Early Diagnosis of Alzheimer’s

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It’s easy to drag your feet when faced with receiving possible bad news. I’ve known patients who lived with quite serious symptoms for months before seeing me.

I understand. No one wants bad news.

But if there are treatment options that can mitigate or cure a disease, it’s best to seek out medical help as soon as possible. Am I right?

I’ve often wondered what personality traits make some people delay seeing a physician about something. It’s probably a lot more complicated than a set of personality traits. Prior bad experiences with the health care system, fear that nothing can be done, worry of overreacting, helplessness, fatalism, and fear of the treatment all play a role.

I’ve seen this play out many times with patients who have been experiencing cognitive issues. Some patients took months or years before presenting. Most never presented alone, but with a family member Sometimes a family member contacted me prior to a visit, to ask me to evaluate for cognitive decline.

Alzheimer’s disease is a scary diagnosis for sure. That was my immediate response when I first sensed something was wrong with Harvey’s cognitive abilities. I was petrified! Scared to death about what it all meant for him and our family.

But because he was a physician, I knew it was important to pursue a diagnosis quickly before any of his patients were put in harm’s way.

The average delay in time from the onset of the first symptoms of dementia until seeking care is 6 years, longer in the African American population.

So why is it important to diagnose Alzheimer’s disease or another dementia early rather than waiting?

Firstly, there are medications available that can slow down the progression of cognitive decline, and they work best if given early in the disease. There are currently two classes of medications that do this—not by a direct effect on the cause of Alzheimer’s disease, build up of amyloid plaques and tau tangles—but by assisting the brain cells in carrying messages through the system more efficiently. It’s akin to treating a fever without treating the cause.

There are no medications available that treat the underlying plaques and tangles. There are some in development, though.

The current pharmaceuticals are successful in delaying decline—donepezil by 9 months, and memantine by 6 months. The effects last about 3 years with donepezil, less than that with memantine. Neither medication will increase memory, but they can increase the length of time a person can be independent.

Most drug studies enroll patients in the very earliest stage of Alzheimer’s disease, so delaying a diagnosis may cause a patient to lose out on a potential new therapy.

It would also be important to have a clear diagnosis before a catastrophic event occurs. A spouse may seek divorce from a partner with behavioral symptoms, leaving the affected spouse alone. Too, law enforcement may become involved if behavioral issues are early symptoms of dementia. Employment and family issues may arise causing sudden unemployment and family rifts.

Lastly, another important consideration would be getting the patient’s affairs in order while he or she can still actively participate. It is much easier to obtain legal documents, such as a power of attorney or a will, when the person can make sound judgments and legally sign off on the documents.

I know it’s hard—there is actually nothing easy about Alzheimer’s disease, is there?— but putting off getting a diagnosis when there is a concern about cognitive impairment is not a good idea.