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   The New Old Age - Caring and Coping   
       
   Is It Really Dementia?   
   By PAULA SPAN  OCTOBER 21, 2014 1:22 PMOctober 21, 2014 1:22 pm 31 Comments   
      
   Maybe it's something else.   
      
   That's what you tell yourself, isn't it, when an older person begins to lose   
   her memory, repeat herself, see things that aren't there, lose her way on   
   streets she's traveled for decades? Maybe it's not dementia.   
      
   And sometimes, thankfully, it is indeed some other problem, something that   
   mimics the cognitive destruction of Alzheimer's disease or another dementia --   
   but, unlike them, is fixable.   
      
   "It probably happens more often than people realize," said Dr. P. Murali   
   Doraiswamy, a neuroscientist at Duke University Medical Center. But, he added,   
   it doesn't happen nearly as often as family members hope.   
      
   Several confounding cases have appeared at Duke: A woman who appeared to have   
   Alzheimer's actually was suffering the effects of alcoholism. Another   
   patient's symptoms resulted not from dementia but from chronic depression.   
      
   Dr. Doraiswamy estimates that when doctors suspect Alzheimer's, they're right   
   50 to 60 percent of the time. (The accuracy of Alzheimer's diagnoses, even in   
   specialized medical centers, is more haphazard than you would hope.)   
      
   Perhaps another 25 percent of patients actually have other types of dementia,   
   like Lewy body or frontotemporal -- scarcely happy news, but because these   
   diseases have different trajectories and can be exacerbated by the wrong   
   drugs, the distinction    
   matters.   
      
      
   The remaining 15 to 25 percent "usually have conditions that can be reversed   
   or at least improved," Dr. Doraiswamy said.   
      
   In trying to tell the difference -- not a job for amateurs -- one key   
   consideration is age, said Dr. Ronald C. Petersen, director of the Mayo   
   Clinic's Alzheimer's center.   
      
   Dementia is highly age-related, he pointed out. In a 50-year-old, memory   
   problems might very well have some other cause. But "the likelihood that a   
   75-year-old's becoming forgetful over six to 12 to 18 months is due to   
   something treatable and fixable is    
   low," Dr. Petersen said. "But not zero."   
      
   Which points to another key question: speed of onset. Dementia tends to   
   develop slowly; family members often realize, in retrospect, that an older   
   person has shown subtle cognitive decline for years.   
      
   When a person's mental state changes suddenly over a few days or weeks,   
   however, "that's not the usual picture of a degenerative disease," Dr.   
   Petersen said. "That means looking for something else."   
      
   The list of other causes for dementia-like symptoms runs surprisingly long.   
   Among the leading culprits, Dr. Doraiswamy said, are depression and anxiety.   
   Like dementia, they can interfere with the ability to concentrate and remember.   
      
   He looks next for thyroid deficiency. "Thyroid problems are very prevalent,   
   and thyroid has a huge effect on the brain at every age," he said. Usually,   
   "this can be relatively easily tested for and relatively easily fixed" with   
   daily medication.   
      
   Vitamin deficiencies probably qualify as the most hoped-for scenario.   
   Cognitive problems caused by lack of vitamin B1 (thiamine) or B12 are   
   reversible with pills or injections.   
      
   Heavy drinking also causes memory loss. "If you stop drinking, if it's not too   
   late, the brain can repair itself," Dr. Doraiswamy said. After years of   
   alcoholism, "you may not be able to repair the damage, but you can keep it   
   from getting worse."   
      
   Sleep disorders, and in particular sleep apnea, can take a cognitive toll on   
   older people. "Their cognitive function may become slower, with poor attention   
   and concentration," Dr. Petersen said. When patients with apnea use a C.P.A.P.   
   machine, "they come    
   back the next year markedly improved."   
      
   Sleeping pills -- you knew this was coming -- and a variety of other drugs,   
   especially in combination, frequently cause dementia-like symptoms, too.   
      
   "There's a long list, several hundred drugs, both prescription and over the   
   counter, that can impair memory," Dr. Doraiswamy said. He rattled off a bunch:   
   medications for nausea and urinary incontinence, older antihistamines like   
   Benadryl, cardiac drugs,    
   painkillers, certain antidepressants and anti-anxiety medications -- yes,   
   including benzodiazepines. Selectively deprescribing may help clear a   
   patient's head.   
      
   There's more. Head injuries that lead to the blot clots called subdural   
   hematomas. High blood pressure. Diabetes. Infections. A condition called   
   normal pressure hydrocephalus. Delirium that develops during hospitalization.   
      
   Plus, older people can have any of these problems along with actual dementia.   
   Treating the other causes may at least slow, though not stop, cognitive   
   decline.   
      
   So it makes sense, Dr. Petersen said, to tell patients and families -- many   
   already terrified of dementia -- that other causes exist. "We shouldn't just   
   dismiss them," he said. "We scan the brain, do blood tests. We look for these   
   other conditions. That'   
   s common and not inappropriate."   
      
   On the other hand, "I want to be realistic," he said. "I do it softly at   
   first, but I introduce the notion that we might not find something else."   
      
   Because even though the list of other possibilities is long, so are the odds   
   against restoring a patient to normal functioning. When it looks like   
   dementia, sadly, most of the time it is.   
      
   Paula Span is the author of "When the Time Comes: Families With Aging Parents   
   Share Their Struggles and Solutions."   
      
      
   http://newoldage.blogs.nytimes.com/2014/10/21/is-it-really-demen   
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    * Origin: you cannot sedate... all the things you hate (1:229/2)