Recognizing Alzheimer's Disease: The First Step

by Bruce Finke, MD, IHS Elder Health Consultant and Blythe S. Winchester, MD, MPH, Chief Clinical Consultant, Geriatrics and Palliative Care, Indian Health Service

September 21, 2016

Mrs. B is worried. Last week her husband of over 50 years got lost driving home from church. Then he got mad at her for “talking too much and confusing me.” And, this wasn’t the first time. He’s been making a lot of mistakes with the bills and sometimes gets very irritable. Nobody else in the family seems to notice and he won’t admit it when he makes a mistake. She had to work hard to convince him to come to the clinic because “he hates doctors.”

At the clinic, Mr. B flashes his most charming smile and chats with all of the staff. He greets Dr. W warmly with “Hi Doc, I’m just fine thank you.” When Dr. W asks him questions about his health and medicines he just shrugs, “I don’t pay any attention to that. You can ask the wife about those things. But I’m doing just fine.” When Dr. W turns to Mrs. B she just shakes her head “no.” She doesn’t know what to say.

Warning Signs of Memory Problems

Repeating questions or stories.

Trouble doing ordinary things or usual activities or tasks like paying bills, cooking or simple household chores.

Getting lost in places that should be familiar.

Forgetting time, people and places.

Now Dr. W is paying closer attention and while doing the physical exam talks more with Mr. B, listening carefully to how he answers questions. He asks Mr. B if he has had any trouble with his memory and then turns and asks Mrs. B if she has any worries. Then Dr. W asks Mr. B to do a couple of simple tasks that help identify memory problems. He has a lot of difficulty with these tasks and Dr. W knows that there is a problem here. A more detailed and careful evaluation is needed. Dr. W orders some blood tests to look for the causes of memory problems that can be reversed or cured and schedules a return visit. All the tests are normal.

At the second visit Dr. W does a more detailed neurological and memory examination and asks questions about how well Mr. B is able to manage simple and more complicated daily tasks. With the information from Mr. and Mrs. B and from the tests and exam Dr. W is able to say that Mr. B has memory problems, most likely caused by Alzheimer’s disease. They discuss what this means for Mr. and Mrs. B and their family, what kinds of treatment are available and what kind of help they might need. They can begin to plan for the changes that will come in the future.

By bringing her husband in to be assessed Mrs. B has bravely faced her fears. Now they can begin to adjust and get the help they need.

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