The 'Grey's Anatomy' Alzheimer's Test: Could You Pass It?

By Sharon Tanenbaum | Medically reviewed by Ed Zimney

Characters from the hit show are testing patient memory as part of an Alzheimer's disease clinical trial — but should you worry if the questions trip you up? 

 

Wednesday, March 30, 2011 — What did you do for Thanksgiving last year? Where did you go on your honeymoon? Starting at 100, count backward by seven. Remember the following three-word sequence: truck, cabin, spoon.

These are among the series of questions Derek Shepherd and Meredith Grey are asking of Alzheimer’s disease patients to determine whether they’re qualified for entry into a clinical trial on this season’s Grey’s Anatomy.

But if you’re sitting on the couch five minutes later struggling to remember the word “cabin,” should you worry about your own brain health? And just how accurate is such a test at gauging Alzheimer’s disease risk? Everyday Health asked leading memory experts for answers. 

What the Grey’s Memory Tests Means

 

Although the test used on the TV show is not identified by name, some of the questions, like the three-word memory sequence and counting back directive, are included in the Folstein Mini Mental State Examination (MMSE), a 30-point questionnaire introduced in 1975.

“It’s the most commonly used cognitive evaluation for memory loss,” says Cynthia Green, PhD, assistant clinical professor of psychiatry at Mt. Sinai School of Medicine in New York City. “It’s a screening test, so it doesn’t delve deeply into someone’s mental functioning across different areas of intellectual performance.” (Other types of MMSE questions include drawing certain pictures and performing a three-step command, such as “take a piece of paper, fold it in half, and place it on the floor.”)

Keep in mind that the questions used by Derek and Meredith in their fictional version of the test are just a sampling of the total number of questions that would be used in a real test. Otherwise the limited number of answers wouldn’t tell clinicians much. The questions portrayed on TV are such a small snippet that the results are not that significant for the average person, says Dr. Green. And the question of whether a patient can remember where she spent her honeymoon isn’t likely to be on a real test: “That’s more of a remote memory, which is usually retained until later stages of the disease,” Green notes.

 

Senior Moments vs. Real Red Flags

 

So why can’t you remember the above word sequence or where you parked the car at the supermarket? You probably just weren’t paying attention, or you were multitasking or just plain distracted. Such everyday “senior moments” aren’t enough to raise a red flag for dementia, says Green.

“Everybody forgets things once in a while. It’s important to forget, otherwise think how awfully full your brain would be. You wouldn’t be able to sleep at night,” says Laurel Coleman, MD, a geriatric physician in Augusta, Maine, and national board member of the Alzheimer’s Association.

What is concerning, according to Green: “When a change in memory lasts for four to six months, impairs your ability to function independently at work or at home, and if your family and friends notice a change in your abilities or behavior.” If you or a loved one experience any of these symptoms of possible dementia, you should talk to your doctor and get evaluated.

Even then, keep in mind that memory loss doesn’t automatically mean you have Alzheimer’s, which counts language problems, disorientation, and face-recognition issues among its other symptoms. “Memory loss can be a symptom of at least 75 different medical conditions,” says Green, including a vitamin B12 deficiency, thyroid disorders, emotional distress, depression, and side effects from medication.

Alzheimer’s is the most common form of dementia, accounting for about 70 percent of cases in people age 71 and older. But it strikes only five percent of people between 65 and 74. The younger you are, the more likely a memory-related issue is something other than Alzheimer’s.

“We worry so much about memory loss because it’s something we’re afraid of,” says Green. “But since there are so many different things that can cause it and many of those conditions are reversible, it’s important to seek evaluation, and to do it sooner rather than later.” 

The Role of Memory Tests in Real-Life Alzheimer’s Studies

 

Diagnosing Alzheimer’s disease is challenging, since the only way to definitively determine the presence of disease is by looking at brain cells after someone has died. Instead, doctors evaluate the likelihood of Alzheimer’s with a variety of tests that also seek to rule out other possible causes of dementia.

These can include a thorough medical history, complete physical examination, lab tests of blood, urine, and sometimes spinal fluid, and brain scans, in addition to cognitive testing. Doctors at specialized Alzheimer’s treatment centers can diagnose the disease with 90 percent accuracy, according to the National Institute on Aging. Read more about how Alzheimer’s is diagnosed here.

During the cognitive tests, clinicians check on a wide range of brain functions — assessing not just memory— but a patient’s calculation ability, attention, insight, judgment, and how they prioritize things, says Dr. Coleman. “We examine a variety of things because people think in so many different ways.” 

