When One Forgets That One Forgets -- MEDICA - World Forum for Medicine

When One Forgets That One Forgets

Photo: Computergenerated nerve cells

The nerve cells of patients with
Alzheimer's die off; © SXC

Many years ago Paul A.* clambered high mountains in Austria. Today, the 85-year old senior hardly can walk alone. The reason for his weakness is not his age, but the insidious disease Alzheimer. His daughter Laura N.* helps him to button up his shirt, she cooks for him and she goes with him to the doctor. Four years ago a physician diagnosed dementia. What type of the disease it was exactly, he did not analyse. “I thought he wanted to get rid of my father”, Laura N. says.

Maybe it is not enough time, maybe missing interest, maybe the symptoms are not identified in the right way. Fact is, that Alzheimer ’s disease often is diagnosed too late in many German medical offices. So Tillmann Supprian asks: “Further information about diagnose and treatment is necessary. In consequence of the demographic change we have to prepare about the fact, that more and more people will develop the disease” Supprian is head of the department geriatric psychiatry of the LVR-Klinikum in Düsseldorf, Germany, and active in Alzheimer research. A late diagnose can be fatal for the patient. Peter A.’s diagnose was also too late. At this time a ct-image showed already gaps in his brain, says his daughter Laura N.

The disease comes up slowly

The metabolism of proteins in the brain is disturbed and responsible for the loss of the nerve cells. Harmful proteins which are built in the body itself, deposit on the nerve cells. These plaques form agglutination in the brain and destroy the nerve cells more and more. Why some people develop the disease and others not, researchers could not discover yet. About one million people suffer from the loss of memory in Germany at the moment. The disease is not curable, but the process can be decelerated if it is diagnosed in early stage.

First symptoms appear already many years before the change of the brain is seen in imaging modality. They can be detected with psychological tests. At this time drugs still work. Pills can decelerate the progression of the disease by protecting the nerve cells from the dangerous plaques. In doing so, they can prevent the nerve cells from destruction about one year. That means more quality of life for patients and relatives. However, such tests often are not used in practical because medical staff and relatives have to look exactly on the patient’s behaviour to recognize Alzheimer ’s disease behind the diffuse symptoms. And in many cases they do not so, because obliviousness often is explained and accepted as an age-related characteristic.

Photo: Squares with letters

If one cannot remember words,
Alzheimer's could be the reason;
© Lea M. / Pixelio.de

However, not every loss of memory points out that Alzheimer must be the origin. “High values of blood pressure and cholesterol, a deficiency of vitamin B12 or a depression can also influence the capacity of memory, but then another treatment is in demand”, says Anja Schneider, doctor at the memory clinic of the University of Göttingen, Germany. Typically for patients with Alzheimer’s is that they have problems to remember something what recently happened. The short-term memory is affected mostly. If the loss of memory gets relevant in daily routine, it can be a characteristic of Alzheimer’s.

Support comes to the patient

“Relatives play an important part in diagnosing the disease early”, says Supprian. They often see better into the everyday life of the older people. However, they sometimes cover up the memory problems by reason of shame. So they seem to be normal at first sight. But often the patients really do not realize their behaviour. Peter A. always does it the same way: „He often reacts only superficial on a question or he changes the topic”, says his daughter. Peter A. has no problem with that, because he thinks even today that he is a robust and healthy man.

In a pilot project in Düsseldorf, Germany, medical staff tries to detect the disease in early state. In this project, relatives play an important part. They can call for help in various information centres all over the city. Doctors and caregivers inform these people about symptoms of the disease and arrange a doctor’s home visit for the patient. “Concerned people do not visit a doctor because they do not feel ill. But if the doctor visits them at home, they often accept help more easily”, says Supprian. And a medical inspection is necessary to diagnose the disease.

* name changed by editor

Simone Heimann