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I Forget Names All the Time: Could This Be Alzheimer's Disease?

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

November 24, 2021

I have reached the age where I place items in special locations throughout the house, believing I will easily remember where I put them. Unfortunately, I do not remember where the items are located, which is incredibly stressful to me, especially on days when time is tight.

I am also dreadful at remembering the names of patients and peers. This finding is not new, but I worry: Do I have Alzheimer's disease?

As increasing numbers of aging adults demonstrate signs and symptoms of the disease, my worries may be warranted, but how would I know?

Background Information

Alzheimer's disease is a disease of the brain much like coronary artery dysfunction is a disease of the heart. The overall impact on society and healthcare has been steadily rising in the United States: an estimated 6.2 million Americans over the age of 65 are "living with Alzheimer's dementia" today. Experts have predicted this number could grow to more than twice that amount (to 13.8 million) by 2060 unless medical breakthroughs to prevent the disease become widely available.

Prior to the COVID pandemic, Alzheimer's disease was the sixth leading cause of death in the United States. Between the years 2000 and 2019, deaths from stroke and heart disease decreased, but deaths from Alzheimer's disease increased more than 145%.

For these reasons, recognition of signs and symptoms of the disease becomes crucial, especially during the month of November (Alzheimer's Awareness Month).

The Disease

As I have discovered, Alzheimer's disease is not a normal part of aging. Risk factors for the disease include older age, family history, and genetics, especially the presence of specific apolipoprotein genes (APOE e4). Older age alone is not enough to cause Alzheimer's dementia, thankfully.

People with a first-degree relative with Alzheimer's (a parent or sibling) are more likely to develop the disease than those without. Although we cannot change heredity, the onset of Alzheimer's disease may be slowed by attention to modifiable risk factors, such as maintaining a healthy diet and active lifestyle. Alternately, engaging in risky behavior, such as contact sports that predispose people to chronic traumatic encephalopathy, eventually results in abnormal tangles of protein in the brain that are like an Alzheimer's presentation.

Early symptoms of Alzheimer's disease include the following:

  • Difficulty with everyday tasks, such as keeping track of what bills are due or remembering how to make a favorite recipe for Thanksgiving.

  • Repetition: telling a story over and over or asking the same question repeatedly.

  • Communication problems: Does a loved one stop in the middle of a thought and is unable to complete their idea?

  • Getting lost: An early sign is difficulty with visual/spatial tasks, such as getting lost while driving or while in a store.

  • Personality changes: Symptoms could include getting unusually anxious, fearful, or depressed, as well as withdrawing from normal activities.

  • Confusion about place and time: forgetting how/when they arrived at a certain location or forgetting what day of the week it is.

  • Troubling behavior: Difficulty with cleanliness and grooming or an inability to manage money warrants close attention.

Testing for the Presence of Alzheimer's Disease

An at-home, simple test called the SAGE test (Self-Administered Gerocognitive Exam) is available for assessment in the home environment. It is a pen-and-paper exam designed by Dr Douglas Scharre, director of the Division of Cognitive Neurology at The Ohio State University Medical Center in Columbus. This test is designed to assist an individual in evaluating every part of the brain for impairments in thought and memory. SAGE will not diagnose Alzheimer's, but it is a quick tool to identify mild cognitive impairment for anyone concerned about themselves or a loved one.

When Alzheimer's disease Is Present

Prior to the year 2000, pathologists diagnosed Alzheimer's disease on autopsy. However, the ability of specialists to examine the brain via sophisticated scans, such as CT, MRI, and PET, allows the physician to rule in Alzheimer's or find clinical markers of organic disease, such as cerebrovascular accident.

The physician may also order a psychiatric assessment to rule out depression as a cause for lethargy and disorientation. Physicians will perform a full physical exam to rule out infectious disease and other causes (eg, polypharmacy) as a reason for memory lapse and difficulty in focusing.

Once the specialist has confirmed a diagnosis of Alzheimer's, experts repeat testing at intervals of 6 months to 1 year to document how functionality is changing over time. Specialists classify Alzheimer's as one of three stages: mild, moderate, or severe.

In mild Alzheimer's disease. protein tangles affect neurons in the hippocampus and entorhinal areas of the brain, causing the person to begin forgetting the names of places they frequently visit, among other changes. By the time Alzheimer's disease has advanced to a severe stage, the patient may be incontinent and nonverbal.

Treatment Options

Both drug and nondrug options are available to treat Alzheimer's disease. The FDA approved the drug aducanumab quite recently, although controversy exists over the price of the drug as well as how experts will determine inclusion criteria. Further drugs like aducanumab will be emerging soon, with similar controversies related to which persons receive treatment.

The purpose of Alzheimer's medication is to slow progression of the disease, as there is currently no cure. Additional medications to treat Alzheimer's, include donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon), among others.

Nondrug therapies focus on behavior modification and maintaining physical strength via nutrition and therapy.

Conclusion

The baby boomer population is aging, and with the passage of time, the incidence and prevalence of Alzheimer's disease will dramatically affect healthcare and society. One of the primary challenges will be the ability to evaluate and screen adequate volumes of the population, particularly during the presence of the COVID pandemic.

While it may be optimistic to imagine that Alzheimer's disease will affect someone else, nurses need to recognize changes within themselves or their loved ones that may signal a need for assessment.

Fortunately for me, the ability to find items stored in "special places" has proved to be intermittent. I may never be adept at remembering names and faces, but that has been a chronic issue unrelated to neurologic dysfunction. My neurologist assures me I am fine; however, we will keep an eye on it and retest if needed.

Now if I could only find my Christmas card list from last year (sigh).

What about you? Is it time for a SAGE test? SAGE tests are available on the Ohio State University website, where they can be downloaded for free.

In the interim, have a fabulous November!

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who works from home contributing to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Diane worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!

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