In 2016 The New York Times devoted a special section to Alzheimer’s. It was a beautifully written story, Fraying at the Edges, by N.R. Kleinfield, that focused on Geri Taylor’s heroic journey with the disease. Ms. Taylor had become forgetful; mundane tasks often confused her. One day she got off the subway and had no idea why she was there. She tried to pass off increasingly frequent memory problems as inevitable infirmities of old age. But the day she looked in the mirror and didn’t recognize the face staring back at her was her come-to-Jesus moment. She knew she could no longer ignore what was happening to her mind.
Diagnosis: Mild cognitive impairment, a precursor to Alzheimer’s disease
Her doctor put her on Aricept, a drug designed to improve cognitive performance, and it seemed to sharpen her thinking. But as her doctor told her, she wasn’t just losing her memory, she was losing “executive function”— forgetting the sequence of steps in the processes of all the little things we do, the things we take for granted.
It’s important to get help sooner for people whose minds are slipping
Patients showing signs of mental decline or dementia should be getting checked during routine medical visits. Dementia is an uncomfortable topic for patients and their families. It’s also a difficult topic for their doctors, but family physicians need to do a thorough evaluation and share the diagnosis.
Patients and family members should push for an evaluation if they’re worried that symptoms might not be normal aging. We all laugh about misplacing our keys. But there’s a difference between occasionally misplacing keys and putting them in the freezer. By the time you’ve gone from misplacing your keys to forgetting what those keys are for, you’re too far gone to participate in your own care. It’s not just memory that suffers, but judgment, and sometimes it can be years before dementia is diagnosed.
The growing need for early diagnosis
- About 50 million people worldwide have dementia; Alzheimer’s is the most common form of the disease. In the U.S., nearly 6 million people have Alzheimer’s and an estsimated 12 million have mild cognitive impairment, a frequent precursor.
- In 2015, Alzheimer’s Association research using Medicare records suggested that only about half of those being treated for Alzheimer’s had been told by their health-care providers that they had been diagnosed with the disease.
- Physicians often hear of symptoms or memory complaints from patients or their spouses and say, “you know, you seem okay to me today, so check back in six months”. The consequences? Patients may end up hospitalized because they forgot to take their medications.
Medicare has begun covering mental assessments
Medicare recently started covering mental assessments as part of annual wellness visits, but doctors aren’t required to do it and there is no guidance on how to do it. In some cases, it might be as cursory as asking “how’s your memory?”
The guidelines do not recommend screening everyone
The Medicare guidelines outline what health care workers should do if people describe worrisome symptoms. It includes checking for risk factors that may contribute to dementia or other brain diseases, including family history, heart disease and head injuries. There are pen-and-pencil memory tests and imaging tests to detect small strokes or brain injuries that could be causing memory problems.
Doctors are trained to heal, when there is no cure for Alzheimer’s
Dr. Michael Sitorius, family medicine chairman at the University of Nebraska Medical Center, said dealing with mental decline adds to the challenge of caring for frail elderly patients. It’s a tough diagnosis to make for many doctors, he said, because medical training focuses on “trying to cure people, and Alzheimer’s and dementia are not curable.”
Dr. Sitorius gives his older patients mental tests at their annual checkups, but sometimes patients or their loved ones don’t want to hear the results. In those cases, Sitorius still addresses related issues including depression, safeguarding medication, nutrition and whether patients should continue driving. The new guidelines are a welcome reminder for family doctors to tackle these issues earlier. “We strongly encourage a full disclosure,” including diagnosis, stage and prognosis, he said.
Meet Anne Hunt, 81, who once ran a busy Chicago cooking school
At her daughter’s urging, Anne Hunt visited her family doctor in 2011 because of increasing forgetfulness. The 81-year-old now recalls struggling with memory tests involving letters and numbers that her doctor had her perform. The test results were inconclusive and there was no diagnosis.
“We didn’t do much about it,” said Bruce Hunt, Anne’s husband, until five years later, when her behavior was clearly worsening – more memory lapses, repeating herself and forgetting where to put things. She was diagnosed with Alzheimer’s after an imaging test showed brain changes associated with the disease.
The benefits of early diagnosis
“There’s no pill they can take to make it go away, so some people think there’s no point to getting a diagnosis,” but that’s being short-sighted, the National Institute of Aging’s Silverberg said. “It really does offer an opportunity to plan.” Alzheimer’s medication such as Aricept and Namenda can ease symptoms. Other benefits include a chance to join experiments testing treatments, opportunities to resolve finances, find caregivers, make homes safer and use memory aids and calendars to promote independent living. The diagnosis energized the Hunts. They joined support groups and a singing ensemble, finding new things to help them cope.
