Why it’s important to get an early diagnosis when cognitive problems appear

Doctor talking with patient

There were several indications that something was wrong with my husband two years before he was diagnosed. This tall, good-looking man, a graduate of the Wharton School of Business at the University of Pennsylvania, was having trouble calculating how much tip to leave a waitress. When we went to Spain for our twenty-fifth anniversary, Morris couldn’t figure out how much money the hotel would cost in dollars. This man, who once memorized trains and airplane schedules without even trying, followed me around the city like a puppy dog as we boarded a subway or bus enroute to tourist attractions.

That following fall — our daughter’s last year in high school — Morris couldn’t give directions to a friend who was taking the SAT at the high school my husband had attended. I got out the map to help him, but he couldn’t read the map. That was the moment I knew something was very wrong. When he left for a road trip to California without our son and forgot his suitcase, I sat on the stairs and cried. I couldn’t deny it any longer. I had a strong suspicion that Morris had Alzheimer’s disease, and although I pleaded with him for two years to see a neurologist, he refused.

What if he had gotten an early diagnosis? Would it have helped?

There’s no way to know for sure, but probably it would have. Because as soon as he started taking Aricept he stopped getting lost driving around our small city. And I started giving him nutritional supplements, which also seemed to help. Read “5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned.” https://barbracohn.com/2019/09/25/5-things-that-help-dementia-that-your-doctor-probably-hasnt-mentioned/

Professionals, both researchers and physicians and the Alzheimer’s Association, recommend that an early, accurate diagnosis is the key to living a less stressful life for both the patient and the family.

Here’s why:

  1. Cognitive problems can be caused by a number of physical conditions other than Alzheimer’s disease, vascular cognitive impairment, Lewy Bodies dementia and Frontotemporal dementia (FTD). These include thyroid problems, hydrocephalus, a brain tumor, and even depression. When my mother was severely dehydrated and hospitalized with a urinary tract infection (UTI), a psychiatrist called to tell me that she had full-blown dementia. “No she doesn’t,” I said. And sure enough, after being put on an IV saline drip Mom regained her full mental capacity. Memory problems can result from dehydration, severe diabetes and some forms of Parkinson’s disease, traumatic brain injury, HIV, and Huntington’s disease.

Certain medications can affect mental clarity and balance. Be sure to ask your pharmacist about drug contraindications, and interactions with natural supplements. Alcohol abuse and binge drinking can destroy brain cells that are critical for memory, thinking, and decision making and mimic or lead to dementia.

2. Cognitive symptoms may be reversible. There are a number of holistic doctors who claim that their protocol can treat the root cause of cognitive decline and Alzheimer’s disease. Please read my blog ” Significant study points to MIND diet for improving brain health and preventing Alzheimer’s disease.” https://barbracohn.com/2018/11/09/significant-study-points-to-mind-diet-for-improving-brain-health-and-preventing-alzheimers-disease/

Dale Bredesen, MD, a physician scientist in the Department of Pharmacology at UCLA who’s published more than 220 papers on Alzheimer’s, has spent 30 years looking at the root causes of the neurodegenerative phenomenon in hopes of eradicating it. In 2018, Bredesen published the case studies of more than 100 patients in cognitive decline in the Journal of Alzheimer’s Disease & Parkinsonism. https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

In her editorial in the Lancet Neurology, published in May 2020, Joanna Hellmuth, MD, of the UCSF Memory and Aging Center, said the “Bredesen protocol” – named by neurologist Dale Bredesen, MD – has reeled in patients and their families seeking hope outside of the physician’s office for a disease that is currently incurable.

The Bredesen protocol is propounded in his 2017 bestseller The End of Alzheimer’s Program and can be accessed for $1,399, which includes protocol assessments, lab tests and contact with practitioners, who provide the regimen for additional fees. Online support and cognitive games are available for an additional monthly charge. This protocol is timely, costly and requires steadfastness. But if you have the time and means, it’s probably worth a try.

3. An early diagnosis is empowering. Before the disease has progressed to the point where decision making is difficult, the patient can be included in financial and estate planning, creating end-of-life wishes and durable power of attorney decisions, etc.

