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Senior moment or Alzheimer's disease?

October 19, 2011
By Mary Lou Williams, M. Ed. , Fort Myers Beach Bulletin, Fort Myers Beach Observer

Dementia is not a normal consequence of aging. However, as we age, our memory is not as good as it used to be. Of course, nothing is as good as it used to be. But in the case of memory, we worry that it could be Alzheimer's. What is the difference between the normal forgetfulness of aging and Alzheimer's disease? What follows are twelve warning signs of Alzheimer's disease and how they differ from normal aging.

1. Absence of the "Ah-ha" factor. A warning sign of Alzheimer's disease is the absence of the "Ah-ha{ experience, that is, the absence of the sense of recollection. People with Alzheimer's disease forget that they have forgotten. They forget often, never recall, and repeatedly ask the same question, forgetting the earlier answer.

When I was a young woman, I saw exactly this symptom in an elderly widow. She was my landlady. I rented an apartment in her house across the street from my brother and his family. She had taken to greeting me when I came home from work and chatting before I went upstairs to my apartment. One day I mentioned to her that my brother and his family were moving to another state. She was visibly startled. She grasped the banister. Her eyes widened. "What!" she exclaimed. "Your brother is moving! But he's lived here for so long!"

We talked about why he was moving and where and when. I then asked her about her health and her relatives, the usual polite small talk. As I turned to go into my apartment, I said how much I would miss my niece and nephew when my brother moved. She was visibly startled. She grasped the banister. Her eyes widened. "What!: she exclaimed, "Your brother is moving! But he's lived here for so long!: I looked at her in amazement. But she wasn't putting me on. This same scenario was repeated again a few minutes later. Within the span of five minutes, she had forgotten what she had just heard twice before.

What's normal? Forgetting names and appointments on occasion or losing your train of thought when interrupted.

2. Difficulty performing familiar tasks. People with Alzheimer's disease forget how to make a telephone call, how to use the microwave, lose track of the steps in making a meal they've made many times before.

What's normal? Walking into a room and forgetting what you came for. "I know I came in here for a reason. Now what was it?" Needing the help of a teenager to work your VCR, forget TIVO.

3. Difficulty with language. A person with Alzheimer's may forget simple words like clock of broom or toothbrush. Clock becomes the thing that tells time. Broom becomes the thing that sweeps the floor. Toothbrush becomes the thing I use to clean my teeth.

What's normal? Having trouble finding the right word, but not the name of your spouse.

4. Disorientation as to time and place. People with Alzheimer's can become lost in their own neighborhood, forget where they are and how they got there, and not know how to get home again.

I witnessed someone in just this situation about two years ago. I live in a condominium development where the villas are situated around an oval green. There is a walkway around the green and a pathway from the back door of each of the villas leading to the common walkway. One warm, sunny afternoon I was cleaning the oven. All of a sudden, I became aware that there was someone in my living room. I screamed before I realized that my unannounced visitor was my across-the-green neighbor. He was standing in the middle of my living room in his bathing suit and a straw hat, holding a towel. He looked as bewildered and startled as I was. After the initial shock, I regained my composure and asked him as calmly as I could what he was doing there. He was on his way home form the pool. "I thought this was my house,." he said. "They all look alike, you know." I agreed that they did. I showed him where his house was - directly across the green from mine - and watched him wobble his way to his back door, and then I locked mine.

A person with Alzheimer's disease can wake up in the dark at six in the morning, look at the clock and think it's dinner time.

What's normal? Forgetting the day of the week and/or the date, but usually not the year.

5. Poor judgment. A person with Alzheimer's may dress inappropriately, wearing pajamas and a bathrobe to go shopping or a coat on a hot day or no coat on a cold day.

What's normal? Forgetting to bring along a sweater or a jacket on a chilly night.

6. Problems with abstract thinking. A person with Alzheimer's may not be able to recognize numbers or understand how to use them. This disability manifests itself in financial chaos. Checks do not get written, bills go unpaid, credit cards get maxed out, taxes are ignored.

I have a friend who became aware that something was wrong with her older sister when her sister called in a panic because she had received a notice that her house was going to be auctioned off for unpaid real estate taxed. The house was worth close to a million dollars. Her sister was a very wealthy woman. She had spent her career in financial management.

What's normal? Having trouble balancing a checkbook.

7. Misplacing things. A person with Alzheimer's may put things in bizarre places. For example, they might put laundry in the dishwasher, mail letters in the breadbox, plant their keys in a flower pot. Then they forget where they've put them and think they've been stolen.

What's normal? Misplacing eyeglasses or a purse or a wallet or not being able to find your car in a crowded parking lot. When you can't find your house keys, that's normal. When you can't find your house, that's Alzheimer's.

8. Changes in mood or behavior. People with Alzheimer's may exhibit rapid mood swings - from calm to tears to anger - for no apparent reason. For example, they can burst into tears in public.

What's normal? Occasional feelings of sadness or moodiness, but usually for a reason.

9. Changes in personality. The personality of people with Alzheimer's can change dramatically. A macho man may become a milquetoast. A reasonable, rational, soft-spoken woman may become a Calamity Jane, angry, paranoid, and subject to outbursts of temper.

What's normal? To become even more like yourself rather than less. Whatever traits you had in the past become more pronounced with age. If you were a stick-in-the-mud in your youth, you can become even more stuck in the mud as you age.

1). Loss of initiative. A person with Alzheimer's my become very passive, staring at the TV for hours and losing interest in activities they formerly pursued with enthusiasm.

What's normal? Becoming tired of the routines of work, household or social obligations.

11. Diminished or lost sense of smell. This seemingly unlikely connection often occurs as much as two years prior to the beginning of mental decline in people with Alzheimer's. The sensation of smell is carried by the olfactory nerve from the nose to the midbrain. The midbrain shows damage early in Alzheimer's, and this accounts for the loss of the sense of smell. The loss worsens as the disease progresses.

In a study published in the American Journal of Psychiatry in September 2000, scientists gave a "scratch and sniff" test to elderly people who were suffering from mild cognitive impairment, but not Alzheimer's. Of the 30 people who did best on the test, none went on to develop Alzheimer's disease. Of the 47 who did poorly, 19 went on to develop Alzheimer's.

A diminished sense of smell by itself should not be considered a definitive sign of Alzheimer's, since it can be caused by many other factors. But it can add one more helpful piece to the diagnostic puzzle.

What's normal? Diminished sharpness of all the senses. Nothing tastes as good as it did when you were a kid.

12. Sundowning. As the sun goes down, restlessness increases and sometimes continues through the night until morning with symptoms of increased confusion, anxiety, agitation, and disorientation. The person with Alzheimer's rambles through the house, turns on lights, decides to cook a meal or go for a walk. Sundowning seems to peak in the middle stages of Alzheimer's but lessons as the disease worsens. It is thought to occur because of the poor sleep quality in Alzheimer's disease.

What's normal? Normal adults awaken four or five times a night as they get older, but with Alzheimer's, awakenings may total 15 or 20 a night.

Mary Lou Williams, M. Ed., is a writer and lecturer in the field of nutrition. She welcomes inquiries. She can be reached at 267-6480.



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