Forgetfulness Isn’t Always Related to Alzheimer’s
My thanks to the many readers who have been sending e-mail and letters to Benefits Bob with their questions about health insurance, Medicare, Medi-Cal, nursing homes and other topics. The name of this column changes today to Health Dollars & Sense, reflecting the broader scope of issues beyond health insurance. But the purpose remains the same: to give you the information you need to deal with the complex world of health care.
*
The Alzheimer’s Assn. has done great work in teaching us about this terrible disease that robs victims of their minds, their dignity and eventually their lives. And we’ve learned of the suffering it brings to families, the financial, emotional and physical toll.
But the Alzheimer’s educators made us so smart that we became terrified. Panic seizes us too easily. Lost your keys? Oops, it must be Alzheimer’s. Forgot the name of a neighbor you’ve known for 20 years? Big trouble--you’re headed for the nursing home.
It is a good idea to stop, take a deep breath and think hard about the realities of aging. Life brings a natural memory loss, but it is not always something to fear. Here is some advice about what you should be looking for, and what sort of help is available from the doctor.
“As people age, we become more forgetful,” said Dr. Leon Thal, professor of neurosciences at the UC San Diego Medical School. “The kinds of things we forget are names, and we have difficulty retrieving words. This can be annoying at cocktail parties, but it is not disabling.”
The time to start worrying is with a persistent loss in the skills one needs for navigating everyday life: paying the bills, doing the shopping, balancing the checkbook, driving to familiar places.
Another significant clue is unusual behavior. Is someone you love suddenly much more irritable, quick to get riled and angry? Or, in the opposite direction, is she strangely apathetic or withdrawn?
Some people with Alzheimer’s disease “start having behavioral problems long before they have memory problems,” said Dr. Israel Coutin, chief of geriatrics at Kaiser Permanente’s hospital in Fontana.
These people suddenly have “a lower threshold before they yell and scream,” according to Coutin. “It is not a part of the personality they had when they were 40 years old. Families and friends start excusing it, and say, ‘He is not himself.’ ”
If this is happening to someone you love, make a note of the incidents. Write down what happened and when it happened. Don’t spare any details; then you have something valuable to tell the doctor.
The next step is scheduling an appointment with the family doctor for a thorough discussion and medical examination.
Doctor Needs to Know What Patient is Taking
The physician’s best tool is a complete history of the patient, a portrait of physical and mental health, and information about any family history of ailments.
And be sure to bring a paper bag filled with everything the patient takes, from a high blood pressure drug, to a daily aspirin, to the herbal supplement from the health food store.
“I want to know everything they are taking and the amounts,” said Dr. Donna Masterman, clinical professor of neurology at UCLA Medical School.
Coutin is more graphic: “Everything you put on your skin, or through one of your orifices [nose, mouth or rectum]--put it in a brown bag and bring it in.”
When all those compounds get mixed in your body, brain and blood, a reaction could cause confusion easily mistaken for memory disorder or dementia.
The doctor should ask whether you’ve had any illnesses.
“Sometimes a person with just a urinary tract infection can get confused,” Masterman said.
In older people, an illness causing a fever can lead to delirium or confusion, a condition the family could mistake for dementia. Once the infection is gone, the confusion disappears too.
The doctor should also do a series of blood tests, to check for thyroid problems, Vitamin B-12 deficiency, liver dysfunction, or syphilis, all of which can cause confusion in a patient. Something as simple as dehydration can cause delirium.
Depression is yet another condition in which the symptoms can be confused with the withdrawal and forgetfulness seen in Alzheimer’s patients. Once again, a thorough physician at the first examination will ask probing questions that could uncover depression or will make a referral to a specialist.
Testing for Loss of Short-Term Memory
A conscientious doctor also will perform some cognitive tests, asking the patient a series of questions to measure alertness and memory. One commonly used tool is the Mini-Mental State exam, which measures short-term memory and orientation with questions such as: Who are you? When were you born? Where are you now? What day, month and season is it?