4. An early diagnosis is easier for the physician to make when the patient is able to answer questions. Later in the progression of the disease, the patient isn’t able to make observations or answer accurately.

5. Family and loved ones who might be confused by particular behaviors such as anger, depression, disinterest, can better understand why their parent or spouse or significant other is behaving the way they are. This helps to preserve the person’s dignity rather than have someone close to them yell at them, treat them poorly, or want to distance them self, etc.

6. Individuals diagnosed early can take advantage of support groups, and caregivers can learn ways to better manage medications, and learn strategies for coping with unexpected and unusual behaviors and the ordinary progression of the disease. The Alzheimer’s Association was a godsend for me. I was able to connect with other caregivers who knew exactly what I was going through. I could talk about what was happening all day with my best friend, but there was no way she would be able to fully understand the stress of caregiving and the grief of losing a partner to Alzheimer’s. https://www.alz.org/alzheimers-dementia/research_progress/clinical-trials/about-clinical-trials

7. Getting an early diagnosis provides the opportunity to possibly enroll in a clinical trial. TrialMatch is a clinical trial matching service for Alzheimer’s and other dementias. It is a free, easy-to-use service that connects individuals living with AD, caregivers, and healthy volunteers with current research studies. Their continuously updated database of AD clinical studies includes hundreds of pharmacological and non-pharmacological studies being conducted at sites throughout the U.S. and online.

8. An early diagnosis allows the patient to prioritize what is important to them, whether it’s creating a masterpiece or traveling the world. There is still time at this point in the disease to enjoy a happy, satisfying life.

————————————————————————————————————–

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Why hydration is crucial, especially during the pandemic

Glass of waterAdipsia is the fancy name for the loss of the sense of thirst. As we get older, our sense of thirst diminishes, just as our sense of smell and taste diminish. Chronic dehydration  is one of the most common problems among seniors and the elderly who reside in care facilities.

If you have a loved one at home with dementia or in a care facility it’s important that you learn the signs of dehydration (below) and offer water or another beverage to your patient every hour and throughout the day.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

Better monitoring of fluid intake is needed at care facilities

Studies have shown that nearly all nursing home residents suffer from inadequate hydration. Additionally, in one study, 25 out of 40 participants suffered from diseases that may have been caused or exacerbated by their being dehydrated.

If your loved one is in a care facility now—during the COVID-19 pandemic–it is more important than ever to try to encourage them to drink. Ask the staff to put signs up in their room as a reminder. It’s especially important if your loved one has dementia and forgets to drink or is not thirsty.

What happens when you are dehydrated?

Your blood begins to thicken, which interferes with normal blood flow and viscosity. This is one of the reasons why, especially during the  pandemic, it’s crucial to stay hydrated. There have been many reports of blood clots and other cardiovascular episodes in patients with COVID-19. The kidneys, liver, pancreas and other organs can be severely affected from dehydration, and severe dehydration can lead to acute pancreatitis in some individuals.

Dehydration can interfere with brain function

This is a good example of what happens when our brains are dehydrated. My mom wasn’t able to walk the last two years of her life, and was dependent upon two private caregivers. She also drank thickened water, which is a disgusting thickened pudding-like liquid that substitutes for water. The reason?  She aspirated water and food into her lungs, which caused her to cough. Sometimes, the result was pneumonia. She may have felt thirsty and not wanted to bother with the thickened water, or maybe she wasn’t thirsty. But she ended up being severely dehydrated on more than one occasion.

When Mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear:

  • dry lips and sticky or dry mouth
  • no tears when crying
  • dry, papery skin that tents when it is pressed
  • decreased urine output
  • sunken eyes
  • headache
  • lethargy
  • dark urine
  • extreme thirst
  • unable to sweat
  • fast breath rate
  • low blood pressure
  • the mental symptoms are not as obvious, but can result in mental confusion, irritability, delirium
  • extreme cases of dehydration can lead to loss of consciousness, coma, kidney failure, and seizures.

Ways to stay hydrated

If you are a caregiver (and that includes caring for yourself!) here are some helpful guidelines:

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by herbal teas, milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.
  • Smoothies and shakes are nourishing and filling.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity. It is especially important now as we head into summer and during the COVID-19 pandemic. But it’s just as important all year round.


image-1