Clinical Trials for Alzheimer’s Disease

 

The fictional Grey’s Anatomy clinical trial highlights the importance of real-life research: According to the Alzheimer’s Association, there currently are more than 100 Alzheimer’s clinical trials that need 50,000 volunteers — with and without the disease — to participate. Such trials are studying new ways to detect, treat, and prevent Alzheimer’s and related types of dementia.

Although researchers can’t offer regular mental state exams by Dr. McDreamy, if you or a loved one is coping with an Alzheimer’s diagnosis, consider finding a study that may be right for you through the Alzheimer’s Association Trial Match program or on ClinicalTrials.gov. Research shows that people involved in studies tend to do somewhat better than people at a similar stage of Alzheimer’s who are not enrolled in trials, the association says.

Language Fluency May Ward Off Dementia

By Michael Smith, North American Correspodent, MedPage Today

The ability to learn and speak two languages in addition to one's native tongue appears to keep the brain in shape, protecting it from dementia.

 

Wed. Feb. 23, 2011 — Speak English? Parlez français? Habla espanol?

Those who can say yes, oui, or si to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Dr. Magali Perquin, of the Public Research Center for Health in Luxembourg, and colleagues. 

---

Get a Memory Boost From These Foods

---

Moreover, the effect appears to add up — more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

“It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study,” Perquin said in a statement.

The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called “cognitive reserve” — developed by intellectual activities — protects against dementia.

Indeed, a similar study from a Canadian group, presented at the annual meeting of the American Association for the Advancement of Science this month, showed that having two languages rather than one appeared to delay the onset of dementia.

The “use it or lose it model of cognitive function” has been gaining popularity for several years, according to Richard Lipton, MD, of Albert Einstein College of Medicine in New York City. With colleagues, Lipton showed in 2003 that such activities as chess, bridge and doing crossword puzzles appeared to protect against Alzheimer’s disease.

In that context, Perquin’s findings “are not surprising to me,” Lipton told MedPage Today.

But he cautioned that there are at least two other possible explanations for such data, including his own findings.

On one hand, he said, it’s possible that the intellectual activities themselves are not protective, but that being the sort of person who does crossword puzzles or learns several languages is the key factor.

On the other hand, he said, it may be that the causality is reversed — that incipient cognitive impairment impairs the ability to perform such activities.

But the study is “fascinating,” he added, and “as an optimist, I would like to believe it is completely true.” 

---

Which Conditions Are Related to Dementia?

---

The so-called MémoVie study in Luxembourg is a longitudinal analysis of cognition and its risk factors in the elderly and one of the aspects of the study is the effect of multilingualism.

Luxembourg, a small country in the heart of western Europe, has three official languages and a large number of people who speak several tongues.

For the analysis, participants in the MémoVie study were classified as having normal cognition, some cognitive impairment, or frank dementia, with the latter being excluded.

All told, 44 participants had cognitive impairment and the remaining 186 were cognitively normal, the researchers reported.

Participants had spoken — or currently spoke — two through seven languages; those with only two languages were considered the reference group for a multivariate analysis that adjusted for age and years of education, Perquin and colleagues reported.

Analysis showed that, compared with bilinguals:

• Participants who had spoken three languages were four times more likely to be protected against cognitive impairment.
• Those with four or more languages were even better off — they were six times less likely to develop dementia than those who mastered only their native tongue.

Perquin noted that more research is needed to confirm the findings and to see if protection is limited to thinking skills related to language “or if it also extends beyond that and benefits other areas of cognition.”

Common Causes of Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Alzheimer's disease is the best-known cause of dementia — but there are a slew of other causes, too. Do you know what they are?

 

Dementia is really a big umbrella term that covers a number of different conditions that cause dementia symptoms. Of these, Alzheimer’s disease is the most common and perhaps best known — but it’s not the only one.

“There are many different types of dementia,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa. “The most common types of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, and Parkinson’s disease. All types of dementia are characterized by abnormal neurodegeneration, that is, brain cells dying off in high numbers daily. In most cases, this leads to cognitive and behavioral deficits or, in Parkinson’s disease, to deficits in motor skills.”

One of the ways in which types of dementia are categorized is by where the damage to these cells is occurring in the brain.

Broadly speaking, types of dementia are grouped as cortical or subcortical. Cortical refers to dementias that originate in damage to the cortex — the outer, gray, wrinkled layer layer of brain tissue with which people may be most familiar. Subcortical dementia has its roots in structures below the cortex, inside the brain. The dementia symptoms vary based on whether the dementia is cortical or subcortical. Despite this distinction, dementias of all kinds often involve multiple parts of the brain, and there is ongoing debate as to whether this is a meaningful way to categorize dementia symptoms.

