Memory Loss: Is it Alzheimer's?

I am noticing increased forgetfulness and anxiety in my 69-year-old husband. He refuses to go to the doctor and has not been seen for at least 20 years (though he will go to the dentist and eye doctor). I wonder what I can do to inform myself and possibly convince him to get help. I wonder what might cause these symptoms other than Alzheimer's disease and whether it might possibly be treated successfully.

-- JoAnne

Question:

There are many possible causes of forgetfulness and anxiety besides Alzheimer's. For instance, depression and other emotional conditions can result in memory impairment (often related to attention/concentration problems) and anxiety. Therefore, appropriate diagnosis is important.

Alzheimer's is a type of dementia (a disorder characterized by multiple problems in mental functioning). Long-term alcoholism can result in dementia, as can transient ischemic attacks (TIAs, or "mini-strokes"), brain injuries or tumors, Pick's disease, Parkinson's disease, Huntington's disease, infectious diseases (such as the AIDS or syphilis), endocrine disorders (such as hypothyroidism or hypoglycemia), Creutzfeldt- Jakob disease, vitamin deficiencies, multiple sclerosis, and other conditions. Alzheimer's is, however, the most common form of dementia. Some forms of dementia (or the diseases causing the dementia) respond to treatments, while others are essentially incurable, although medication and other interventions may slow or ease their course. I'm not aware of any cure for Alzheimer's.

A medical examination by a physician, including appropriate laboratory tests and imaging such as CT scans or MRIs, can determine whether your husband has a physical or medical condition resulting in dementia. However, a medical examination alone CANNOT determine whether memory loss is caused by a dementia rather than a depressive disorder or other emotional or psychological condition. A neuropsychological evaluation performed by a psychologist is the best way to do that.

So I'd recommend first trying to get your husband to see a psychologist for a neuropsychological evaluation. If the psychologist determines that your husband's changes are related to depression or another psychological condition, he or she can talk with both of you about options such as therapy or counseling or medication. If the psychologist believes your husband has a type of dementia, you can then follow through with a physical examination. In that case, the psychologist can still continue to work with both of you regarding treatment planning.

Answer: