Why Diagnose and Treat Memory Loss, Alzheimer’s Disease, and Dementia?

A 72-year-old woman comes into the clinic at the urging of her son. She has noticed some difficulties finding words for the past six months, but denies problems with memory or other aspects of her thinking. Her son reports that his mother has had memory problems that began five years ago, and have been gradually worsening. He notes that his mother used to have an excellent memory, and would keep her calendar, grocery, and other lists in her head. Now she needs to write everything down or she is totally lost. She used to send out birthday cards to her grandchildren every year, but over the past two years has either forgotten to do this or sends them out at the wrong time. In addition to memory problems, he agrees that she also has word-finding difficulties, and often has trouble finishing sentences. From a functional standpoint, she is also having difficulty. She is living with her husband, and he has gradually been taking over household responsibilities that she used to do, such as going to the grocery store. She continues to cook, but there are now just a few meals that she prepares, and these have become much simpler than they used to be.

Quick Start

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Current treatments can help improve or maintain the patient’s cognitive and functional status by “turning back the clock” on memory loss.
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Families and other caregivers are helped by treatments that maintain or improve functional status and neuropsychiatric symptoms.
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Using current treatments saves money, as shown by pharmaco-economic studies.
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New, disease-modifying treatments are being developed and may be available soon.
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Accurate diagnosis helps define prognosis, facilitating future planning.
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Improving the quality (not quantity) of life is the goal.

The first question that needs to be addressed in this book is: what should be done about this 72-year-old woman? Is it important to diagnose and treat memory loss? Although the answer to this question may seem obvious to some, in the current healthcare climate it is a very reasonable question. There are four basic answers to this question: (1) to help the patient, (2) to help the family and other caregivers, (3) to save money, and, lastly, (4) to plan for the future.

Helping the Patient

Current treatments for Alzheimer’s disease have been shown to be able to “turn the clock back” on memory loss for 6–12 months ( ). That is, although memory loss cannot be halted or reversed to where it was prior to their developing Alzheimer’s disease, current treatments are able to improve patients’ memory to where it was 6–12 months ago. Although to some this may not seem worthwhile, we believe that this level of improvement can make a significant difference in the lives of our patients. Treatment can enable patients with very mild memory loss to be able to take that last trip to Europe, attend and remember their grandchild’s wedding, or finish writing their memoirs. For patients with mild memory loss, treatments allow them to continue independent activities such as shopping for groceries and paying bills. For patients with moderate to severe memory loss, treatments may provide functional improvements in basic activities of daily living such as dressing, bathing, and toileting.

Perhaps most importantly, many new treatments are being developed for patients with memory loss, some of which have the potential to dramatically slow down or even stop memory loss entirely. These so-called “disease-modifying” treatments will be specific to different diseases causing dementia, and thus accurate diagnosis will be critical.

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