Excerpt from Live Now, Age Later by Isadore Rosenfeld M.D., plus links to reviews, author biography & more

Make Sure It's Alzheimer's

Dementia is not always due to Alzheimer's. At least 20 percent of older people suffer from other conditions that mimic it, the most important of which are:

• Depression: When you're depressed, you're not terribly concerned with remembering details, learning new facts, mastering new skills, or socializing---criteria by which mental capacity is often judged. Lack of involvement and enthusiasm are often interpreted as evidence of Alzheimer's. In one of my other books, I recounted the story of a man whose children were convinced that he had Alzheimer's because he'd become withdrawn for no apparent reason. He was a widower who lived alone, and the family didn't think he was really able to care for himself. They decided he'd be better off in a "retirement" home. He agreed to move---or, rather, he didn't resist the decision because he couldn't care less where he lived or what he did. A few weeks after moving into the senior citizens' residence that had been chosen for him, he met a woman whose company he enjoyed. They fell in love and---presto---his "personality change" cleared up and his "Alzheimer's" disappeared. The couple married moved out of the home, rented an apartment in the city, started visiting museums, went to the theater and movies, and developed a close circle of friends. So always think of depression before deciding someone has Alzheimer's.

• Subdural hematoma refers to a pocket of blood that has accumulated on the inside of the skull, usually as a result of a blow or other injury to the head. This damages blood vessels on the inner surface of the skull and makes them bleed. The blood that accumulates exerts pressure on the underlying brain, causing headache, personality changes, and a variety of other neurological symptoms. Because blood vessels are more fragile in older people, they tear more easily so that even a minor knock on the head can cause a subdural hematoma. This condition can be cured by either removing the blood clot with a needle or by shrinking it with steroid drugs.

Subdural hematomas are often unrecognized when the injury that caused them is trivial and not immediately followed by symptoms. Always suspect this possibility in any older person with an unexplained change in behavior or personality or a persistent headache. And when you do, get a CT scan of the brain to confirm the diagnosis. I remember one man who knocked his head on a shelf in his bathroom while looking for some aftershave lotion. The injury had left no bump, scar, or other mark, so he didn't tell anyone about it. A few weeks later his wife noticed that he was drowsy and confused. Probably Alzheimer's, she thought. After all, he was eighty! Yet he had always been so sharp. Why now? And why so suddenly? A CT scan revealed a large subdural hematoma from just this little bang on the head. It was removed with a needle, and the "Alzheimer's" was cured!

• Multiple small strokes: A stroke occurs when an area of the brain is suddenly deprived of its blood supply. This can happen in several ways: blockage of one or more of the arteries situated either within the brain or leading to it from the neck (thrombosis); when an artery in the brain bursts after being weakened by long-standing, untreated high blood pressure, or by a congenital abnormality of its wall (an aneurysm); or when the flow of blood in a brain artery is cut off by a clot that has made its way into the cerebral circulation from somewhere in the heart or neck vessels (embolism).

The symptoms of stroke (paralysis, impaired speech, blindness, loss of balance, incontinence), and their severity, depend on what caused it---a hemorrhage, a traveling blood clot, or a blockage. Was the involved vessel large or small? How much of the brain and what part of it was damaged or destroyed? Involvement of just a single small blood vessel usually results in only limited injury, and the symptoms are apt to be minor and transient. However, when such little strokes keep recurring, their cumulative effect can cause enough brain damage to produce memory loss and personality change. This train of events is referred to as multi-infarct dementia (infarct means death of tissue). We can often stop the progress of such dementia by preventing these strokes by dietary means, blood pressure control (so that blood vessels are not prematurely clogged by arteriosclerotic plaques), or blood thinning (either with aspirin or other anticoagulants). By contrast, the dementia of Alzheimer's disease usually progresses relentlessly.

From Live Now Age Later: Proven Ways to Slow Down the Clock,by Isadore Rosenfeld. © June 1999, Isadore Rosenfeld. Used with permission.