The Small Guide to Alzheimer's Disease. Gary Small

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СКАЧАТЬ They found that symptoms of depression occurred in approximately half of the patients over 20 months prior to their diagnosis of dementia. Symptoms of anxiety occurred in more than one out of five patients 8 months prior to their diagnosis of dementia. Both depression and anxiety symptoms may continue to develop after the diagnosis of dementia. As the disease progresses, other behavioral disturbances are more likely to emerge, such as agitation, irritability, hallucinations, and aggression.

      Often these different syndromes of combined mood and cognitive impairment can be sorted out based on the most prominent symptom, whether it is depression, anxiety, memory loss, or something else. For depression, mood changes are usually present, but physical symptoms are common as well, such as appetite loss, insomnia, and fatigue. However, it can become confusing when patients present with what appears to be a dementia but their condition is actually due to an underlying major depression. The syndrome has been termed pseudo-dementia, and patients will complain about memory issues and confusion as well as other symptoms typical of depression, such as sleep disturbances, fatigue, and appetite loss. Interestingly, the patient may not actually feel sad.

Diagnosing Major Depression

      To help doctors identify the cluster of symptoms that indicate severe cases of depression that go beyond normal mood fluctuations, they sometimes use a diagnostic mnemonic: SIG E CAPS. “SIG” is what doctors write on prescription pad directions and is short for the Latin signetur, or “let it be labeled.” E stands for “energy,” and CAPS is short for “capsules.” So the mnemonic tells us “when to prescribe the energy capsules.” Each of the letters stands for one of eight diagnostic features of major depression:

       Sleep decline or increase

       Interest loss

       Guilt feelings

       Energy depletion

       Concentration difficulties

       Appetite change

       Psychomotor disturbance (e.g., pacing, fidgety, or slowed down)

       Suicidal thoughts

      When people with depression have any four of the SIG E CAPS symptoms together, they should see a doctor to determine if they have a major depression that will respond to treatment.

If in Doubt, Just Find Out

      Because of fear and anxiety about the possibility of a diagnosis of Alzheimer’s disease, many people play down their memory symptoms and deny that they have a problem. It is easy to rationalize since so many people experience forgetfulness as they age. Memory-loss deniers tell themselves that everyone their age has the same forgetfulness they do, so there’s probably nothing really wrong.

      The danger of waiting while symptoms worsen is that the longer a person waits to seek out help, the further the degree of neurodegeneration, which means that symptomatic treatments may be less effective. The research and common sense indicate that it is easier to protect a healthy brain than to try to repair damage once it becomes extensive.

      My advice to people who are concerned about their memory is to have it checked out sooner rather than later. At best, the doctor can reassure the patient that their memory decline is normal for their age. If a diagnosis of mild cognitive impairment or Alzheimer’s dementia is made, then the patient can get started early on a treatment. Such treatments will not cure the disease, but they can mitigate the symptoms, delay future cognitive decline, and help the patient live a longer and more fulfilling life despite any cognitive losses.

       Chapter 2

      Seeing the Doctor

      I become faint and nauseous during even very minor medical procedures, such as making an appointment by phone.

      —Dave Barry

      My office door was closed, but I could still hear my new patient, George, arguing with his wife, Karen, in the waiting room. Both in their late 60s, they had been referred to me by their family doctor because of George’s memory problems. I opened the door and asked them to come in. Karen marched in first, angry, and sat on the edge of the couch. George sat beside her and remained silent.

      “How can I be of help?” I asked.

      “I’m worried about George’s memory,” Karen said. “He’s forgetting things right and left, and he seems spaced out half the time. It reminds me of when my stepfather came down with Alzheimer’s disease. He needs help.”

      I looked to George and asked, “What has it been like for you?”

      He shrugged and said, “It’s not just me. Everyone I know is becoming forgetful. Even you, Karen.”

      Karen rolled her eyes. “You see, he’s in complete denial. I don’t know what to do. It reminds me of my stepfather.”

      George reached out to comfort her, but Karen moved her arm away.

      I said, “I’d like to ask you both some questions and put together a history—”

      “Why ask me questions?” Karen snapped. “George is the one with the problem.”

      George shrugged, and I said, “That’s fine, Karen. Perhaps you could step back into the waiting room while I speak with George?”

      Karen said, “I’ll wait outside.”

      Once we were alone, George seemed to relax.

      “Look, Dr. Small, it’s not me, it’s Karen who has the problem.”

      “Oh?”

      “Sure, I’m a little forgetful like everyone else I know, but Karen has real memory issues and refuses to admit it.”

      “When did you start noticing this?”

      “She’s been gradually losing it for almost two years now. She repeats herself constantly, forgets people’s names, and can’t find things she just put down. Whenever I try to bring it up, she gets mad and says it’s me who has the problem. I don’t know what to do.”

      “So you’re saying she is the one in denial?”

      “Absolutely. There’s no way she would have come with me to see you today if I hadn’t said the appointment was for me.”

      Like Karen, many people in the early stages of cognitive decline are unwilling to face the reality of what it may mean. Fear of memory loss as we age is almost universal because memory is so important to our independence and sense of self. Karen didn’t want to accept that her memory was getting worse because she worried that she was developing Alzheimer’s like her stepfather did. She felt shame about her increasing forgetfulness and feared that she might eventually become dependent on others for her daily needs. Denial is a common psychological defense mechanism that people use to protect themselves from such uncomfortable СКАЧАТЬ