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Dementia signs may come early
Old 07-18-2013, 04:31 PM   #1
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Dementia signs may come early

This subject is meaningful to me, as I have written about it here on ER a number of times, and as it addresses my personal concerns.
Quote:
The man complained of memory problems but seemed perfectly normal. No specialist he visited detected any decline.

“He insisted that things were changing, but he aced all of our tests,” said Rebecca Amariglio, a neuropsychologist at Brigham and Women’s Hospital in Boston. But about seven years later, he began showing symptoms of dementia. Dr. Amariglio now believes he had recognized a cognitive change so subtle “he was the only one who could identify it.”

Patients like this have long been called “the worried well,” said Creighton Phelps, acting chief of the dementias of aging branch of the National Institute on Aging. “People would complain, and we didn’t really think it was very valid to take that into account.”

But now, scientists are finding that some people with such complaints may in fact be detecting early harbingers of Alzheimer’s.
http://www.nytimes.com/2013/07/18/he...Y&ei=5065&_r=0
I have been keeping notes and intend to post here as the movement into more memory loss and coping issues increase.

In particular, the point that the article makes about doctors and close friends not noticing change is especially meaningful. Virtually all persons of my acquaintance, who are my age, are very quick to say that they too, experience memory lapses and that it is common. IMHO, it's not that simple, and the problem is progressive. At this point, I am concentrating on trying to track the degree of progression, and the individual types of disfunction... ie. concentration, multitasking problems, names... including "proper names", and the ability to place memory incidents in the framework of time.

Of course the main concern is how rapidly the problems will increase. Will it be months?... No... First indications came more than five years ago. Will it be years?... hopefully. A good friend has been coping for more than ten years. Will it affect motor skills?... Not so far. Is there a way to slow the progress?... Not sure. Trying to do the suggested mental excercises, and keep the social interaction (skills) intact, though this is becoming more difficult as patience tends to be shorter, and social events less interesting.

Fear is probably the first hurdle to overcome but that is giving way to acceptance. I have basically given in to what others seem to want to see... "It's just a sign of normal aging!". It is easier to handle.

I expect that many, if not most, members have dealt with this, with parents or other family members, and have made their own judgements... pretty much from the outside, looking in. In the instances that I have experienced with family members and my current neighbors, it always looked as if they were not aware of their declining abilities, and that dementia didn't become a serious problem until major incidents with driving, or money matters, or other serious issues became obvious.

Of course the underlying worry is that medical diagnosis will be made. That commonly results in restrictions on driving... the ultimate fear, realized. Anyway, the article is interesting in that it takes the subject of dementia out of the realm of medical diagnosis and into personal, practical experience.
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Old 07-18-2013, 09:38 PM   #2
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Have you gotten evaluated by a specialist? Do they detect evidence of cognitive decline, relative to others in your age group? I know the article says that people can sometimes detect it when the tests cannot, but I'm just wondering if you've been tested.
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Old 07-19-2013, 06:18 AM   #3
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Quote:
Originally Posted by imoldernu View Post
This subject is meaningful to me, as I have written about it here on ER a number of times, and as it addresses my personal concerns.

http://www.nytimes.com/2013/07/18/he...Y&ei=5065&_r=0
I have been keeping notes and intend to post here as the movement into more memory loss and coping issues increase.

In particular, the point that the article makes about doctors and close friends not noticing change is especially meaningful. Virtually all persons of my acquaintance, who are my age, are very quick to say that they too, experience memory lapses and that it is common. IMHO, it's not that simple, and the problem is progressive. At this point, I am concentrating on trying to track the degree of progression, and the individual types of disfunction... ie. concentration, multitasking problems, names... including "proper names", and the ability to place memory incidents in the framework of time.

Of course the main concern is how rapidly the problems will increase. Will it be months?... No... First indications came more than five years ago. Will it be years?... hopefully. A good friend has been coping for more than ten years. Will it affect motor skills?... Not so far. Is there a way to slow the progress?... Not sure. Trying to do the suggested mental excercises, and keep the social interaction (skills) intact, though this is becoming more difficult as patience tends to be shorter, and social events less interesting.

Fear is probably the first hurdle to overcome but that is giving way to acceptance. I have basically given in to what others seem to want to see... "It's just a sign of normal aging!". It is easier to handle.

I expect that many, if not most, members have dealt with this, with parents or other family members, and have made their own judgements... pretty much from the outside, looking in. In the instances that I have experienced with family members and my current neighbors, it always looked as if they were not aware of their declining abilities, and that dementia didn't become a serious problem until major incidents with driving, or money matters, or other serious issues became obvious.