 

Cortical Dementia 

 

Cortical dementia is likely to result in dementia symptoms such as loss of memory, loss of the ability to recognize people, and difficulty recalling the right words for things or concepts. Cortical dementias include:

• Alzheimer’s disease. Alzheimer’s disease causes a loss of memory and ability to think clearly. It is a progressive disease, eventually leading to a loss of ability to complete tasks of daily living.
• Creutzfeldt-Jakob disease. Also sometimes called mad cow disease, Creutzfeldt-Jacob occurs when naturally occuring brain proteins called prions start to change shape. This leads to cognitive impairments such as loss of memory, changes in thought processes, and changes in behavior.
• Frontotemporal dementia. This type of dementia results from degeneration of cells in the frontal lobe; it's characterized by behavioral and language deficits at a relatively young age — as young as 40.
• Wernicke-Korsakoff syndrome. This type of dementia is due to a deficiency in thiamine (vitamin B1) but is also often related to a history of heavy alcohol consumption or to having AIDS, or acquired immunodeficiency syndrome. Memory is affected, and people with this dementia often tell untrue stories that they fully believe to be true. Physically, this dementia can interfere with a person’s ability to move smoothly.

 

Subcortical Dementia

 

Dementia symptoms associated with subcortical dementias include loss of motor skills and the ability to learn processes, resulting in a general sense of slowing down. These types of dementia include:

• Huntington’s disease. A rare, inherited cause of dementia, Huntington’s disease leads to problems with motion such as twitches and lack of balance or coordination and may also lead to changes in mood, personality, and behavior.
• Parkinson’s disease. Parkinson’s disease is characterized by the gradual loss of motor skills, or shakiness and tremors while in motion. People with Parkinson’s disease may eventually experience other dementia symptoms, such as loss of memory.
• Vascular dementia. Vascular dementia occurs as the result of loss of oxygenated blood to parts of the brain. This can be the result of a single stroke or many small strokes, in which case it is called multi-infarct dementia. Evidence shows that subcortical vascular dementia also has effects in the cortex, leading to cortical dementia symptoms.

Some types of dementia appear to affect both cortical and subcortical areas of the brain. Dementia with Lewy bodies falls in this group. This type of dementia occurs because clusters of a certain type of protein called alpha-synuclein form in the neurons in various areas of the brain, leading to impaired memory, motor skills, and mood. Dementia with Lewy bodies can resemble both Alzheimer’s disease and Parkinson’s disease — and Lewy bodies are often found in patients with other types of dementia.

These are only a few of the many possible causes of dementia — and it’s important to understand the cause of your dementia because it will affect treatment decisions.

8 Dementia Myths and the Truth Behind Them

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Maybe you've heard that drug abuse causes dementia, or that red wine will protect you from the disease. Here are the facts. 

 

Perhaps because Alzheimer’s disease and dementia are something of a mystery, there are a number of myths surrounding their causes. A few of these common myths hold some truth, but some are complete falsehoods that muddy the water about the roots of symptoms and how to prevent dementia.

Need help separating good dementia information from bad? We’ve gone to an expert to get the facts.

Myth No. 1: Dementia is caused by exposure to aluminum.

Cooking in aluminum pots and drinking from aluminum cans came under suspicion as a cause of dementia a number of years ago, when this myth first spread. But there is no truth to the fear, says Paul B. Rosenberg, MD, assistant professor of psychiatry and behavioral sciences in the division of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine in Baltimore.

“This was an inference from a type of dementia caused many years ago by aluminum that made its way into dialysis patients, but aluminum has nothing to do with dementia as we diagnose it now,” explains Dr. Rosenberg.

Myth No. 2: Dementia is caused by early drug abuse.

Rosenberg says this is an area that has not been thoroughly explored, but currently there are no data to support a connection between drug abuse and Alzheimer's or dementia. Drug abuse isn’t a healthy choice for many other reasons, however.

Myth No. 3: There is nothing you can do about dementia once you have it.

While dementia is by definition a progressive disease, there are steps you can take to slow its progress and find ways to compensate for your lost cognitive abilities in the early stages. Work with your doctor to find medications that might help address symptoms of dementia, and try to stay as physically, mentally, and socially active as possible.

Myth No. 4: Concussions in youth and middle age cause dementia.

News about the increased rates of early dementia in former football players has stimulated this myth, but the jury is still out, says Rosenberg. “There is a suspicion that concussions in young or middle age increase risk for dementia in old age, and we are trying to study this now.”

Myth No. 5: Red wine protects you from dementia.

“There is a little evidence that low-level social drinking — one drink or less per night — may be protective, but that finding is quite controversial,” says Rosenberg. The controversy arises because heavy drinkers tend to die young, skewing the data. Meanwhile, people interested in the protective benefits of resveratrol, a chemical found in red wine, should take heed: “You probably have to drink 20 bottles per night to get a good dose,” says Rosenberg.

Myth No. 6: If someone in your family has dementia or Alzheimer’s disease, you will have it too.

Not so, say the experts. Some forms of dementia do have a genetic component, especially if a close relative such as a parent or sibling has the disease — but as with many inherited diseases, you have some control over how inherited risk plays out in your own life. “Our evidence is that good heart health — exercise, controlling blood pressure and cholesterol — will help prevent dementia,” says Rosenberg.

Myth No. 7: Alzheimer’s disease and dementia are the same thing.

Alzheimer’s disease is the most common form of dementia, but there are other types of dementia characterized by different symptoms.

Myth No. 8: Gingko biloba can prevent memory loss.

For a while, researchers were looking at the herbal supplement gingko biloba as a way to slow or prevent memory loss — but studies have shown no effect on memory. “Gingko was a nice idea, but it didn’t work at all,” says Rosenberg.

These are just some of the myths that surround the subject of dementia. But remember, it's always advisable to get dementia information from reliable sources, such as your doctor, instead of relying on rumors about causes or ways to prevent dementia.

Normal Memory Loss or Dementia?

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH 

Lost your keys? Don't stress — a memory glitch here and there often accompanies aging. Lost your way home? This could be signaling something more serious.

 

Is it just age-related memory loss — or the early signs of Alzheimer’s disease? Sooner or later, you will ask this about yourself, your spouse, or someone else in your family. But the question of whether you are noticing dementia signs is not an easy one to answer.

A certain degree of forgetfulness may accompany aging. Normal memory loss most often means that you have a harder time recalling new pieces of information, such as the name of a person you met for the first time last week.

“Typical signs [of dementia] are extreme forgetfulness, not just forgetting the keys here and there. Rather, forgetting where one is, whether or not one just ate, forgetting to put shoes on before going outside, and that sort of thing,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa.

So if you go for your daily walk and experience a little confusion about how to get home, should you worry? Many experts, like Andel, think it’s a good idea to err on the side of caution and get in touch with your doctor if you have moments of forgetfulness that worry you.

“The difference can be very subtle, and any suspicion should be consulted and/or confirmed by a professional, such as those working at memory clinics of Alzheimer’s disease centers,” he says. The advantage to working with an expert, such as a neurologist, is that an expert can give you memory tests that help determine whether your experience with memory loss is normal or not.

 

Dementia Signs that Indicate a Problem

Consider these red flags of memory loss and cognitive problems:

• Does it interfere with daily life? Everyone forgets a name, only to remember later — but if you’re consistently forgetting appointments, can’t remember how to cook foods you’ve always been able to cook, or people tell you you’ve asked them for the same information multiple times, those are more serious signs.
• Do you have trouble thinking things through? We’ve all made a mess of our accounting once or twice, but if you just can’t figure out how to balance your checkbook or plan the kind of trip you used to enjoy, it may be time to seek help. In fact, a recent study suggests that problems remembering how to handle money foreshadows an Alzheimer’s diagnosis by up to a year.
• Are you having trouble retracing your steps? Everyone misplaces their keys, but most people usually can go back over their steps to find them again. Dementia signs include an inability to retrace your steps to find lost items.
• Are you at a loss for words? We all know about the tip-of-the-tongue phenomenon, when a word you want is just out of reach. But frequently being unable to come up with the word or phrase you want can be a sign of Alzheimer’s disease.
• Do you lose your sense of place and time? Forgetting where you are, how you got there, the order of events, or even what day it is — these are all more than just “normal” signs of memory loss.

 

Other Causes of Forgetfulness

It’s natural to worry about dementia and Alzheimer’s disease as causes of your more-than-normal forgetfulness, but you should know there are some other possible causes, including:

• Alcoholism
• Dehydration
• Depression
• Head injury
• Medication side effects
• Protein deficiency
• Stroke(s)
• Vitamin B12 deficiency

When you talk to your doctor about your concerns about memory loss and the risk of Alzheimer’s disease, she should also ask questions that will help her find out whether there may be other causes of your problems.

“True dementia cannot be reversed whereas cognitive impairment due to other causes can be reversed" in many circumstances, says Andel.

So if you’re worried, talk to your doctor. At best, you will be reassured that your occasional forgetfulness is normal for your age — and at worse, you will be able to start early with dementia treatment and management strategies.

The Enigma of Early-Onset Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH

The risk of being diagnosed with dementia increases with age — but for a small group of people, dementia symptoms start appearing as young as 35. 

 

Dementia is usually thought of as a health concern of the elderly — but for a few patients, a dementia diagnosis comes earlier. This loss of memory and cognitive abilities at a younger age is called early-onset dementia. Diagnosis of early dementia is a challenge, and dementia treatment is complicated by the demands of younger families and jobs.

