Are you at risk for Alzheimer’s disease (AD)? Here are some hints if you are in trouble.
The field of aging and dementia is in particular focus today. When is it just aging? When is it dementia? When is it more than just absent-mindedness, yet not Alzheimer’s disease (AD)? Is there a premonitory state, a category of people who are at particular danger of developing AD? The answer today is yes. Though not all of those fulfilling these symptoms will develop AD, a majority will. Concentrating our efforts on this group may be important for prevention.
Dementia comes from two Latin words: ‘de,’ meaning out of, and ‘mentis,’ meaning mind. Therefore, dementia means to be out of one’s mind. The practical difference between natural aging and dementia is that an aging mind still has the ability to live independently. The demented mind, even with one’s best effort, cannot do so. One recognizes reality and the other one increasingly loses it. Recent research has identified a transitional state between normal cognitive decline and AD. We call this Mild Cognitive Impairment (MCI). Both clinical criteria and now imaging and laboratory criteria seem to overlap in distinguishing a segment of our population that is at high risk for developing AD. Studies have estimated that those fulfilling the criteria for MCI develop AD at a rate of 17-20% per year.
However, not all develop AD. Recognizing this group is important for both medical treatment and practical reasons. The practical reasons are that these individuals can make the proper choices for their future health care and life before they lose their ability to do so. Medical treatment, risk mitigation, and prevention are a must. Family, financial, and social support can begin to optimize their life, mitigate their being victimized by predators, and delay early entry in a nursing facility.
Reverent George, well known and loved at the hospital, told me the story of how he first met his wife in Brooklyn back in the days when horse drawn buggies still carried the groceries to the people (rather than the huge markets that we have today). As he described the sounds of wagon wheels, the sights of the red clay buildings, and smells of fresh fruits that permeated the air of the city (as if it existed at that moment in the hospital cafeteria), I could not but feel anxiety as he recounted these wondrous events for at least the tenth time to me in the past thirty mornings.
Reverend George still drove himself, visited patients diligently, and was no danger to himself or to others. However, everyone had begun to notice his recurrent stories, name and word finding difficulties, decreased attention to detail and personal hygiene, and a heavy reliance on his daily planner. The tell-tale signs of his last meal he often wore on his tie. His great wealth of history and his pastoral empathy overshadowed any shortcomings, except for those who knew him as intimately as I did. Since I had moved from New York to California, Reverend George had become my extended family father. Through the years, he had cultivated my interest in Bioethics through casual references of books that I might find interesting, which I did. Soon, our early morning visits at the doctors’ dining room for breakfast became a tradition or a habit I looked forward to, as I knew he did.
Four years after the onset of these symptoms, I was called to the Emergency Room after he had not shown up for breakfast. He had been in a motor vehicle accident that morning, having gone through a red light. Now looking back at the typical signs of MCI criteria, Reverend George had started to fulfill them four years before.
The criteria can be categorized into four main points. First, memories of recent events become vague and a reliance on old stories predominates. Second, behaviorally they become less fastidious and occasionally need to be reminded to groom. Third, though their judgment perception and reasoning is intact, there is a measurable difference noted by family and friends. Fourth, in comparison to their age related contemporaries, their reaction time and memory performance lags with heavy reliance on notes.
The dividing line between MCI and AD is not a line at all, but a grey zone often demarcated by an event that clearly indicates an inability to function independently or safely. It may be as apparent as an accident, a sudden episode of disorientation or hallucinations, or as subtle as forgetting an appointment. Once it begins, it slowly but insidiously worsens with peaks of lucidness and valleys of sudden deterioration.
