If you haven’t seen the acclaimed movie Still Alice, starring Julianne Moore, who won an Academy Award for her performance, all we can say, without being “spoilers,” is that the movie provides powerful food for thought for anyone concerned that dementia is setting in—and happening way too soon. The movie is about a linguistics professor and mother of three who is diagnosed with Alzheimer’s disease at the tender age of 50.
For those of you who are middle-aged and feeling more distracted and forgetful—or more easily agitated than you once were—the movie will shake you up. It’s not always easy to tell whether these symptoms are simply due to stress and multitasking or the beginnings of true cognitive decline. So how can you tell?
The key symptom to look out for is trouble managing “bills and pills,” said Susan Maixner, MD, a clinical associate professor of psychiatry and director of the Geropsychiatry Program at the University of Michigan Health System. If you are younger than 65 and bill-paying becomes increasingly difficult to keep track of and if you find yourself forgetting to take medications or doubling up on doses (a danger in and of itself), you may be in the danger zone for early-onset Alzheimer’s disease. For those still working, being unable to retain information for work, such as frequently used computer passwords, may be a very early sign of cognitive difficulties, said Dr. Maixner.
A decline in short-term memory, such as too often forgetting whether or not you paid that bill or took that med, usually comes first when early-onset Alzheimer’s sets in, said Dr. Maixner. Other telltale signs are the same as those for Alzheimer’s in older age groups—getting lost while driving, repeating yourself, inability to plan or to solve problems, confusion with time or place, the inability to comprehend visual images (for example, not recognizing acquaintances), difficulty writing or speaking, often misplacing things, failing judgment, social withdrawal and change in mood or personality, such as feeling more short-tempered or frustrated.
The first step to getting a diagnosis is scheduling a thorough medical exam that your family doctor can perform, said Dr. Maixner. “Make sure that you tell your primary care doctor, up front, that you are scheduling the physical exam because you are experiencing memory problems and are concerned about early-onset Alzheimer’s,” said Dr. Maixner. The exam will be tailored to rule out physical as well as psychological ailments that may be causing the cognitive decline. And, because approximately 20% of early-onset Alzheimer’s disease is inherited (genetic), tell your family doctor if you have a family history of dementia. Many primary care physicians won’t think to ask this question—so be sure to bring it up, said Dr. Maixner.
Make sure blood work is done to rule out thyroid problems or vitamin deficiencies that can cause memory issues, advised Dr. Maixner. Medications and the use of drugs and alcohol also should be considered. The primary care doctor should then perform in-office cognitive tests, such as the Mini-Mental State Exam or Montreal Cognitive Assessment, which evaluate mental sharpness and short- and long-term memory. If the test results reveal signs of cognitive decline, your doctor should refer you to a geriatric psychiatrist or a neurologist with expertise in managing cognitive disorders such as dementia. The specialist may order an MRI or a CT scan of the brain to rule out whether a stroke, brain injury lesion or tumor may be causing the symptoms. A geriatric psychiatrist also has special training in differentiating dementia from depression, anxiety and other conditions that can accompany memory problems, said Dr. Maixner.
COPING WITH EARLY-ONSET ALZHEIMER’S
So far, there is no cure for Alzheimer’s disease. Although progressive worsening of the disease is inevitable, the clock can be turned back on symptoms with lifestyle interventions and medications. It is crucial to keep up physical activity, social interactions and mental stimulation, according to Dr. Maixner. Also, routines, predictability and structure are essential coping tools that will help you or a loved one with early-onset Alzheimer’s function better.
Planning about who will manage financial affairs and health decisions is important because if it is Alzheimer’s, a time will come when you or your loved one will no longer be able to make those decisions, said Dr. Maixner. Support groups and a 24/7 information hotline that can help with finding a dementia specialist, coping, staying active and legal issues are available through the Alzheimer’s Association.