Diagnosing memory loss

by Kelli Coomes

Imagine standing in your entry hall, keys in hand. You can’t remember where you need to go, only that you have some place to be. A few minutes later, you still can’t remember why you’re standing there.

Brian Fisher, an in-home certified nursing assistant, woke at 6 a.m. to find the 85-year-old man he cares for up and ready for work. Since Arvel hasn’t worked for more than 20 years, Fisher took him to McDonald’s instead. Arvel doesn’t care where they’re going, as long as he’s going somewhere.

Later that day, Fisher drove his patient to the doctor’s office. Arvel’s family was having him tested again for Alzheimer’s. Despite previous tests that showed he does not have the disease, his family keeps sending him to the doctor for further testing.

Arvel knows where he is and who the people around him are. He can understand most things that are told him, Fisher said. But what worries his family is that he cannot remember a lot of the little things. Arvel forgets he doesn’t work, so he gets ready when he wakes. He can’t remember where some things in the house are.

Dr. Edward Zamrini is the director of clinical trials at the Center for Alzheimer’s Care, Imaging and Research. Alzheimer’s Disease isn’t just about memory loss, but how much the loss progresses, Zamrini said. Doctors at the clinic look at how frequently a problem occurs and the loss by degrees, such as remembering where one’s keys are to where one’s car is located.

“To lose one’s memory is the ultimate loss,” said Scott D. Wright, director of the Gerontology Interdisciplinary Center at the University of Utah. “It’s like they’re dying twice.”

Alzheimer’s is the most common cause of memory loss in roughly 50 percent of cases. But it isn’t the only reason for memory loss.

“We jump to it too soon,” Wright said. There are about 25 other factors that can cause memory loss that are ruled out first. These include diet, diseases, stress and medications.

Zamrini said some health issues that cause memory loss include Lewy body disease and dementias like frontotemporal dementia.

Lewy body disease is a disease that is commonly mistaken for Alzheimer’s. Johns Hopkins Medicine states that like Alzheimer’s, Lewy body patients have memory loss, but there are other symptoms that distinguish it such as trouble with attention, hallucinations and symptoms that are similar to Parkinson’s disease. There are often problems with sleeping, falling and depression.

According to the Mayo Clinic, dementia describes a group of symptoms, both social and intellectual, that interfere with daily life.

Dementia, after several tests, can be diagnosed with complete accuracy about 90 percent of the time. However, dementia can lead to and be a symptom of Alzheimer’s.

Alzheimer’s can only be diagnosed with complete accuracy after death. According to the Mayo Clinic, a microscopic exam of the brain is the only way to accurately diagnose the disease. A brain with Alzheimer’s has plaques and tangles that are visible only with a microscope.

One form of dementia that can be tested accurately is frontotemporal dementia. The Mayo Clinic notes that it is commonly mistaken for Alzheimer’s, but it occurs at a much younger age.

The starting age for Alzheimer’s is roughly 65, with incidents increasing every five years. By age 85, people are 40 percent to 50 percent likely to develop it.

Frontotemporal dementia typically develops between the ages of 40 and 70.
Symptoms of frontotemporal dementia vary according to what part of the brain is affected. The term is used for disorders that affect the frontal and temporal lobes of the brain that are associated with personalities, behaviors and language.

Depression is another cause of memory loss. Zamrini said depression often causes forgetfulness. As people get older, they tend to lose their loved ones. Friends and family members die. This can create or add to depression. Often they stop caring about memories, or forget them because they become too painful. Often the memory loss is self-inflicted.

The hardest part for the families of Alzheimer’s patients, Zamrini said, is that they’re physically fit but not mentally well. This distinction is what’s helping doctors re-diagnose patients. Alzheimer’s only affects memory, Zamrini said. Diseases like Lewy body and dementia have some physical symptoms.

The testing for the other diseases is progressing and better diagnoses between them are increasing. Early detection helps with all these issues, Zamrini said.