American Medical Association Family Medical Guide - American Medical Association [431]
Usually, personality does not change as a person gets older but, in the early stages of Alzheimer’s disease, two key aspects of personality—conscientiousness and the ability to handle stress—may decline. People with the disease eventually display poor judgment and may become angry and belligerent, especially when someone tries to prevent them from doing something inappropriate or tries to help them.
Other Causes of Dementia
Dementia is a term for a progressive loss of memory and other mental functions, such as language. Alzheimer’s disease is the most common form of dementia. Vascular dementia, the second most common form of dementia, occurs when small blood clots obstruct tiny blood vessels in the brain, causing multiple strokes that damage brain tissue. The symptoms of vascular dementia can be identical to those of Alzheimer’s disease.
Lewy body dementia results from the presence of abnormal structures (Lewy bodies) in multiple areas of the brain. Symptoms often start with hallucinations or impaired thinking and movement difficulties similar to those of Parkinson’s disease (see page 691). Less common types of dementia can result from thyroid problems (see page 901), vitamin B deficiencies, hydrocephalus (enlargement of the fluid chambers in the brain), syphilis (see page 483), or AIDS (see page 909).
Creutzfeldt-Jakob disease and a variant of it, bovine spongiform encephalopathy (also called mad cow disease), are degenerative diseases of the brain caused by an infectious protein called a prion.
In general, symptoms become more obviously abnormal as the disease progresses. People with Alzheimer’s disease have difficulty expressing themselves and understanding what is said to them, and they have trouble reading and writing. They may have problems sleeping and may feel anxious, suspicious, and agitated. They frequently are restless and may pace. These behavior problems often get worse in the evening, a situation doctors call sundowning.
When mentally impaired people live alone, or when they are unsupervised, they are in danger of falling, setting fires, or having other accidents. Impaired hearing or vision can complicate the problem, preventing them from taking their medications as prescribed, crossing the street safely, or eating properly. Some people wander away from home frequently. You can minimize these risks by giving your loved one proper supervision and an identification bracelet to wear at all times or a card to carry, with your address and telephone number on it.
The late stages of Alzheimer’s disease bring speech loss as well as the loss of bladder and bowel control. People with the disease lose weight as they lose their appetite or simply forget to eat. They may neglect their personal hygiene and need help using the toilet. They may forget how to perform simple tasks, such as combing their hair or using a can opener, and be unable to recognize family members. Eventually, people with Alzheimer’s disease become totally dependent on their caregivers, who are usually family members—primarily spouses or daughters. Caregivers face an immense amount of pressure as they are forced to look after the person 24 hours a day. Many families are forced to make the difficult decision to place their loved one in a nursing care facility.
Diagnosis
No test is available to diagnose Alzheimer’s disease in a living person. At present, the only way to make a definite diagnosis is by performing an autopsy to detect the characteristic plaques and tangles in the brain. A doctor can, however, diagnose probable Alzheimer’s disease with about 85 percent accuracy using a number of diagnostic tools. He or she will get a detailed