Is It Alzheimer’s… or Something Else?
If there’s one thing my patients have in common, it’s concern about developing Alzheimer’s disease. With more than 4 million sufferers in the U.S. alone, most of us either know someone with the disease or have heard the horror stories — an elderly person wandering off, starting a fire after forgetting to turn off the stove, or driving somewhere and not remembering how to get home. But don’t fall into the trap of assuming problems with mental functions inevitably mean Alzheimer’s disease. As my patient Ted discovered, many Alzheimer’s symptoms are shared by several different conditions that can be corrected to restore normal behavior.
Because of my patients’ concerns, I’ve spent quite a bit of time researching the aging brain and looking at ways to enhance its functions. One of the most intriguing questions is how to diagnose Alzheimer’s disease. As you may know, there is no definitive test for the condition. And memory problems alone do not necessarily indicate Alzheimer’s. In fact, Alzheimer’s is just one of several types of dementia, and a number of conditions mimic some aspects of this memory-stealing disease, including:
- Vitamin B12 deficiency (see below)
- Confusion or delirium caused by a health problem, such as encephalitis or over-medicating (see below)
- High blood pressure
- NPH, or normal pressure hydrocephalus (excessive fluid in the brain)
- High levels of the amino acid homocysteine
- Brain tumor
- Subdural hemorrhage or ruptured blood vessel in the brain
- Creutzfeldt-Jakob (mad cow) disease
- Exposure to lead or other toxins
- Head trauma
- Sleep disorders
- Thyroid dysfunction
- Alcohol abuse or addiction to legal or illegal drugs
Is It Alzheimer’s?
Diagnosing Alzheimer’s usually requires identifying and eliminating copycat conditions, like those listed above. Some of these non-Alzheimer’s conditions are fairly simple to remedy. For example:
- High homocysteine levels can be lowered with supplemental B vitamins, especially folic acid.
- High blood pressure can be reduced with lifestyle changes.
- Sleep disorders can be improved with supplements like melatonin or, in the case of sleep apnea, with appropriate treatment.
However, if forgetfulness worries you, keep in mind that normal, everyday memory issues happen to many of us as we age. But Alzheimer’s symptoms go beyond that:
- Judgment often suffers.
- The ability to recognize people or things is increasingly difficult.
- Appropriate use of language decreases.
- Completing ordinary tasks becomes taxing.
- Skills we take for granted continue to deteriorate as Alzheimer’s escalates, requiring nearly constant assistance and supervision.
Diagnosing Alzheimer’s Disease
Last year, the National Institute on Aging and the Alzheimer’s Association updated the guidelines for Alzheimer’s diagnosis, identifying three stages:
- Presymptomatic: Physical changes to the brain that may take place a decade or more prior to observable symptoms
- Mildly symptomatic but pre-dementia: Noticeable, but tolerable cognitive impairment that still allows the individual to live independently
- Alzheimer’s dementia: The terminal phase of the disease
Scientists are working to identify early-stage Alzheimer’s with tests of cerebrospinal fluid, as well as with brain scans, but these methods are not yet reliable enough for public use. So for the time being, we rely on observation and eliminating similar conditions.
Conditions That Mimic Alzheimer’s
As you saw in the list above, a number of health conditions have features in common with Alzheimer’s disease. Space limitations prevent me from discussing all of them, but let’s take a look at two common problems that may cause similar symptoms — a deficiency of vitamin B12 and over-medicating.
Vitamin B12 Deficiency
Low levels of vitamin B12 can cause exhaustion, headaches, numbness or tingling in hands and feet, confusion, depression, and memory loss. Since eating meat and dairy products commonly provides most of our B12, vegetarians and vegans are at risk unless they take appropriate supplements.
But even carnivores can be low in B12. For absorption, vitamin B12 needs to hook up with a protein known as intrinsic factor. Not everyone produces enough intrinsic factor to absorb vitamin B12 properly. Pernicious anemia, a potentially fatal autoimmune disorder, is one outcome of a vitamin B12 deficiency. Celiac disease and Crohn’s disease are two more conditions that may interfere with proper absorption of vitamin B12. Fortunately, supplemental vitamin B12 — either in the form of vitamins or injections — can alleviate the deficiency.
