Caregiver Series: Aging or Alzheimer's: Know the Warning Signs

Some changes, like needing bifocals to read the newspaper, are perfectly normal as our eyes age. As our brain ages, it's normal to briefly forget the day of the week or struggle a bit to find the right word. For some people, changes in their brain's ability to function as it used to may signal the onset of a dementia-related illness such as Alzheimer's disease.

So is it aging or Alzheimer's?

It can be difficult to tell the difference between a normal change and a potential warning sign of Alzheimer's disease. That's why it's important to seek an evaluation from a board-certified geriatrician, such as Rosemary D. Laird, MD, MHSA, Geriatrician with the AdventHealth Medical Group.

Dr. Laird and her team at the Centre for Senior Health in Winter Park are deeply knowledgeable about geriatric cognitive issues. Whether a patient has a concern, or a family member has noticed a problem, our interdisciplinary team is ready to help listen to the concern and take steps to find the answers.

Getting the conversation started

Often, a patients own complaint starts the process of diagnosis and treatment. However, and perhaps even more often, it's the patients family member who has observed changes and brings up the issue.

The Alzheimer's Association lists the following 10 warning signs and symptoms of a memory disorder:

1. Memory loss that disrupts daily life: Includes forgetting important dates or events, asking for the same information over and over and increasing reliance on notes to help you remember.
2. Challenges in planning or solving problems: For example, having trouble following a familiar recipe or keeping track of monthly bills.
3. Difficulty completing familiar tasks at work, home and leisure: If you have difficulty driving to a familiar place or remembering the rules of a favorite game, consider seeing a doctor.
4. Confusion with time or place: Those with Alzheimer's can lose track of dates, seasons and the passage of time. Includes having trouble understanding something if it's not happening right now.
5. Trouble understanding images and spatial relationships: Alzheimer's may cause difficulty reading, judging distance or determining color. This can cause problems with driving.
6. New problems with speaking or writing words: Includes trouble following or joining conversation. A person with Alzheimer's may stop talking and have no idea how to continue or call things by the wrong name (e.g. calling a watch a hand-clock).
7. Misplacing things and losing the ability to retrace steps: Alzheimers may lead a person to put things in unusual places and be unable to go back over their steps to find them.
8. Decreased or poor judgment: For example, a person with Alzheimer's may give large amounts of money to telemarketers or pay less attention to grooming.
9. Withdrawal from work or social activities: They may have trouble keeping up with a favorite sports team or practicing a hobby. They may avoid being social as a result.
10. Changes in mood and personality: Alzheimers can lead a person to become confused, suspicious, depressed, fearful or anxious. This may lead them to become easily upset.

Let's assume you have the patients permission to speak on their behalf. If you notice these symptoms in a loved one, you're presented with a challenge and an opportunity.

The challenge, shared by you and your doctors, is using compassion, honesty and hope to persuade your loved one to get treated. After all, knowledge is power. Knowing what is happening, earlier in the process allows patients and caregivers more opportunity to work together to make treatment decisions as well as plan for the future.

Some patients resist being evaluated for memory loss. They may not notice the change in their abilities or, believing nothing can be done, fear a diagnosis. Here are some tips from Dr. Laird that might encourage a hesitant loved one to agree to an evaluation.

• First, if your loved one hasn't noticed a big change, acknowledge it may not be a big issue now but could threaten his or her independence in the future. Getting evaluated now will provide a starting point to make comparisons against in the future.
• Some patients may suspect there is a problem but simply don't want to know for sure. They may also believe it is pointless to be evaluated because the condition is hopeless.
• Be sure to point out that there are some medical conditions that can mimic Alzheimer's disease, but in fact are reversible. Getting a full medical evaluation will allow these conditions to be examined.
• In the past, there really were no treatments. Now, we have medications that can lessen some of the symptoms patients face. The sooner we know why something is happening, the sooner we can address it with appropriate treatments, she said.
• The Alzheimers Association, too, says early detection can allow patients to maximize the benefit of treatments, including a greater chance to participate in clinical drug trials to advance research.
• Early diagnosis also allows a patient to make their wishes known and help make decisions about care, transportation, money and living options.

Listening to family

Because family members are often the first to spot a potential issue, Dr. Laird has learned the most common symptoms they report:

• Financial mistakes paying twice, forgetting to pay and misplacing bills
• Language struggles to find a word and missing words in speech
• Social activities cancelling bridge games and no longer attending club meetings

Dr. Laird also refers families to resources that can help them, including an Alzheimers Association support group. The association's website lists about two dozen such groups and meetings in Central Florida.

Getting help

Once you've noticed a sign or symptom, make an appointment with your/your loved one's primary care doctor. Explain your concerns. He or she may do an evaluation or may refer you on to a geriatrician or other physician who specializes in cognitive issues. At such an appointment, the physician will do a full history and physical looking for the reversible causes. The visit will also include some form of cognitive testing to assess the areas of strength and weakness that can help identify the type of condition causing the symptoms.

Why a Geriatrician?

While you should first talk over your concern with your primary care provider, you can self-refer for consultation with Dr. Laird and her team at the Centre for Senior Health.

With a team that includes a nurse practitioner, medical assistant and social worker, Dr. Laird's practice can deploy a more holistic approach to meet a patient's needs. It boils down to comprehensiveness, said Dr. Laird, who was named the American Geriatrics Society 2013 Geriatrician of the Year.

We focus on our patient's whole life, including their health, function, and family relationships she said. In other words, they want to know what your challenges and abilities are and what's important to you in order to help you maintain your spirit and quality of life. The clinic's team approach means you have a range of professionals helping you through memory loss issues and the many other challenges that can come with aging.

Dr. Laird has more than 20 years of experience helping patients and families navigate the joys and challenges of life's later stages. Her team members at Centre for Senior Health in Winter Park are all experts in supporting older patients and their families.

To reach Dr. Laird's Winter Park practice, call Call855-303-DOCS. Make the choice to meet Alzheimer's disease on your own terms. Click here to read more from Dr. Laird's Caregiver Series.