It is difficult to make a definite diagnosis of Alzheimer's disease during life, although it is possible to be almost certain. Unfortunately there is no simple test which indicates that only this condition is at the root of a persons problems, unlike many other conditions where a blood test can be conclusive.
Making the Diagnosis
When making the diagnosis the doctor has to ensure that many other illnesses which cause memory loss are not involved and the condition must also be differentiated from the forgetfulness that is sometimes a feature of normal aging.
It is therefore important that every patient with this type of symptom is brought to the attention of his or her doctor, so that he can decide whether or not they are abnormal and whether further tests or a second opinion are necessary. Many investigations are often required and some of these are quite complex, but the majority of the tests are used to exclude the other, more readily treatable conditions, that may be confused with Alzheimer's disease.
Some of the more complex include special x-rays or brain scanning techniques, (similar but more sophisticated x-ray like tests) and can often help to confirm the diagnosis if this has not become apparent from simpler investigations. The diagnosis is eventually made on the basis of the medical history, the physical findings on examination, the psychological deficit and the tests, but sometimes it is necessary to follow the course of an illness before one can be definite and ultimately it is only possible to be absolutely sure after post-mortem examination of the brain.
For practical purposes however, it is usually possible to make the diagnosis during life with a high degree of certainty, by excluding other causes.
The Symptoms of Alzheimer's Disease
The symptoms vary from person to person and at first are indistinguishable from the mental changes often encountered in people as they age. In the elderly therefore, they will be accepted by unsuspecting relatives as part of the normal forgetfulness of old age. In younger patients, the relative youth of the sufferer, brings earlier recognition of what is an abnormal situation. When the condition starts in the 40s, 50s and 60s, it is sometimes labelled pre-senile dementia and in older patients senile dementia.
Loss of memory for recent events often occurs early on, although in most older people it may well represent part of the normal aging change. However when it begins to affect their daily activities, for example when they neglect to turn off a fire or lose their way in familiar surroundings, it may herald the onset of Alzheimer's disease, particularly in the younger person.
It sometimes appears as if the onset of the illness can be linked to a particular incident, but in the majority of cases the symptoms are usually found to pre-date this, when carefully considered. The patient is often prone to cover up for or avoid answering questions that would reveal poor short term memory. In addition the ability to remember facts from the remote past leads friends and relatives to believe that the memory is unimpaired.
People often exhibit catastrophic reactions, such as outbursts of tears, aggression, spitefulness and a tendency to be restless. Increasing memory loss, frank confusion, irritability, difficulty in feeding and dressing, reading and writing, loss of balance and abnormal groping or jerking movements may eventually follow. The restlessness and agitation may aggravated by the inability to communicate about any discomfort they may experience, such as a full bladder or distended bowels. All this may have an effect on the personality, mood and behaviour of the patient.
Other Problems Associated with Alzheimer's Disease
Other problems can include deterioration in the ability to concentrate, insomnia, incontinence and difficulties with speech and swallowing. The actual pattern varies from person to person and the rate of decline also differs, but usually takes several years. Later on resistance to other diseases may become reduced, resulting for instance in recurrent episodes of pneumonia. Finally the patient may become bed-ridden and need very careful nursing.
Thankfully the person with Alzheimer's disease of any severity is as far as we know, usually unaware of his or her condition. Although in the early stages insight into the declining intellectual performance may cause depression. It is usually the relatives and friends and other supporters who suffer most since they must bear the brunt of the effects of the disease, which is particularly hard if it strikes a relatively younger person in their pre-retirement years, when their families are just beginning to anticipate a well earned retirement. It is especially distressing psychologically for relatives when someone they love and respect no longer recognises them, or regards them with mistrust.
The Treatment of Alzheimer's Disease
At the moment there is unfortunately no curative treatment, but present concepts of medical care attempt to reduce as many of the consequences of the condition as possible, but social support services are often called into play to help reduce the stress and strain on caring relatives. All people suffering with this condition need to be under the care of their family doctor, who may call upon a neurologist, a psychiatrist or a specialist in diseases of the elderly. Physiotherapy may help preserve some of the declining motor function and loss of mobility, although there comes a time when the patient is unable to co-operate adequately with remedial therapists.
It is important that a person suffering from the disease should live as normal a life as possible until this is unsafe or he or she is unable to do so for other reasons.
Original Information for this article: - The Alzhiemer's Society 1982
Join the Conversation