Regular readers of this newsletter probably know by now that I would prefer to see fewer drug prescriptions and more lifestyle changes when it comes to treating many common ailments. While drugs are appropriate for certain conditions, handing out statins like candy, for example, is not the best way to fight heart disease — not in my opinion.
The way drugs are prescribed to older people these days is nothing short of a scandal. I can’t tell you how many elderly patients I’ve seen who are taking 10, 12, sometimes 20 different medications. Usually this happens because of multiple health conditions and different doctors who often aren’t aware of what’s already been prescribed.
Unfortunately, I know of almost no clinical trials that examine the effects of combining medications. No one really knows what happens when an individual mixes commonly prescribed drugs like statins with blood pressure medication, antidepressants, digestive aids, and/or diabetes drugs, with a few aspirin or over-the-counter remedies thrown in. No wonder so many older people have problems with memory! And I can tell you that very often these patients improve dramatically when they find a physician who helps them remove the unnecessary meds from the equation.
This is why I recommend my patients make a list of all their nutritional supplements and medications, including dosages and the prescribing doctor’s name. The list should be in your purse or wallet, so it’s with you at all times. It may prevent dangerous drug interactions and duplications of similar medicines from different doctors (and pharmacists) who aren’t aware of what others have prescribed.
Maintain Your Brain
Meanwhile, you can do plenty of things to keep your brain functioning the way it should. In fact, healthy brain functions are one of the foremost reasons I recommend patients follow my seven guidelines for good health:
- Drink plenty of fresh, filtered water.
- Get 7 to 8 hours of deep, restful sleep each night.
- Eat real, unprocessed food.
- Exercise moderately most days of the week.
- Practice stress management.
- Maintain a healthy weight.
- Take appropriate nutritional supplements, but be sure to ask your doctor and/or pharmacist about any possible drug interactions.
Each of these seven steps is important, but I’d like to say a few more words about the last point. Some recent studies show that supplements are demonstrating real abilities when it comes to Alzheimer’s prevention. For example, new research shows that curcumin, an extract of the herb turmeric, inhibits the formation of brain-damaging substances linked to Alzheimer’s. Not surprisingly, countries like India, where turmeric is a regular dietary ingredient, have some of the lowest levels of Alzheimer’s in the world. Take 500 mg of curcumin one to three times daily, preferably with food. If you are taking any blood-thinning prescription medications, such as warfarin (the brand name is Coumadin) or Plavix, you must consult with your physician before taking curcumin, since it has a blood-thinning effect.
While fish oil has a stellar reputation for easing joint pain and reducing markers of heart disease, research shows it also minimizes levels of beta-amyloid, one substance commonly found in the brains of Alzheimer’s patients. More recent research indicates that fish oil also reduces inflammation by modulating genes involved in the process.
Obviously, eating salmon, trout, mackerel, herring, and other fish rich in good fats is one way to get fish oil. But I suggest limiting fish consumption to once or twice per week because of the toxins in both farmed and wild-caught fish. Purified or molecularly distilled omega-3s are a better choice, but I prefer those found in Calamarine, a purified and stable omega-3.Take 1,000 mg twice daily. Vegetarians or those who are allergic to seafood can take advantage of flaxseeds and flaxseed oil as alternatives. Take one to two tablespoons of flaxseed oil daily. Omega-3s act as blood thinners, so if you are taking blood-thinning medication (warfarin, Coumadin, Plavix, etc.), please consult your physician before adding this type of supplement to your daily regimen.
Please don’t wait for researchers to discover a solution to Alzheimer’s disease. You can do plenty of things now to keep your mind fresh, active, and well nourished. Even simple measures, such as changes to routines, or doing things a bit differently (walking backward for a few minutes, for example, or using your non-dominant hand to do things like eating or cleaning) challenge the brain in a good way.
Meanwhile, please don’t panic and assume you have Alzheimer’s every time you forget where you put your car keys. Stress is a major memory thief, so adding extra stress over whether you have Alzheimer’s is not helpful. There are many reasons why you may be having memory problems, and most of them can be corrected. So stay calm, concentrate on taking good care of yourself, and avoid jumping to conclusions.
Last Updated: August 21, 2018
Originally Published: August 28, 2012