dementia that affects behavior and language, and vascular dementia due to strokes. As described in Chapter 2, there are three things that I look for on any standard brain scan, like a CT (or “cat” scan) or an MRI scan.
The first is to look to see if there is any pattern of atrophy or shrinkage of the brain. In Alzheimer’s disease there is typically shrinkage of the hippocampus—the part of the brain that forms new memories, the anterior or front part of the temporal lobe—involved with words and their meanings, and the parietal lobes—involved with attention and finding one’s way around in the world. In frontotemporal dementia there is shrinkage of the frontal lobes—involved with behavior, judgment, reasoning, and language.
The second is to look for any strokes. Most people know if they have had a large stroke, but there are also mini strokes, which neurologists call “small vessel ischemic disease.” These mini strokes are typically asymptomatic, and most older adults have some of them. I need to judge whether the patient’s symptoms can be attributed to the mini strokes—in which case it is a vascular dementia—or whether the patient simply has the average amount of mini strokes for their age. In this latter case the strokes are not the cause of the dementia. More on vascular dementia can be found in Chapter 6.
The third is to look for surprises, such as blood clots, fluid collections, tumors, infections, bleeds, and any other unexpected findings.