World Alzheimer's Day 2009

Diagnosing Dementia: See it Sooner

This World Alzheimer's Day, Alzheimer Societies across the globe are raising awareness about the importance of early diagnosis.

Two and a half years ago, Jim Mann, a former airline employee who had travelled the world, froze in the middle of a small regional airport in the United States. He had no idea where he was, or what to do next.

A couple of weeks later, at home in Vancouver, British Columbia, he got lost walking the dog in his own neighbourhood. Then he drove his wife on a routine trip to the drugstore and could not remember how to get there, within yards of the destination.

After a few tests, Jim's doctor told him he had dementia. After more rigorous testing, he was diagnosed with Alzheimer's disease, the most common form of dementia. He was 58 years old.

Jim was lucky. He had been seeing the same doctor for years. When he described his symptoms, the doctor knew they were unusual for Jim. When he went for more extensive testing, however, one specialist questioned the diagnosis, saying, "You don't look like you have Alzheimer's disease."

"I wasn't sure how I was supposed to look," Jim says. "Since then, I've been told I'm too young, too healthy, too capable, to have the disease. It can be a hidden illness for years, but when you have it, the impact is unquestionable."

Elderly Canadians rate cognitive impairment and dementia as one of their top three concerns. According to figures released in January 2009 by the Alzheimer Society of Canada, one in 11 seniors has dementia. Even more troubling is that an estimated 70,000 Canadians under the age of 65, even in their 40's and 50's, are also affected.

Yet less than 25 per cent of Alzheimer cases in Canada are diagnosed and treated¹.

"Many Canadian doctors think that since you can't cure dementia, a clinical diagnosis is less important," says Dr. Jack Diamond, the Alzheimer Society's Scientific Director. "But delay in diagnosis means that people don't get the right care and are not identified for updates. New treatments, for example, are fast approaching the time when they'll be available for doctors to prescribe."

Mary Schulz, Alzheimer Society Director of Support Services, Information and Education, agrees. Early diagnosis is critical not only for people with the disease, but also their families. "People with dementia can seem depressed, paranoid, angry or passive. Caregivers can become frustrated, irritated and angry because the person they love is changing in a way they do not understand. Once diagnosed, the person can benefit from treatment that is most effective when started early. It also means everyone involved can find support and learn ways to maintain as high a quality of life as possible."

Jim suspects that people avoid seeking help because they are embarrassed, afraid of losing friends, or not being believed by their doctors. He recommends being persistent to get the answers needed. When the specialist questioned the diagnosis, for example, he asked for a referral to a special Alzheimer Clinic. "When you know something is wrong, it's important to push until you are satisfied," he says. "The answer may be frightening, but it's better to have a diagnosis, find out what help is available and have time to plan for the future with family members and caregivers."

Diagnosing Alzheimer's disease is, admittedly, not easy. "The process is one of eliminating other possibilities," explains Kathy Hickman, Education Manager for the Alzheimer Society. "Research has resulted in better diagnostic tools. But an accurate conclusion requires a number of methods over time. That's why the Alzheimer Society does not support the practice of simple memory screenings."²

"If individuals and families are worried," Hickman adds, "they can find out about resources through their local Alzheimer Society."

The importance of early diagnosis is reaching global heights this fall as Alzheimer's Disease International and its 77 member countries, recognize World Alzheimer's Day September 21 with the message of Diagnosing Dementia: See It Sooner.

The goal is to help people understand that memory loss, confusion and difficulty with day to day tasks are not a normal part of aging and may well be a sign of dementia, and encourage them to seek professional advice earlier.

Jim Mann knows first hand the benefits of getting a diagnosis and he is passionate about helping others overcome their fear. A Board member of the Alzheimer Society, he takes the opportunity to educate others about the disease whenever he can. "It boils down to taking responsibility for your own care," he says. "The earlier you admit to having mental confusion, the better off you'll be. There is no cure for dementia. But the medication today helps keep you functioning at a reasonable level. That's a lot better than going undiagnosed for a long period of time and missing out on some of these opportunities."

Footnotes

1. Howard H. Feldman MD, Claudia Jacova PhD, Alain Robillard MD, Angeles Garcia MD PhD, Tiffany Chow MD, Michael Borrie MB ChB, Hyman M. Schipper MD PhD, Mervin Blair BSc, Andrew Kertesz MD, Howard Chertkow MD. Diagnosis and treatment of dementia: 2. Diagnosis. CMAJ 2008/03/25;825-836.
2. Population Screening for Dementia – Position Statement – Alzheimer Society of Canada, August 2008

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