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Diagnosing brain disorders

November 14, 2005|by Dr. Matthew Wagner

My memory is getting worse. I think I am getting Alzheimer's."

This thought occurs to many people as they get older and perceive their memory as failing.

Dementia often is misunderstood by the public. Dementia is a syndrome of loss of memory, language, non-verbal abilities and the ability to plan and carry out tasks. When someone suffers a loss of memory and other brain functions severe enough to cause problems in everyday functioning, doctors will consider a diagnosis of dementia.

Since memory, language, non-verbal abilities and the ability to plan and carry out tasks reside in the brain, the syndrome of dementia can be thought of as brain failure.

A diagnosis of dementia does not refer to the cause of the problem. Just as other organ failures (heart or kidney failure, for example) can have many causes, so can dementia.

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The task of the evaluating doctor is to find out what is causing the loss of brain functions so as to guide treatment. This is made easier by the fact that 90 percent of dementia cases are caused by only two diseases - Alzheimer's disease and vascular disease of the brain.

Let's take them one at a time.

Alzheimer's disease is a gradually progressing condition that starts out with trouble retaining new information and leads to more severe memory problems later on. The disease becomes obvious when a person starts to have trouble remembering things like how to write a check or follow a recipe. A person might become lost while driving.

As the disease progresses, problems arise in using words properly or in comprehending ideas. Later on it might be difficult to do simple things such as putting on clothes or bathing properly. Persons with Alzheimer's often show personality changes. They might lose interest in things they once enjoyed and start to withdraw from life. They become excessively anxious or angry at times.

Alzheimer's usually gets worse over a period of years. In the late stages, a person loses the ability to meaningfully communicate. He or she becomes confused and has trouble walking, eating and managing simple things such as going to the bathroom. At this stage, constant supervision is needed because of loss of basic judgment.

Alzheimer's disease shortens life span, although predicting how long an individual will go on with the disease is difficult.

Behavioral and emotional problems are common during the course of this disease. A person might show signs of depression. Paranoia and hallucinations can occur. Sleep problems are common. A person might do embarrassing things because of loss of social judgment. Doctors have treatments for these complications that can be helpful.

The cause of Alzheimer's is not known, but research suggests genetic factors. A person might have a hereditary vulnerability to the disease, but other factors might affect how early or late it develops. These factors will be discussed in another article.

The disease is rare in middle age but becomes more common in the 70s and 80s. The basic problem is premature death of brain cells in the different regions of the brain. There is a lot of research going on to understand why and how this happens. This might help us to prevent or slow down the disease.

There is at present no test for Alzheimer's. The diagnosis is made based on a person's history and examination and by doing simple tests to rule out other medical conditions that can cause similar symptoms. A doctor will order tests for thyroid or vitamin deficiencies, infections of the brain and anemia. If the doctor suspects other neurological conditions such as stroke or tumor of the brain, he will order imaging studies of the brain (CT or MRI).

Blood vessel disease of the brain ("hardening of the arteries") includes strokes or "mini-strokes" which are lesions that might not produce stroke symptoms but accumulate over time to damage the brain.

Blood vessel disease causes dementia similar to that caused by Alzheimer's, but it is often accompanied by other signs. These often include incontinence, speech problems and unsteady walking.

Less common causes of dementia include Parkinson's disease, head trauma, alcoholism and a number of other, rare causes.

Dr. Matthew Wagner is a staff psychiatrist with Behavioral Health Services of Washington County Health System.

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