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One of my favourite books is The Cider House Rules by John Irving, where one character is a middle-aged man who is confused and forgetful. It turned out he had early Alzheimer’s disease.
Today, it would be barely credible that people hadn’t heard of Alzheimer’s – the most common cause of dementia – as it seems to be constantly in the media, thanks to widespread awareness-raising campaigns. Half of people now say dementia is the health condition they fear the most, according to data from Alzheimer’s Research UK.
So, I was fascinated to see that a book is being published called Is it Alzheimer’s? 101 answers to your most pressing questions about memory loss and dementia.
The author is Dr Peter Rabins, formerly a psychiatrist at Johns Hopkins University School of Medicine in the US, who specialised in treating people with dementia.
On formal memory tests, the difference may not be as much as you think. In one kind of test, for instance, people are given a list of 10 unrelated words, and then several minutes later, are asked how many they can recall. The average 25-year-old can remember six or seven of them. The average 75-year-old can remember five.
“What normal ageing involves is misplacing glasses, or your keys, or having difficulty coming up with familiar words or the names of people,” said Dr Rabins. “There’s no doubt that there are people who are worrying unnecessarily.”
“We usually require that the problem affects somebody’s daily functioning,” said Dr Rabins. “So if someone always paid the bills, was able to cook and clean the house, was able to plan trips – if those kinds of things start to be much more difficult, that’s when they should be evaluated by a professional.”
Brain scans can help in diagnosis (Photo: Tek Image/Science Photo Library/Getty)Memory loss that is not yet dementia
In Alzheimer’s, this is caused by the death of brain cells and loss of their connections to each other, perhaps triggered by the build-up of a toxic protein called amyloid.
This progression is not inevitable, though, and a quarter of people with MCI revert to “normal” memory levels in the next year. This may be because in their initial test, their performance had was artificially low because of temporary problems, like having a cold or a bad night’s sleep.
Of course, that’s impossible for a person to gauge by themselves – it would have to be measured on tests. But there are some signs that help distinguish between whether someone has ordinary forgetfulness and MCI or early dementia, said Dr Rabins.
“It’s often helpful to ask somebody that the person knows well – a partner or a good friend – if they’ve noticed any forgetfulness or other problems in thinking, beyond just coming up with words or names every so often.”
In the UK, there is no simple blood test for Alzheimer’s that can give a definitive diagnosis, although these are in development.
One condition that can be confused with dementia – but has a better prognosis – is functional cognitive disorder or FCD.
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FCD may begin if someone wrongly thinks that the ordinary memory lapses that happen with ageing are a sign they have dementia, which starts a vicious circle of effortful remembering and worsening memory performance.
Benefits of raised awareness
The raised awareness of dementia that has happened over the past decade or two has benefits, of course. It must have been awful for the families of those affected when few people had heard of their condition and there was so little understanding or support.
Early diagnosis has its advantages, like letting people get their financial affairs in order and set up lasting powers of attorney. On the other hand, there are as yet no good treatments for dementia that can slow its progression to any meaningful degree, so it can upset patients for little purpose, he said.
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I’ve been reading
The plot couldn’t have been better designed to lure me in. It’s about a female journalist who stumbles across the scoop of her career, and it has a science angle: a woman is claiming to have had a virgin birth. I won’t give away any more of the plot, but will say that I couldn’t put it down. I’ve now just started another of her novels, Shy Creatures, and it’s just as absorbing.
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