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.

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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.

Five surprising causes of memory loss

Mind concept graphic for memory loss or alzheimer's diseaseAfter my husband had a surgical procedure that required anesthesia, not only did he wake up groggy, but his early stage Alzheimer’s disease worsened. He got lost driving in our home town and had more difficulty with everyday activities. Years later, it was a kidney stone that sent him over the edge into a downward spiral. It’s not a surprise that anesthesia can cause memory loss, temporary or permanent. But it came as a surprise when something as common as a kidney stone had a severe impact on my husband’s mental condition and overall health.

There is a link between common infections such as UTIs (urinary tract infections), the flu, colds, and stomach viruses and their effect on memory in the elderly and dementia populations. A significant study found that people with Alzheimer’s, who get even a mild respiratory or gastrointestinal infection, or a bump or bruise are at risk for having a significant, permanent memory loss, according to a report that was published in the September 8, 2009 issue of the journal Neurology. These patients can have high levels of tumor necrosis factor—alpha (TNF-a)—a protein that is linked to inflammation and is associated with memory loss and cognitive decline.

In the study done at the Clinical Neurosciences Research Division at the University of Southampton, United Kingdom, 222 Alzheimer’s patients were followed for six months. Of those, 110 people had an infection or injury that resulted in inflammation. These individuals had twice the memory loss during that period of time as the individuals who did not have an illness or injury. Researchers attribute the memory loss to inflammation. In patients whose TNF-a levels were high to begin with, an infection increased their memory loss to 10 times more than those who had low TNF-a levels. Clive Holmes, PhD, lead researcher, said that this population should be vaccinated against the flu, and infections and injuries should be treated as soon as possible.

Other surprising causes of memory loss

  1. UTIs–Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who recently died from a UTI that quickly became septic.
  2. Vitamin B12 is essential for normal nerve function. A deficiency can lead to confusion and dementia. It is vital to get 2.4 micrograms of B12 in your diet every day from sources such as dairy products, meat and fish, or from foods fortified with vitamin B12. Vegans must take a B12 supplement since the vitamin is found in animal foods.
  3. Sleep apnea causes one to stop breathing during the night. It can be very brief and very frequent, but it is treatable. Unfortunately, sleep apnea islinked to memory loss and dementia, according to Constantine Lyketsos, MD, director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins Medicine and professor and chair of psychiatry at Johns Hopkins Bayview. You might have sleep apnea if you wake up with a headache and have daytime fatigue — or if your partner complains of loud snoring. A study published in The Journal of Neuroscience found that untreated sleep apnea affects spatial navigational memory. This type of memory includes being able to remember directions or where you put things like your keys. The research suggests that deep sleep, also known as rapid eye movement (REM) sleep, plays an important role in memory. Dr. Lyketsos explains that for people with sleep apnea, oxygen delivery to the brain is interrupted several hundred times during the night . He says, The brain is stressed, so people wake up, and the injury sleep apnea causes can show up as a variety of memory loss symptoms. If you or someone you know has sleep apnea, please make an appointment with your health practitioner.
  4. Some medications such as statins (cholesterol-lowering drugs), sleeping pills, antidepressants, anti-anxiety medications and some painkillers have been found to increase the risk for reversible cognitive side effects, including memory loss and confusion. A commonly prescribed type 2 diabetes drug, metformin, has also been associated with memory problems. A study published in Diabetes Care found that people with diabetes who took the drug had worse cognitive performance than those who did not take it.
  5. Thyroid disease can cause poor memory, especially in seniors. Hypothyroidism is very common in people over 60 and it steadily increases with age. It is believed that up to one in four individuals in nursing homes may have undiagnosed hypothyroidism. Memory loss or declining cognitive functioning which is frequently attributed to old age, might be the only symptom of hypothyroidism in an elderly person. If there is a family history of thyroid disease, past treatment for hyperthyroidism or a history of surgery and/or radiotherapy to the neck, a physician might be able to better establish a link leading to a diagnosis. Thyroid disease is a lifelong disorder that can be treated with medication, but the patient must be closely monitored to make sure the correct dosage is prescribed.

Tips for protecting your memory and keeping you and your loved one healthy and safe

  • Inoculate against flu, pneumonia and shingles
    Boost immunity with zinc, vitamin D and vitamin C
  • Take a complete B-vitamin supplement to make sure you are getting a balanced amount of B vitamins.
  • Prevent falls and accidents (recommended: Complete Guide to Alzheimer’s Proofing Your Home by Mark Warner http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=BtoC&Count1=668834865&Count2=585975289&CategoryID=3&Target=products.asp
  • Reduce systemic inflammation with a curcumin (turmeric extract) supplement
  • Use a humidifier to moisturize nasal passages and mucous membranes to help keep them healthy
  • Engage in gentle exercise to reduce inflammation
  • Keep hydrated by drinking at least 6-8 glasses of water each day
  • Encourage seniors to use the bathroom several times a day, approximately every two to three hours.
  • Make sure the senior is maintaining good hygiene, with showers at least several times a week.
  • If the person is incontinent, make sure he or she changes undergarments frequently.

There are other articles on my blog that discuss how to support your memory and cognition. Please subscribe today, and feel free to send me your questions.

To your health.

Sincerely,

Barbra Cohn