Because of the number of questions, his answers are being split into several parts. The first two, today and Friday, focus on diagnostic issues, including new tests, the role played by genetics and inheritance, causes and policy issues.
Next Wednesday Dr. Doraiswamy will address treatment, patient care and new clinical trials. (Some questions published here have been edited, and not all questions could be answered.)
The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.
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Q. Why can I remember everything about a person except his or her name? — Horick, Texas
A. This is known as the “cook-Cook problem.” It is a result of how our brains are wired to enable predictions of future needs based on relevance and strength of associations. Common words with strong functional associations (for example, a cook who will prepare food) are easier to retrieve than proper names (Mr. Cook). Surveys show that more than 80 percent of normal older people report trouble with names. In reality, most of these individuals could probably recall several hundred names, but it’s the one they forget that causes panic. This helps explain why traditional American Indian names like Sitting Bull, which bring up a vivid image, are probably easier to recall.
Q. My question is not medical per se: Do you believe that people diagnosed with Alzheimer’s disease (or other dementias) should be told about their diagnosis? My mom, who had Alzheimer’s, died in 2008, and this was a very contentious issue separating me and my oldest sister who, alas, had health-care power of attorney. I emphatically believe people have to know that they have dementia. I am curious to know if you have an opinion on this. — Carol, Chicago
A. I believe they should be told since they have a right to know and make plans as well as a right to grieve. There are some situations where it may be appropriate to withhold information, such as when the exact diagnosis is uncertain or when obvious harm (such as suicide) may result. Surveys indicate that most family members would withhold the diagnosis from a loved one, but when asked if they themselves would like to know if they had the illness, most said "yes." This issue is likely to become more contentious as it becomes possible to predict disease more precisely using genetics and brain scans.
Q. “Can you tell me, wait, I forget ...” What are initial signs of Alzheimer’s?
If I place an object (i.e. cellphone, keys) in a different spot than usual, it seems to have disappeared. I’ve been leaving house key outdoors in the lock; forget names of folks I’ve met a few times (once reminded, I recall); almost totally forget titles of movies/books - when reminded, I recall..??.age-first of baby boomers, mother is 100+, has Alzheimers.
What are the initial signs of dementia? Memory loss? hysical affectations? Language dysfunction? I am nearing 65, in good health, but often can’t think of a specific word while speaking or briefly forget how to spell a word while typing.
— Wally Wallace, Ames, Iowa; Technic Alley, Toronto; Maureen64, Calif.; Motmista, Pensacola, Fla.; Canadian Content Only, Toronto; Lulu858; Marie Marley, Kan.; Unknown; Susa Bruce, Brooklyn.
A. The “tip of the tongue” (also called “Teflon brain”) phenomenon becomes more common as we age, perhaps due to chemical changes in the brain’s wiring. This commonly affects recall of names and words, and sometimes where you placed objects. Often, turning your mind to something else will make the information pop up. If what you forgot comes back to you a few hours or days later or comes back readily with a cue, it’s probably benign. Sometimes there is a “feeling of knowing,” but other times your mind can go totally blank — for example, where you parked your car at an airport. “Relax, and call me in the morning” is what memory doctors sometimes call this problem.
If you don’t pay close attention to something because your life is hectic, you’re multitasking, feeling anxiety or it has little emotional relevance, the thought will not register as well in your memory. It’s helpful to stick to a routine (e.g. park your car in the same spot daily) or write things down (e.g. a memo to yourself on your phone about where you left your keys).
If cues don’t help or if memory is forever lost or if things are starting to affect your daily activities frequently, then a medical evaluation is in order. Trouble remembering new information is the classic early problem in Alzheimer’s. In some people early changes can also include mild depression or apathy, and trouble with words, repeating oneself and confusion. Some of the things that suggest a serious memory problem are:
1) Memory getting worse over time, and cues don’t help with recall.
2) Memory problems are affecting your work and functioning, and friends or family members are getting concerned.
3) You have trouble learning new information or doing tasks you know well.
4) Forgetting entire experiences rather than parts of an experience
5) Making up stories to cover up the memory gaps.
Bottom line: if you are concerned, don’t hesitate to get your memory checked.
Q. What is the average risk of someone getting Alzheimer’s? If a sibling has it but parents don’t, what is the risk? What about if a parent or aunt has the disease?
My father, his mother and most of his siblings had Alzheimer’s. My mother’s immediate family had no incidence. She is 86 and pretty sharp. What are the chances I will get it?
My father had Alzheimer’s and my oldest sister has also been diagnosed with the disease. What are the chances of having it since we are obviously genetically predisposed? My memory has always been poor and is definitely getting worse. I’m 65.
— Christine R, Roseland, N.J.; Mitchell McG, Manhattan; Penguinwoman, Toronto; Tosia, New York; Ms. Skeptical, Alexandria, Va.
Ask an Expert: Answers About Alzheimer’s, Part 1
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Ask an Expert: Answers About Alzheimer’s, Part 1
