Alzheimer Disease

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Is It dementia of Alzheimer, Depression or Normal Aging Memory Decline?

A.  Overview

From time to time, you forget where you left your keys, walked into a room not knowing why you went there in the first place, or have trouble recalling what you ate last night.  If you are over 50, your first thought or fear is “Am I getting Dementia or Alzheimer’s?”  Not necessarily. There are over 100 conditions which mimic dementia (memory and thinking problems) that are actually reversible and treatable.   These are sometimes called “pseudodementia” “pseudo” meaning “not genuine or false”.  In other words, disorders or conditions that mimic dementia like symptoms.  For example, reactions to medications, emotional distress (i.e., depression), vision and hearing (undetected problems of vision or hearing (may result in inappropriate responses, which may be misinterpreted as dementia), nutritional  deficiencies, endocrine abnormalities, infections, brain injury, normal pressure hydrocephalus (increased pressure on the brain due to interruption of the flow of the spinal fluid), brain tumors,  or stroke, are some of those “reversible” dementias .  The reason your memory is not as sharp as when you were younger could also be subsequent to normal aging process of the brain.  As the body ages, so does the brain. As the body ages, it becomes physically more difficult to perform so does the brain; it becomes slower and loses its ability to think efficiently.  This does not mean you have a disease or illness, it may be just normal aging process.

The proportion of US citizens older than 65 years of age is growing steadily.  It is estimated that 20% of the population will be over 65 years of age by 2030.  This aging of the population is expected to bring an increase in the incidence of depression and dementia.  It has been estimated that as many as 10-20% of people over the age of 65 may be affected by chronic brain syndromes with a rise of 25% when individuals over the age of 80 yeas old are considered separately. As many as 4 million people have an intellectual impairment severe enough to meet the criteria for dementia.”  Although depression and dementia have many similarities, they also have important distinctions.

B.  How to Differentiate Between Dementia or Depression?

It is important to know that “dementia” is a syndrome consisting of disturbances in distinct cognitive functions.  The main symptom in dementia is memory loss, but other functions are also affected, such as orientation, reasoning, problem solving, judgment, visual-spatial performance, language, and change in personality and emotions. Dementia is an acquired disorder with evidence of decline in cognitive functions from a previous level of function, as demonstrated by history and Neuropsychological (cognitive) testing.  As a result, social, occupational, and functional abilities can deteriorate. The most common pseudodementia and the most easily misdiagnosed is that associated with depression. General internists and family practitioners fail to recognize major depression in up to 20% of their outpatients with the disorder, either as depression misdiagnosed as dementia or vice versa.  The ability of primary-care physicians to recognize and correctly treat depression is important since only approximately 20% of people with depression are treated by mental health professionals.  This is especially crucial since both disorders especially depression, are treatable and misdiagnosis may cause an individual with potential full cognitive function to be unnecessarily confined in long-term care faculties (Yesavage, 1993).  While cognitive and behavioral difficulties (e.g., forgetfulness, sad mood, slowed thinking) in depression are similar to those with suspected dementia, performance on neuropsychological tests offers a distinct profile.  To diagnose the cause of dementia, a complete medical and Neuropsychological evaluation is recommended and a complete patient history is very important. It is of vital importance to understands the differences between depression and dementia, as the treatment for each is different.

C. What is Neuropsychological Evaluation?

A neuropsychological evaluation is a comprehensive evaluation of cognitive, behavioral, and emotional functioning performed using standardized tests and procedures. A Neuropsychologist uses a wide variety of paper/pencil and computerized tests that are very sensitive to even mild brain dysfunction.   Typically the evaluation includes 60-90 minutes of clinical interview about presenting problems, symptoms, medical history, and background, followed by 4-6 hrs. of formal testing. The evaluation can be scheduled for a single day or divided into several days, dependant upon the fatigue level of the patient and time.  At the completion of the report, the Neuropsychologist reviews the results of he evaluation with the patient and his/her family and makes treatment recommendations.  A copy of the report can also be forwarded to the referring physician and other health care providers.

If you or a loved one  is interested in being examined for possible  dementia, we offer memory loss testing for dementia in Laguna Woods Orange County CA

ARTICLES BY DR KALINIAN

 

 

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