Diagnosing Alzheimer's. A Mayo Clinic specialist explains the process and importance of early detection.
Eric Tangalos, M.D.
In this interview, Eric Tangalos, M.D., a primary care physician and geriatrician affiliated with the Alzheimer's Disease Research Center at Mayo Clinic, Rochester, Minn., explains why older people with memory problems should have a thorough diagnostic workup. If fears are confirmed, information and planning can smooth the path for the ensuing years.
Does everyone have to go through a battery of tests?
It is a good idea to have a full evaluation when contemplating the diagnosis. I tell people that there's not a better investment in time or effort. There are lots of brief tests that can be done in the office, but they can only screen for disease and may miss a problem altogether. Longer cognitive tests are more thorough and provide information that has greater accuracy.
How can people recognize the early signs of Alzheimer's?
In the earliest stage of the disease, a diagnosis can be really difficult. What you're looking for is something that doesn't fit with the individual's former level of function. That's why family members often notice the symptoms first. The disease is more than just memory — it can involve language, problem solving or even how we draw a clock.
It's easy to misplace your car in the parking lot. That's happened to all of us. But most of us eventually find our cars. People with Alzheimer's lose the capacity to adjust and solve the problem of the lost car. In fact, they might jump to the conclusion that the car has been stolen.
Alzheimer's is a progressive disease that first manifests itself with problems usually related to memory. Over time, people have more difficulty with tasks. By the end of the disease process, Alzheimer's is pretty easy to recognize. Our goal is to find out from family as quickly as possible when something is truly amiss in order to do something about it.
Why don't people go to their doctor sooner?
There remains a tremendous anxiety regarding Alzheimer's. They want to blame aging even when they can tell that other people their age aren't having the same difficulties. People hide their symptoms, or spouses cover for them. There's a fear of losing control. They don't want to give up their driving privileges or go in a nursing home. But just because you have a memory problem doesn't mean you can't drive a car. We look for what you have retained as well as what you may have lost.
Do some doctors hesitate to make an Alzheimer's diagnosis?
Many doctors still believe that an early diagnosis of Alzheimer's would overwhelm both families and physicians. It takes a lot of time and effort to manage the disease, both from the person's family and from his or her physician. That's why the Alzheimer's Association tries to provide resources in the community.
I like to use the Alzheimer's word sooner rather than later. I don't want my patients or families to hide from it. We believe in diagnostic disclosure because we think there is a lot that can be done for the problem and that the sooner it is recognized, the more we have available as treatment options.
Today, I think we're talking about Alzheimer's as openly as we were starting to talk about cancer 30 years ago and about depression 10 to 15 years ago. It's a real disease, long before it prevents a person from functioning, and we need to do something about it.
Do people need to be referred to a neurologist?
Most of the doctors treating Alzheimer's are primary care physicians. I've asked neurologists for help with a diagnosis, especially with younger patients. But many people, particularly frail older adults, can't get to any medical center with specialists. It's just too hard for them to travel.
The problems facing people with Alzheimer's are issues of society and economy, and these are best handled by a primary care physician, as long as there are resources in the community to help and the doctor has a true interest in understanding the disease and his or her patients with it.
What's the benefit of an early diagnosis?
There are both drug and nondrug interventions, and everything works best in the earliest stages of disease.
What else can be done?
People with Alzheimer's do better when they have a routine. It allows them to refresh and reinforce their pattern of behavior every day. They get to relearn their habits over and over and this is good.
When you put them in strange surroundings, they don't do well. That's why they may have trouble when you bring them to your house for the holidays, or if they have to be hospitalized. A change in routine is not good for people with Alzheimer's — there are just too many problems to try and solve.
The change in routine is one of the reasons why people with Alzheimer's often have such a swift downturn after the death of a spouse. The spouse may have been helping to both think for and protect the person.
Are there other benefits of early diagnosis?
The earlier you're diagnosed, the more capable you are of deciding how you want the rest of your life to be structured. Predictable routines will help you succeed instead of fail.
The sooner you move into a structured environment, the more protected you'll be. The ideal setting is probably one that includes independent housing, assisted living and nursing services on the same campus. The same philosophy is at play throughout, so there's less to learn with each move.
I tell people to move early or late, but not in the middle stages of their disease. Each move will result in a decline in the person's retained abilities. In the early stages, the person can adjust to it better. And in the late stages, their function is already extremely impaired. The middle stage is where we can still try to keep the patient from really losing ground, and a move at this time causes the disease to deteriorate even further.
The problem is that most people don't get diagnosed with Alzheimer's until they reach the middle stage. If you move them during this middle stage, their function declines and it doesn't come back.
What do you hope to see in the future?
I'd like to see people come in earlier for diagnosis. The real problem is that they're coming too late. That's easy to understand because Alzheimer's is such a devastating disease. But we'd like patients and families to run toward a diagnosis, rather than away from it.
Last Updated: 12/05/2006