“The majority of cases of dementia in the United States are in people over 65, and 50 percent are in people over 85 years old but … we’ve seen patients who have the disease at 35,” says Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago.

As many as 6 percent of Alzheimer’s disease cases occur before age 65, usually in a person’s forties or fifties. Close to 60 percent of those cases are inherited — 13 percent appear in families in which three generations have developed Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia symptoms, but other causes of early-onset dementia include:

• Vascular dementia. Changes in blood flow to parts of the brain, often due to mini-strokes, can begin in mid-life.
• Frontotemporal dementia. A fatal disorder in which parts of the brain shrink.
• Parkinson’s disease. Motor skills — walking, balance, and the like — deteriorate because the brain stops producing dopamine.

The Complications That Come With Early Dementia

 

Early-onset dementia comes with complications that do not arise in later years, including:

• Difficult dementia diagnosis. Dementia is usually not a doctor’s first conclusion when a person starts to lose cognitive function in middle life — which means that it can take a while to arrive at a correct diagnosis. However, while the diagnostic process is taking place, dementia symptoms can wreak havoc on personal relationships and work obligations.
• Family. When people are diagnosed over age 65, they are usually finished with child-rearing responsibilities, but early-onset dementia can interrupt family life as adults in middle age may still be raising children, supporting young adults in college, and even caring for their own aging parents.
• Employment. Dementia treatment often focuses on helping patients stay as long as possible in the working world. Patients and families also have to work with employers to adjust workloads or tasks to suit abilities.
• Finances. The burden of early dementia combined with the possible loss of employment can cripple a family’s financial situation.
• Qualifying for services. Many services and funding programs are only available for people over age 65, which means patients with early onset dementia and their families have to work harder to get the support they need.

Handling an Early Dementia Diagnosis

 

“We have to take a slightly different approach to building the care plan,” says Dr. Shah. A care plan is a detailed approach to dementia treatment that creates a so-called web of services around the patient and his family. These services include a medical team, occupational therapists, support groups, and community services or agencies that can provide assistance.

Therapy may be necessary for the children and spouses of the dementia patient, who may experience significant anger, grief, and resentment over an early dementia diagnosis. The care plan has to be adjusted as the needs of the patient and family caregivers change.

There may be a perception that early dementia progresses more rapidly than later onset dementia, but this is likely because everything related to dementia treatment, including entering a nursing home, is happening at an earlier age rather than happening more quickly or severely.

Early onset dementia places a significant burden on families — but with the dedicated help of their medical team, friends, family, and coworkers, patients may be able to maintain quality of life for many years.

The Seven Stages of Dementia

By Madeline Vann, MPH | Medically reviewed by Niya Jones, MD, MPH

From "no impairment" to "very severe," knowing the seven stages of dementia can help guide you as a caregiver. 

 

One of the main topics of discussion when someone is diagnosed with dementia is the “stage” of the disease — a marker of how far it has progressed.

Dementia symptoms can range from mild memory loss to more severe cognitive difficulties that make it hard to manage daily activities without help. These symptoms are broadly grouped into categories called stages that help guide doctors and families in their care of dementia patients.

“Usually we think of memory loss as a continuum,” explains Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago. “Dementia is defined as chronic memory loss, ultimately affecting quality of life.”

Dr. Shah points out that people with dementia progress along the memory loss continuum in their own individual way, and often there is no clear-cut moment when you know that your loved one has moved from one stage to another. Becoming familiar with the stages of dementia, however, is still useful for giving care. This can help guide:

• Expectations. You and your family members will have a general idea of what your loved one’s future may hold and you can make plans accordingly.
• Treatments. The medications available to help control dementia symptoms have been studied in clinical trials during different stages of dementia. Not all medications are necessarily appropriate for your family member, depending on their specific symptoms and stage of dementia.

The Stages of Dementia

The stages of dementia are as follows:

