Alzheimer's Today
Once considered an elderly affliction, it is now claiming younger victims
Schneider's life seemed perfectly normal, with no hint of what was to come. He married, had two children and eventually five grandchildren, and he and his wife became foster parents. He entered the police force in 1977, and worked as a cop in various towns around St. Louis for 10 years and after that, as a fireman. He earned extra money picking up some home remodeling work and building fences. He also moonlighted as a private investigator.
Then around 2001, when Schneider was 50 years old, things started to seem, well, not quite right with both his body and his mind. Schneider was no stranger to physical ailments. In 1995, he got weak and bedridden, sick with what turned out to be a wheat, or gluten, allergy. The next year, he was diagnosed with diabetes and started taking pills and insulin shots. But this was different. "My coordination and balance were off," he says. "I had trouble hitting a light switch when I reached out for it. I found that I really had to concentrate on all my movements."
Over the next two years, memory troubles became more apparent. "At the firehouse, I had to leave my locker open because I kept forgetting the combination," says Schneider. "I had to open every compartment in the firetruck to find a piece of equipment. My driving was OK, because I had grown up in these neighborhoods and knew the streets." But Schneider's short-term memory was failing. "I couldn't recall the names of guys that I worked with." But the last straw, says Schneider, was when he forgot his wife's name, after 35 years of marriage. "So that was just terrible, and I knew something was really wrong."
First, a doctor told him he might have multiple sclerosis. Brain scans ruled that out. Hypertension, depression, and anxiety were all considered. Finally, in late 2003, after a complete neurological workup, a physician diagnosed Alzheimer's. Schneider retired from the fire department several months later, on disability.
"Like a flashlight." The long slog to a diagnosis isn't unusual for early-onset patients, says the Mayo Clinic's Petersen. Part of the problem is that physicians still don't think of dementia as the cause of memory problems in younger people. And there are a lot of other potential causes that need to be ruled out. "It could be MS, or lupus, or an unusual depression, or mild cognitive impairment," says Petersen.
To rule Alzheimer's in or out, a patient's family history is examined. That's especially important with early-onset victims, since a large number of them have a close relative who had serious memory problems. Then the patient undergoes a series of neuropsychological tests. "We need to find memory impairment plus problems in at least one other domain, such as attention or language," says David Salmon, a neuropsychologist and Alzheimer's specialist at the University of California-San Diego.
If dementia is the likely suspect, brain scans such as magnetic resonance imaging or positron emission tomography can help zero in on the specific type. So can a spinal tap. "None of these are good enough by themselves," says Petersen. "So you have to put them all together. Then you can look at your patient and say, 'I hate to say it, but it looks like it's likely to be Alzheimer's.' And then you talk to them about medications like Aricept or Namenda, which seem to keep the disease at bay for a while."
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