Is it Alzheimer's or Just Old Age?

10/11/2017
Milton Sutton

Everyone loved Milton! He made wonderful friendships throughout his expansive life mostly because he was so thoughtful. Moving to Massachusetts for his children after his wife died in 2004 was just one example of him continuously putting others ahead of himself.

When Milton turned 98, his family started noticing changes. At first small recommendations were made, like stop walking while listening to books on tape or get handrails in the bathtub. By the time Milton reached 100 he was enrolled in the CHA House Calls program because he wasn't sleeping and was extremely anxious.

"It's understandable that families want to know if their loved one has Alzheimer's because there's no cure and people are afraid," said Dr. Serena Chao, CHA's Chief of Geriatrics and an Instructor in Medicine at Harvard Medical School. "What's more important, however, is to be honest about cognitive decline so that relief can be provided for any symptoms of dementia, whatever the diagnosis."

"Our care team was wonderful," explained Judy Storeygard, Milton's daughter. "They treated my dad with respect and dignity, included him in all of the conversations and made really helpful interventions - it felt like a team."

Resources

Get a screening. CHA offers two types of screenings, a one-hour brief neuropsychological screen to determine if more interventions are necessary, and a three-hour more comprehensive neuro-psychological evaluation that offers more information about how the brain is working. Ask your primary care physician for more information.

Elder Service Plan (ESP) offers a complete day program and health care plan for patients. In many cases, ESP delays the need to move into a nursing home.

House Calls Program is a special CHA primary care clinical program that offers patients medical care at home, if they cannot routinely attend outpatient clinic visits due to illness. House Calls is currently accepting new patients in Somerville and Cambridge.

Nursing Home Program. CHA has relationships with several nursing homes, where people can receive primary care by specially-trained CHA physicians and nurse practitioners.

The Alzheimer's Association has many resources. Try starting with these and explore their website for more information.

Warning Signs

Dr. Serena ChaoAs we age, it's normal to experience cognitive changes. Walking into a room and forgetting why, constantly searching for a cell phone, struggling to find a word or a name are all common experiences of aging. Memory isn't usually the best marker to identify a problem because it gets weaker as we age and it's difficult to gauge when normal becomes abnormal. Often times loved ones compensate, masking the progression of dementia. "It's the family members who see it first and they are incredibly resourceful," added Dr. Chao. "They're the ones that need to speak up because patients are very good at hiding cognitive changes from their primary care providers."

When should you seek help from a medical provider?

Dr. Maggie Lanca Get help if you notice changes in daily functioning like not being able to solve problems, difficulty paying bills or taking medications correctly, erratic behavior, being less conversational, getting lost in very familiar places like commuting to work, not taking care of personal hygiene or if there are significant mood changes. "Dementia can often come with other psychiatric conditions like depression and anxiety," explained Dr. Maggie Lanca, CHA's Director of Adult Neuropsychology and Psychological Testing and Training, and Assistant Professor of Psychology at Harvard Medical School. "Mood changes, lack of motivation, being more reclusive, and being worried all the time are all symptoms that should be looked at carefully. We can help patients and families get the answers they need with an assessment." See Resources for more information.

What to do?

Get help. Caregivers need support and early intervention can allow patients to try medications to slow the progression of the disease. Start by seeing a primary care provider so she or he can rule out other possible causes of symptoms and help determine if a geriatric or a neuro psychiatric specialist may be helpful. It's really important for caregivers to know that they are not alone. See Resources for more information about assessments and community programs.

Stay active. This may slow the progression.

Reminder Tools. These can allow people to stay in their jobs. Remember, dementia is all about adjustment and readjustment, adding supports as needed.

Take advantage of every moment. Because Alzheimer's, and other dementias, are slow to progress, there's more time than you may think. Recent memory is usually impacted before remote memory which provides opportunities. "My parents saved the programs from every single play that they attended and they saw many," shared Judy. "As my father's memory started to change, we would spend hours sifting through the programs and my father would remember details about almost every play. It was a lovely way to stay connected."

Know your resources. CHA has several programs that can help - see Resources for more information.

Can you avoid Alzheimer's?

The truth is that doctors don't know how to prevent dementia. "What we do know is that the research is showing that good heart health is also good brain health," said Dr. Chao.

Best practices:

  • Eat a healthful diet 
  • Exercise Don't smoke (or stop if you do) 
  • Manage high blood pressure and diabetes 
  • Get enough sleep, 6-8 hours with no interruptions and treat sleep problems if you have them 
  • Minimize stress

A Celebration of an Amazing Life

"My father passed away November 5, 2016", said Judy. "But not before my son reenacted his wedding, complete with a wedding cake, in his assisted living facility. My father couldn't believe that his grandson wanted to get married in his living room, it was a very special moment. My father lived to be 102."

Aging comes with unique challenges and CHA has many programs to make it easier. Please see the Resources section for more information or contact your primary care provider about specific services.

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.