• No impairment. At this stage, there are no obvious signs of dementia and people are still able to function independently.
• Very mild. Dementia signs are barely noticeable and simply appear to be the kind of forgetfulness associated with aging — such as misplacing keys but finding them again after some searching.
• Mild. At this stage, patients are “usually able to do basic activities of daily living,” says Shah — which means they can perform their daily routines, such as getting up, going to the bathroom, getting dressed, and so on, without difficulty. Symptoms of dementia at this stage may include:
  • Some forgetfulness and memory loss
  • Repetition
  • Losing items without being able to retrace steps to find them
  • Slight trouble managing finances, such as balancing a checkbook
  • Confusion while driving
  • Trouble managing medications
  • Loss of concentration
• Moderate. At this stage patients have “trouble doing routine tasks that they always did, such as cooking, laundry, or using the phone,” explains Shah. Other dementia symptoms during this stage include:
  • Trouble holding urine (incontinence)
  • Increase in memory loss and forgetfulness
  • Inability to use or find the right words and phrases
  • Difficulty doing challenging mental math exercises, such as counting backwards from 100 by 7
  • Increase in social withdrawal
• Moderately severe. At this stage, dementia patients will need some assistance with their day-to-day activities. Symptoms of moderately-severe dementia include:
  • Increase in memory loss, including inability to remember home address, phone number, or other personal details
  • Confusion about location or chain of events
  • Trouble with less challenging mental math exercises
  • Needing help to select appropriate clothing for the climate, season, or occasion
• Severe. “Caregivers have to help a lot more with day-to-day activities” at this stage, says Shah. Dementia signs at the severe stage include:
  • Needing help to get dressed
  • Requiring help with toileting, such as wiping and flushing
  • Wandering and becoming lost if not supervised
  • Inability to recall the names of family members or caregivers, but still being able to recognize familiar faces
  • Sleep disturbances
  • Changes in personality or behavior, such as increased paranoia or even hallucinations
• Very severe. This is the final stage of the disease. Symptoms of dementia during this stage include:
  • Loss of language skills
  • Loss of awareness of surroundings
  • Requiring help to eat
  • Lack of control over urination
  • Loss of muscle control to smile, swallow, or even walk or sit without support

In order to determine your loved one’s stage of dementia, your doctor will ask a variety of questions of both the patient and the caregiver. These questions may include some mental tests. One frequently used screening tool is called the Mini-Mental State Examination, an 11-question exam that can help pinpoint cognitive decline on a scale of 0 to 30. In general, Shah says that a score between 14 and 26 points correlates to mild/moderate stage dementia and a score between 4 and 14 correlates with severe dementia.

It’s important to remember that the stages of dementia are somewhat fluid — use them to help plan for future changes and to work with your doctor to develop a solid treatment plan.

What Is Sundowner's Syndrome?

By Dennis Thompson, Jr. | Medically reviewed by Kevin O. Hwang, MD, MPH

People with Alzheimer's may develop agitation and other behavioral problems, which seem to worsen as the day progresses. To help them cope with "sundowning" symptoms, think "calm" and "structured." 

 

Sometimes people with Alzheimer's disease become more and more agitated as afternoon dissolves into evening. They pace and wander about, becoming more and more aggravated as the darkness deepens. Confusion, paranoia, and demanding behavior all become increasingly noticeable. Eventually, the person might yell or even lash out physically because of their growing frustration.

This phenomenon has long been called "sundowning" because of its prevalence during evening hours. Doctors now believe, however, that this behavior has little, if anything, to do with the sun going down. "That term has been around since the 1960s and 1970s and is now a little outdated," says Christopher Callahan, MD, a professor at the Indiana University School of Medicine and director of the Indiana University Center for Aging Research in Indianapolis. "The notion used to be that when the sun went down and it got dark outside, there were less external stimuli, and patients would get confused." But doctors now say that symptoms associated with sundowner's syndrome can occur at any point during the day or night in Alzheimer's patients.

Still, an estimated 12 to 25 percent of people with Alzheimer's experience this phenomenon, so if you're caring for a loved one with the disease, it's important to know how to handle sundowning symptoms in the event that they present themselves.

 

Alzheimer's Disease: Causes of Agitation

Doctors now believe that agitation can occur in Alzheimer's patients for a number of reasons, many of them overlapping. Underlying factors involved in the development of so-called sundowning symptoms can include:

• Feeling tired and overwhelmed. "Your brain is often vulnerable after eight hours of being awake. You're tired and you can't handle stimulation as well, you aren't processing it," says Malaz Boustani, MD, a researcher with the Regenstrief Institute and the Indiana University Center for Aging Research, both in Indianapolis. ·
• Having a biological clock that is out of whack. Suffering a hormone imbalance or reacting to other issues that disturb one's "biological clock" can lead to sundowning symptoms. A common cause of biological clock disturbance, for instance, is a lack of exposure to sunlight. ·
• Changing routines. For those accustomed to daylong activities, a lull in their afternoon or evening schedule can cause them to grow bored and restless. ·
• Suffering depression symptoms. People with Alzheimer's may feel depressed and as a result may have trouble in their daily functioning, increasing their potential for agitation.

Some doctors believe that the caregiver or facility looking after the Alzheimer's patient can also be a reason for the person's behavior. "You see it most of the time in an institutional situation," Dr. Boustani says. If your loved one is cared for in a nursing facility or by other hired help, Dr. Boustani recommends looking at sundowning symptoms as "a red flag that the staffing isn't adequate or skilled enough to meet the needs of Alzheimer's patients."

