Cognitive fluctuations, or episodes when train of thought temporarily is lost, are more likely to occur in older persons who are developing Alzheimer's disease than in their healthy peers.
By Bob DeMarco
Alzheimer's Reading Room
"If you have these lapses, they don't by themselves mean that you have Alzheimer's," James Galvin, M.D., a Washington University neurologist.
"Such lapses do occur in healthy older adults. But our results suggest that they are something your doctor needs to consider if he or she is evaluating you for problems with thinking and memory."
I am no longer amazed by the number of people I see, or bump into that are in the early stage of dementia. I am around a lot of older people here in Delray Beach.
When I notice someone evidencing suspicious behaviors, I usually say something mild like -- has he/she had here memory tested? The answer is always no.....why?
If I don't know the person well, I usually say its a good idea, you ought to talk to your doctor about a memory test.
If I know the person well, I explain to their spouse or children why I think memory testing could be a good idea.
Remember, the key words here are "suspicious behaviors." I am not a doctor so I am not qualified to make a diagnosis. I don't pretend to be anything I am not.
This is where it gets interesting. In every case where I have suggested memory testing to a friend of mine, or a friend of the family guess what happens -- they do nothing.
I often wonder how hard it would be for them to say to their doctor; I know this guy who has been taking care of his mother who suffers from Alzheimer's for six years and he suggested we get a memory tests.
You already know what happens next - the person gets worse and finally the spouse or child gets worried. This usually happens when they can't take it anymore.
Every Alzheimer's caregiver I meet can tell stories about all the behaviors they noticed -- in retrospect. They saw the signs but could not connect the dots. This group includes me.
I am now remembering that at least two years before my mother was diagnosed she started staring off into space while we were walking. She would just stop walking and look at something. I should say, I thought she was looking at something. She was staring into space.
I now remember that sometimes my mother who was far behind me while walking, would often duck into a store without saying a word. I would look back behind me, no mom. Now I have to go back and figure out where she was. Mom has never been easy to spot. She is small.
It never dawned on me that there was one big difference. In the past when mom would duck into a store she would start yelling my name. When I turned around to look at her she would inform me that she was ducking into the store. Seems so subtle. I now know it was a sign. A sign of the coming of Alzheimer's.
Subtle -- difficult to perceive -- changes are often the early signs of mild cognitive impairment, Alzheimer's, and dementia. Subtle -- hard to detect changes. You just don't notice. These changes all say the same thing to most people-- the person is getting old.
I think we need to start a new national slogan -- The Person is Getting Old, Get Their Memory Checked. Every time someone says, she is getting old the response should be --get the memory checked.
Ok, lets practice -- She's getting old, ___________________________.
Collectively we say this enough times, who knows, we might be making a difference. I believe this to be true.
Know someone with an elderly spouse or parent? Send them this article -- you make the difference.
Staring, sleepiness, other mental lapses more likely in patients with Alzheimer's
Cognitive fluctuations, or episodes when train of thought temporarily is lost, are more likely to occur in older persons who are developing Alzheimer's disease than in their healthy peers, according to scientists at Washington University School of Medicine in St. Louis.
Cognitive fluctuations include excessive daytime sleepiness, staring into space and disorganized or illogical thinking.
"If you have these lapses, they don't by themselves mean that you have Alzheimer's," says senior author James Galvin, M.D., a Washington University neurologist at Barnes-Jewish Hospital. "Such lapses do occur in healthy older adults. But our results suggest that they are something your doctor needs to consider if he or she is evaluating you for problems with thinking and memory."
The study appears in Neurology.
Earlier research had associated cognitive fluctuations with another form of dementia called dementia with Lewy bodies, but little information existed on the potential for links between Alzheimer's and such lapses.
Data for the new study came from Alzheimer's disease evaluations of 511 older adults with memory problems. Average age of the participants was 78. Researchers gave participants standard tests of thinking and memory skills. They also interviewed participants and a family member, checking for prolonged daytime sleepiness, drowsiness or lethargy in spite of sufficient sleep the night before, periods of disorganized or illogical thinking, or instances of staring into space for long periods of time.
A total of 12 percent of the participants had at least three of these symptoms, meeting the criteria for cognitive fluctuations. Those with mental lapses were 4.6 times more likely to be diagnosed with Alzheimer's. Of 216 diagnosed with very mild or mild dementia, 25 had mental lapses; of the 295 with no dementia, only two had mental lapses. In addition, participants with mental lapses did worse on tests of memory and thinking than people without mental lapses.
"We have some ideas about why the biology of dementia with Lewy bodies causes these mental lapses, but nothing comparable for Alzheimer's," Galvin says. "It's possible that some of the patients who were diagnosed with Alzheimer's disease in this study will go on to develop dementia with Lewy bodies, but at the time of the study, they weren't showing any of the Lewy body dementia's core features."
Lewy body dementia, which causes clumps of proteins known as Lewy bodies to form in neurons, is thought to be the second most common form of dementia after Alzheimer's. Clinically, it can overlap with Parkinson's disease and Alzheimer's disease. Pronounced cognitive fluctuations are a hallmark of Lewy body dementia, as are visual hallucinations and rapid eye movement behavior sleep disorder.
Galvin suggests that further study is needed to determine the best way to include mental lapses in diagnostic procedures for Alzheimer's.
Escandon A, Al-Hammadi N, Galvin JE. Effect of cognitive fluctuation on neuropsychological performance in aging and dementia. Neurology, Jan. 19, 2010.
Funding from the National Institute on Aging supported this research.
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- Why I Invented Alzheimer's World and the Power of Positive Reinforcement
- Learning How to Communicate with Someone Suffering From Alzheimer's Disease
Original content Bob DeMarco, the Alzheimer's Reading Room