An important tip-off to a possible case of Alzheimer’s is the inability of a patient to learn or remember something new, according to Dr. Victor Henderson, professor of neurology, gerontology and psychology at USC Medical School.
“I will give them new information to remember, maybe a name and address, and see if they can pull it back in five minutes. Memory is the key,” Henderson said.
Experts say that a thorough exam by a primary care doctor, consisting of a complete medical history, a full physical exam and mental tests, should take at least an hour. If the primary-care doctor offers a preliminary diagnosis of Alzheimer’s disease, the family should then ask for a referral to a specialist--a neurologist or a geriatric psychiatrist with expertise in dementia, according to Dr. Debra Cherry, associate executive director of the Alzheimer’s Assn.’s Los Angeles chapter. A specialist can help plan a course of treatment for the patient and provide valuable advice to the family.
An imaging test, a scan of the brain, is sometimes used to help in the diagnosis of Alzheimer’s and other types of dementia. The American Academy of Neurologists says this option should be used at the discretion of the specialist handling the case.
Medical practice varies, however, and some primary care doctors order the imaging tests of the brain.
More information is available from:
Los Angeles Alzheimer’s Assn. (information and referral), (800) 660-1993.
UCLA Alzheimer’s Disease Center, (310) 206-5238.
USC Alzheimer’s Disease Research Center, (213) 740-7777.
UC Irvine Alzheimer’s Disease Assessment Center, (949) 824-2382.
Rancho Los Amigos Medical Center, Neuro-Behavior and Alzheimer’s Center (English and Spanish), (562) 401-8130.
*
Here are some of the things our readers are wondering about.
Question: I moved to Los Angeles from Chicago not long ago, and I’m told by my [health] insurance carrier that my next quarterly payment will be $1,300. Since that sounds like a major investment, I’m looking for an alternative. What I have is major medical with a $3,000 deductible. What I am is healthy but aging gracefully (61). Since this is a new location for me, I don’t know where to turn. How much should I have to pay in California for basic major medical, and whom do I call?
Answer: The rate you are paying, $5,200 a year, sounds high, according to Bill Robinson, an agent with National Business Insurance in West Hollywood. There is a plan available with a $2,250 deductible that would cost you about $2,400 a year. Check with an agent. It pays to shop around for coverage in the competitive California market.
*
Q: My stepdaughter, who is 41 and has her own Blue Cross of California policy, is unemployed. She suffers from loss of vision due to complications resulting from diabetes. Due to the recent death of my wife, my stepdaughter wishes to move to Michigan to live with her father and his wife. I doubt that her private policy is “transportable.” Due to her diabetes, it is highly doubtful that she could obtain a new private policy. And due to her vision impairment, securing employment is questionable. Am I correct in thinking that she realistically can’t give up the coverage she currently has and, therefore, a permanent move might not be practical?
A: Your daughter will be able to move and keep her health insurance protection. She can transfer to a comparable policy at Blue Cross-Blue Shield of Michigan, according to Peter O’Neill, a spokesman for Blue Cross of California. The benefits and the costs of the policy in Michigan should be comparable to her coverage now. She has a six-month grace period after she moves, in which her California coverage is still good. But O’Neill recommends she “notify us when she moves” to get the transfer process under way. Because of her medical condition, she probably would be turned down for a policy or charged very high premiums, if she sought coverage from another insurer.
*
Q: I am paying $200 a month at an HMO under COBRA. This is a bit much for me considering my circumstances (I am on disability at this time). Are there less expensive health plans, and, if so, how can I locate them? Also, can you make any recommendations?
A: Disabled people under some circumstances may be eligible for Medi-Cal, which may help with insurance premiums. Or, if you meet certain low-income standards, Medi-Cal may provide complete coverage without charge. You can get help with unraveling the complexities of state and federal insurance and disability programs from the Health Consumer Center, a project of Neighborhood Legal Services. Call (800) 896-3203.
*
We welcome your suggestions, questions, and tips about the fast-changing world of health care. Write to Bob Rosenblatt, Health Section, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail to bob.rosenblatt@latimes.com