Of course the underlying worry is that medical diagnosis will be made. That commonly results in restrictions on driving... the ultimate fear, realized. Anyway, the article is interesting in that it takes the subject of dementia out of the realm of medical diagnosis and into personal, practical experience.
I sympathize with you and your self-diagnosis may be correct. But on the other hand it may be wrong. There are many people who become convinced that they have some illness, but don't. If I were in your shoes, and I may well be eventually, I would tabulate responses that you feel indicate cognitive decline along with normal responses in order to correct for our normal confirmatory bias. So, I would log failure to recall words, losing track of why you went into a room, etc. along all the times you do those things without any lapse of memory. Then I would graph it and watch it over time.

The purpose would be to try to control for the subject element, which will overemphasize memory errors and underemphasize well functioning. This is analagous to Beck's Inventory for depressive patients. Instead of just reporting that they feel depressed, they repeated answer the questionnaire about how many times they had suicidal thinking, felt worthless, etc. It turns out that by following the changing responses to the detailed questionnaire patients are able to see progress even though their depression has not yet lifted completely. So, it's possible to be more objective even about entirely subjective experiences.

Having assembled some data it may also become apparent under which situations you exhibit loss of memory more often. Perhaps, when you are stressed or in an unfamiliar situation. If so, you may be able to refine strategies for coping.

We have the advantage when we study ourselves. No doctor is going to do anything like that for us, but we can do it ourselves.

Good luck.
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Old 07-19-2013, 06:40 AM   #4
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I would think that by 77 years, virtually everyone will experience some sort of mental decline which could easily be misidentified as Alzheimer's. From the quality of his writing, it's hard for me to see anything other than brilliance.
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Old 07-19-2013, 08:33 AM   #5
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There is a big difference between norma age related memory loss, mild cognitive impairment and Alzheimer's. A neurologist or geriatric psychiatrist can distinguish between these, notwithstanding the NYT article.

Age related memory loss doesn't lead to restrictions on driving, and the impact on one's social life is also limited. A much greater impact on one's lifestyle come from MCI and AD, and this is because the memory loss is much greater, and there is also a decline in reasoning which can lead to other types of risk and exposure.

Here is a useful table from the National Institute of Aging which helps identify different types of memory loss. http://www.nia.nih.gov/alzheimers/fe...early-dementia

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Old 07-19-2013, 09:56 AM   #6
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Thank you guys, for the comments. It's clear that you've thought enough about the subject to be in touch with the part of the article that looks beyond the simple diagnosis of Dementia or Alzheimers.

While my post may have seemed like whining it was far from that. At this point, I don't feel handicapped or even worried about the prospects of disability, but posted as my own approach to looking towards the future... to be aware of possible limitations and to be able to concentrate on whatever workarounds may be necessary in the coming years. My notes to myself lead towards building the awareness, (as Khufu pointed out), and to rely on rote actions, avoidance of risky situations, keeping written reminders, and simplifying responsibilities.

The fear factor, is actually a positive. While I have no intentions of obtaining a diagnosis that could follow me through creating limitations on driving or travel etc, being aware of potential problems has changed some potential bad habits and has led to some "helper" aids for the future.
No cell phone in the car
Removed GPS as a distraction
Added wider rear/sideview car mirrors
Added some handholds in the shower
Railings on stairways
Increased lighting
Calendar on refrigerator
Notepads and pens at strategic places - 3x5 cards
Timers on garage and outside lights
Backups for medications, keys, and even some foods, coffee etc.
All important papers, ID's, Credit cards, Will, Financial details have been scanned and placed in the cloud for access from all of my computers.
Addresses and telephone number lists in both cars.
Our camp in the woods... written list of the shutdowns required when we leave... water, gas, putting away outside things... (back and forth weekly)
List of daily/weekly/monthly tasks and reminders.
-bill dates-trash pickup days-exercise plan-volunteer days-social meetings-cards-medications-appointments etc.

We are in a continuing process of developing permanent locations of household items so that everthing has a place. This means decluttering tables, counters and those corners that seem to accumulate "things". A place for everything and everything in its' place. (A particular nuisance for people like me who have many, many hobbies)

This gets a little far afield from the original post, but represents some early attempts to deal with the possiblity of having to make adjustments.

(Aside)... I use Goggle Alerts to update on news about Alzheimers and recent developments and studies on dementia in general. Of late there have been many, many studies and biological theories having to do with brain growth/decay, chemical imbalance, associated effects of various pharmaceuticals used for other reasons, and large group studies relating dementia to heart disease, smoking, diet (obesity), diabetes etc. The articles on NNT also point in this direction.

I am aware that this subject will not have much interest for younger early retirees, and would only affect a small number of people, but at some point, almost everyone will have some contact with the problem, and some general understanding might help in dealing with those affected. Talking to mom or dad, or uncle John in the context of dealing with the progression of the disease, may be easier and more meaningful in the framework of their own experience.

(thanks for the chart, Michael)
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Old 07-19-2013, 03:06 PM   #7
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My takeaway from the article was that temporary memory loss, like forgetting a name until the next day, was normal enough, but permanent loss of something significant was perhaps indicative of future problems. That's not too bad, since I've had all the normal age related stuff but always recover quickly.
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