Jul 22, 2015

Most People think Alzheimer’s is only about Memory Loss - It isn’t

Recently I read an article on Medpage Today that I believe should be brought to the attention of the general public. The article talks about new research showing that changes in executive function occur even before changes in memory occur.

Alzheimer’s Memory Loss | Alzheimer's Reading Room
The researchers write that memory loss starts showing up 8-10 years before diagnosis, but changes in other types of thinking occur 18-20 years before.

Why can't doctors see that?

Because the screening tools we have today for deficits in that type of thinking just aren’t good enough to show those deficits in people who appear to be fine. Here is the link to that article - Preclinical AD May Manifest Early.

Carole Larkin MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementia care. She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementia issues. Carole can consults with families via telephone nationwide on problems related to dementia. Her company, ThirdAge Services LLC, is located in Dallas, TX.
By Carole Larkin
Alzheimer's Reading Room

Just what are the executive functions anyways? Well, the executive functions are housed in the frontal lobe of our brain, which is located right behind our forehead. Executive functions are also housed in the temporal lobe of our brain, which is located on both sides of our head above our ears. 

Together they make up a pretty big part of our brain. They house the following functions:
  • Activity in response to our environment- for example, knowing not to touch a hot burner on the stove or to not walk off of a cliff.
  • Judgment in our daily activities and decisions- for example, when driving a car, knowing not to turn left in front of an oncoming vehicle, or to not give money to strangers that call you up on the phone.
  • Controls our emotional, social and sexual responses- for example calling a friend of ours “fat” to their face, or being sexually suggestive to someone else in front of our spouse.
  • Assigns meanings to the words we use, involves word associations- for example using the word “toothbrush” rather than “the thing you put in your mouth” or using the word “cup” rather than “cake” when referring to something you drink out of.
  • Flexibility of thought, planning and organizing- for example being able to change one’s mind when it is clear that the thought process won’t work to solve the problem or being able to put on underwear before you put on your shirt or pants.
  • Understanding abstract concepts- for example, understanding what freedom, good and evil, love, feminism, success, morality, and chauvinism mean.
  • Reasoning and problem solving- for example figuring out how to open a locked door or how to screw in a light bulb.
  • Attention- for example, finishing the current task you are involved in or keeping eye contact with the person whom you are having a conversation with.
  • Sequencing- for example, telling a story with an order of events that makes sense or making a cup of coffee.
  • Categorization of objects, for example knowing that both glasses and cups hold liquid or knowing that a ruler and a watch measure something.
  • Understanding or processing verbal language, for example, getting the meaning of your words when you speak, or being able to answer a question right after you ask it, not a minute or two later.

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Note: the information on parts of the brain and their related functions comes from Baylor Institute for Rehabilitation Traumatic Brain Injury program. The examples are mine, taken from my 10 years of working with people with Alzheimer’s and their families.

My examples represent deficits shown when a person is significantly into the disease, not what may be shown 18-20 years in advance of the disease. The examples are to make a clear point to the reader of the meaning of the type of brain function being described.

You’ll notice that not one of the above functions involve memory. Yet memory loss is the one aspect of thought that seems to define neurocognitive disease, especially Alzheimer’s disease, to the general public, and even to many healthcare professionals.

I suspect that many members of the general public wait until there is strong evidence of memory loss to begin to think about having the person in question checked out by a physician.

Looking at the above listed executive functions and thinking about how much trouble (in so many areas of life) a person could get themselves into by beginning to have deficits in those, it can be seen, that if the above research holds true, then perhaps emphasis should change to educating the public on what executive function loss looks like, rather than just concentrating on memory loss.

Perhaps families would ask their doctors to screen their loved ones earlier in the disease process, thus allowing for more time for preparation for what is to come.

Also, of course, there could be a larger pool of participants in clinical trials slated to address the “prevention” or “cure” of Alzheimer’s disease and related dementias.

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