For example, the caregiver could be inadvertently communicating stress or fatigue to the Alzheimer's patient, making the person nervous or anxious. Or a nursing home may regularly have a sudden increase in stimulation late in the day, through noise or social interactions, which can then make the person with Alzheimer's agitated. Even bright lights kept on all night can lead to irritation in an Alzheimer's patient.

 

Easing Sundowning Symptoms: Begin with a Structured, Calm Day

The best way to keep people with Alzheimer’s from becoming agitated is to introduce some structure and peace into their daily routine. The following tips can help:

• Maintain a regular schedule. Wake the person at the same time every day and provide meals on a regular schedule each day. Make bedtime the same time every day, too. ·
• Limit caffeine. Be aware of the caffeine content in any food or drinks that your loved one consumes and limit intake as much as possible, especially in the afternoon and evening. ·
• Provide regular activity. It's important to keep people with Alzheimer's involved or interested in activities during the day; this will not only distract them from the agitation and confusion of Alzheimer's but it also discourages napping so that the person is able to fall asleep at bedtime. Activities that incorporate exercise are encouraged as they burn up additional energy and make it easier for the patient to sleep at night. A daily walk, which benefits both the patient and the caregiver, is often recommended, for instance. ·
• Wind down the day. As it gets closer to the person's bedtime, gradually decreasing the amount of stimulation the person experiences will help them to calm down. Turn down the sound on radios, televisions, and stereos and try to keep the home as dark as possible. Limit evening visitors and move noisy family activities to another part of the house, away from the person with Alzheimer's. ·
• Seek out medical help. If your loved one is unable to become calm enough to get to sleep at night, visit your doctor — he or she can look into other medical conditions that might be making it difficult for your loved one to sleep, and can recommend specific treatments.

Can Caffeine Ward Off Alzheimer's?

By Marie Suszynski | Medically reviewed by Pat F. Bass III, MD, MPH

A hot cup of joe may do more than keep you awake through your next meeting. Research is finding that it may help prevent memory problems. 

 

Anyone with a family history of Alzheimer’s disease or dementia wants to do everything possible to avoid the diseases. Now, researchers have found that some protection may be as close as your coffee mug.

The Journal of Alzheimer’s Disease recently published a special supplement of key findings that suggest caffeine may help keep the brain functioning properly and help ward off Alzheimer’s and dementia.

Here’s what researchers are discovering about caffeine’s role in the brain and how it may protect against memory problems.

 

Key Research Findings About Alzheimer’s and Caffeine

Research shows that caffeine seems to have a big effect on adenosine receptors, which are found in brain cells. An imbalance of adenosine has been associated with neurological disorders like Alzheimer’s disease, and higher levels of caffeine intake seem to protect against Alzheimer’s disease. Researchers believe regular consumption of caffeine “normalizes” memory function, or protects against the loss of memory, especially among people who are under stress. And stress is a well-known cause of memory problems.

One study found that coffee drinking during the previous two decades was associated with a lower risk of developing Alzheimer’s disease. Another study of 1,409 people 65 and older found that drinking three to five cups of coffee a day meant a 65 percent decreased risk of developing Alzheimer’s disease, compared with consumption of little or no coffee.

Animal studies also found that caffeine had beneficial effects on the brain, but the research is conflicting. Some studies have concluded that moderate doses of caffeine helped memory, while high doses seemed to hurt it.

Though caffeine seems to help protect against memory problems, researchers aren’t convinced that it actually enhances memory. A review of studies of caffeine’s effect on memory in people who don’t have dementia found conflicting results — several studies that suggested it improved memory, while others found that it didn’t. At best, researchers say, caffeine may be mildly beneficial in this regard.

 

Applying the Research to Alzheimer’s Prevention

Although there’s no evidence that anyone can prevent Alzheimer’s disease, some doctors like Dharma Singh Khalsa, MD, the Tucson, Ariz.-based founding president and medical director of the Alzheimer’s Research and Prevention Foundation and author of Brain Longevity, believe that numerous lifestyle factors can have an important impact on the brain and be protective.

Nutrition, stress-management, exercise, mental stimulation, and possibly hormone therapy may all influence how healthy your brain is, Dr. Khalsa says. “Caffeine is the next level out. Caffeine is a mild stimulant — we think stimulation is synonymous with a better-functioning brain,” he explains, but adds that there’s no one magic bullet. Living a complete, healthy lifestyle is important for keeping your brain healthy.

 

Other Strategies to Thwart Dementia

While filling up your coffee mug every day may offer some protection, here are other important approaches to Alzheimer’s prevention.

