The Small Guide to Alzheimer's Disease. Gary Small

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       • Determine the patient’s functional abilities and level of independence.

       • Draw blood for laboratory testing to assess whether medical illnesses are present.

       • Perform a brain scan, such as a magnetic resonance imaging (MRI), a computed tomography (CT), or possibly a position emission tomography (PET) study.

      Although I first meet with everyone together, I let them know that I will spend time alone with each of them during the appointment. Explaining this at the beginning of the visit helps minimize any anxious or paranoid feelings that patients or family members may experience when I request to speak with individuals alone. It also makes it easier to perform cognitive testing on the patient without caregivers cueing the patient and biasing the assessment. Further, those individual meetings allow family members to speak more freely about their concerns when the patient is out of earshot.

Preparing for the Appointment

      Visiting the doctor can be quite an anxiety-provoking experience. This is especially true when people are concerned that the diagnosis may be one that will have a negative prognosis, such as Alzheimer’s disease. That anxiety can distract patients and family members to the point that they often forget important questions they wanted to ask during the appointment.

      It’s a good idea, therefore, to write out your questions in advance of the appointment with the doctor so you are sure to cover all the points that you wish to address. It’s also helpful to bring in a summary of the patient’s medical history. In order for doctors to summarize the patient’s problems, they generally follow a systematic approach. Knowing this system that doctors use to organize their notes (see box) can help you prepare for their needs.

Information Contained in Doctor’s Notes

       • Chief complaint. Main symptom(s) of concern to the patient/family

       • History of present illness. An account of the timeline and nature of the current illness

       • Past history. A summary of previous relevant illnesses, both general medical issues and neuropsychiatric conditions

       • Educational and social history. A review of accomplishments and challenges

       • Risk factors and protective factors. Smoking, alcohol, head trauma history; exercise, diet, psychological stressors; and other relevant lifestyle habits

       • Review of systems. A check of different body organs and systems (eyes, lower-body function [i.e., gait], lungs, heart, etc.)

       • Pertinent medical history and medications. These details sometimes shed light on physical conditions that can impair cognition

       • Physical, neurological, and mental exam results, previous test and scan results. The doctor’s summary of the findings from the evaluation procedures and medical record

       • Impression. The diagnostic impressions listed by the doctor

       • Treatment plan. The doctor’s itemized plan, including need for more testing, medication interventions, and nonpharmacological strategies

Medicines That Worsen Memory

      It’s important to bring a list of all the patient’s current medications to the appointment with the doctor. Over the years, patients tend to change doctors or have multiple practitioners caring for them, so taking an inventory of all the medicines can not only be revealing; it can also lead to improved cognitive abilities and overall better care. If the medication regimen is disorganized or complicated, I encourage families to bring the actual medication bottles to the appointment so I can review them systematically with the family. This is very important because so many medications can trigger cognitive symptoms, and sorting out what might be causing side effects or drug interactions can have an important impact on the patient’s outcome.

      Usually patients with cognitive complaints are older, and as we age we are more likely to take multiple medications. Approximately 10 percent of patients presenting with suspected dementia are experiencing a medication side effect that is contributing to the cognitive decline. Several medicines used to treat psychiatric illnesses, sedating drugs, or narcotic agents can disrupt cognition as well. Histamine H2 receptor antagonists (e.g., famotidine or Pepcid, cimetidine or Tagamet) for stomach problems, cardiac medications such as digoxin and beta-blockers, corticosteroids, nonsteroidal anti-inflammatory agents (e.g., naproxen or Aleve, ibuprofen or Motrin), as well as antibiotics can all cause confusion.

      Did You Know?

      Although memory lapses are the most common reason that patients see a doctor for cognitive changes, other symptoms can trigger that initial doctor visit as well. For 23 percent of patients, personality changes lead to an evaluation, while 15 percent complain about difficulties with complicated tasks.

Beware of Anticholinergic Drugs

      Many people are not aware of the fact that over-the-counter medicines for allergies (diphenhydramine or Benadryl) or sleep (e.g., Sominex, which also contains diphenhydramine) are anticholinergic. This means that they counter the effects of acetylcholine, a neurotransmitter or brain messenger important for normal memory function. In fact, several of the drugs approved for the treatment of Alzheimer’s symptoms are effective because they boost the function of this brain messenger. Drugs with anticholinergic properties have been used to treat many symptoms of medical conditions, such as asthma, chronic obstructive pulmonary disease, diarrhea, epilepsy, gastrointestinal problems, insomnia, motion sickness, overactive bladder or urinary incontinence, Parkinson’s disease, psychiatric disorders (depression, psychosis, anxiety), muscle relaxation or anesthesia during surgery, and toxicity of certain poisonings.

      Medicines with even mild anticholinergic effects may impair memory function in middle-aged and older adults with minimal age-related cognitive complaints. A recent study published in JAMA Internal Medicine showed that prolonged exposure to several kinds of strong anticholinergic drugs is associated with a greater risk for developing dementia. In that study, Dr. Carol Coupland and her colleagues studied hundreds of thousands of people in the United Kingdom and found that prolonged exposure to anticholinergic antidepressants, anti-Parkinson’s drugs, antipsychotics, bladder anti-muscarinic drugs, and antiepileptic drugs all increased dementia risk. For older people who used the minimum effective daily dose of a single, strong anticholinergic medication over three years, the investigative team found a nearly 50 percent increased risk for developing dementia within a 10-year period.

      People with myasthenia gravis, hyperthyroidism, glaucoma, enlarged prostate, high blood pressure, urinary tract blockage, increased heart rate (tachycardia), heart failure, severe dry mouth, hiatal hernia, severe constipation, liver disease, Alzheimer’s disease, or Down syndrome should avoid using these medicines. If you are taking a medication that you think may be exposing you to anticholinergic effects that СКАЧАТЬ