• Eat a balanced diet with plenty of vitamins. Diets that focus on fruits and vegetables with little red meat, such as the Mediterranean diet, are associated with healthier brain function, Khalsa says. Getting enough B vitamins, fish oil, and vitamins C and E may also contribute to a healthy brain.
• Stop stressing. Lowering your stress level, particularly when you do it with exercise, is also part of the cognitive health picture, Khalsa says.
• Stay mentally active. Continue to constantly challenge yourself with new, stimulating experiences from travel to artistic expression to just enjoying nature. Learn to play a new musical instrument or dabble in a hobby you’ve always wanted to try.

Although caffeine looks promising and is easy to get, leading a lifestyle that includes a variety of brain-healthy practices is your best bet.

What's Involved in Reaching an Alzheimer's Diagnosis?

By Dennis Thompson Jr. | Medically reviewed by Niya Jones, MD, MPH

Learn which medical exams and screening tests may be needed before a clear diagnosis of Alzheimer's disease can be made. 

Diagnosing Alzheimer's disease as early as possible can help patients and their families to better prepare for the progression of the disease. But diagnosing Alzheimer's can be a complicated process, given that it is only one of a group of brain diseases known as dementia, meaning neurological disorders that rob the mind of its intellectual ability.

Alzheimer's expert Malaz Boustani, MD, MPH, recommends that family members get a potential Alzheimer's patient checked out, even if they just have a "gut feeling" something might be wrong. "That feeling in and of itself is a big red flag, and families need to get their loved one evaluated as soon as possible. If you have any doubt — even if it just crosses your mind — it's worth investigating," says Dr. Boustani, assistant professor at the Indiana University School of Medicine and a center scientist with the Indiana University Center for Aging Research.

Alzheimer's Diagnosis: Finding a Doctor
If you or a family member needs to be evaluated for Alzheimer's disease, medical experts say the first stop should be your primary care physician. Your family doctor will often coordinate the diagnostic process. If your doctor wants more input from a specialist, you could be referred to one of the following professionals:

• A geriatrician, a medical doctor who specializes in the care of elderly patients
• A neurologist, a medical doctor who specializes in diseases of the brain or nervous system and can assess different types of dementia
• A psychiatrist, a medical doctor who specializes in mental disorders and can diagnose a mood disorder, such as severe depression that may mimic Alzheimer's symptoms.
• A psychologist, a licensed medical professional (a PhD or PsyD) who can test such mental functions as logic, memory, and concentration.

Boustani says that ideally, any specialist you see should have training in memory disorders and dementia. It can often be difficult, however, to find someone with those qualifications. "Our current health care system, unfortunately, doesn't have enough memory-care practitioners capable of performing a full diagnostic assessment," he says.

Screening Tests for Alzheimer's
Currently, the only definitive way to diagnose Alzheimer's disease is by looking at brain cells under a microscope after a person has died. But since that's too late to do the person any good, physicians have come up with a battery of tests that can help determine the likelihood of an Alzheimer's diagnosis. Experts believe that a skilled doctor using these tests can diagnose Alzheimer’s accurately in nine out of 10 cases.

Doctors can evaluate the possibility of Alzheimer's disease by:

• Taking a medical history. During this process, the doctor will learn whether anyone in the patient's family has suffered from Alzheimer's or other forms of dementia. The doctor will also ask about any medications or illnesses that could cause side effects that resemble Alzheimer's symptoms. Both the patient and their family must be involved in this step, since short-term memory loss is an early symptom in 75 percent of people with Alzheimer's and family members may have to help provide key information.
• Administering a mental exam. A series of tasks will test the patient's memory and problem-solving skills. Attention span is also assessed, as well as the ability to count and speak logically.
• Performing a thorough physical examination. This hands-on exam includes a general check-up as well as a neurological exam that tests things like muscle tone, reflexes, and coordination. The doctor will also order blood work and urine test(s), and may order other, more specialized testing such as an MRI or CT scan of the brain.

Alzheimer's Diagnosis: Ruling Out Other Causes
Most of the aforementioned tests aren't just used to look for Alzheimer's disease. They're also aimed at ruling out other conditions that could be interfering with a person's memory. For example, problems with memory or concentration can stem from an emotional disorder. "You might have depression, which can include memory complaints," Boustani says.

A person with symptoms common to Alzheimer's also might be suffering from a brain tumor, or bleeding inside the brain caused by a bad fall or a stroke. In other cases, memory loss could be caused by different forms of dementia, by a reaction to a medication the person is taking for an unrelated illness, or even by a vitamin deficiency. The important thing is to undergo the screening process so you know what's wrong and can address it appropriately, Boustani says.

As with most medical conditions, an earlier diagnosis can bring quicker treatment and help ease the stress of dealing with a new illness. If you have any concerns about your risk of Alzheimer's, do not hesitate to contact your doctor. Together you can decide on what, if any, testing is best for you or a loved one.