Johns Hopkins Health Alert
Talking About Alzheimer’s
Many physicians fear that revealing a diagnosis of dementia would only further upset an already troubled patient, but a study from Washington University in St. Louis found quite the opposite. When it comes to a diagnosis of Alzheimer's disease, knowing the truth as soon as possible appears to be the better approach, potentially improving the emotional wellbeing of both patients and their caregivers, the researchers report.
Medical advances have made it possible to diagnose Alzheimer's at very early stages, but a study published in the Journal of the American Geriatrics Society found that about half of all physicians were reluctant to inform patients of an Alzheimer's diagnosis.
The study followed 90 individuals and their caregivers as they came to the Alzheimer's Disease Research Center at Washington University's School of Medicine for an evaluation. Sixty nine percent eventually got a diagnosis of Alzheimer's disease, but no significant changes in depression were noted and anxiety decreased substantially.
"The major finding is that both patients and their families feel relief, not increased anxiety, upon learning the diagnosis," says study co-author John C. Morris, M.D., Director of the Alzheimer's Disease Research Center. This was true regardless of the degree of impairment.
"Nobody wants to hear the diagnosis of Alzheimer's disease, but even that is preferable to recognizing there's a problem and not knowing what it is. At least having the diagnosis allows people to make plans for the future, including treatment as appropriate." One reason an Alzheimer's diagnosis can be comforting to both family members and patients, suggests Carpenter, is that it provides an explanation for what's been going on with the patient. Caregivers, he says, are often quick to attribute symptoms of dementia to the person, rather than the disease, and patients wonder if they are going "crazy."
Bottom line: Knowledge is power, and earlier diagnoses allow for earlier interventions to delay the effects of Alzheimer's and dementia. Medications currently on the market can slightly delay symptoms in some patients and may delay institutionalization. Perhaps more importantly, providing a diagnosis as early as possible gives people a chance to prepare for what is coming. "They know that things are going to get worse rather than better, and they know that there's going to come a time when they're not going to be able to do the things they can do now," says Carpenter. "They can get ready for what's coming, and we can connect them to support services. We can get their family ready, so they'll be better prepared."
Posted in Memory on November 23, 2009
Reviewed January 2011
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Not until allopathic medicine becomes genuinely committed to identifying, preventing, and mitigating the "root causes" of neurodegeneration will there be progress in the dementia industry.
Foxfire's observations (87 yo mother with delayed diagnosis of presumptive A.D.) are a chilling harbinger of the epidemic yet to come:
a patient, status post three cycles of ECT, yet the medical profession was apparently reluctant to consider the problem of iatrogenesis.
Regrettably, physicians seem to be poorly educated about the scientific research which has shown that antidepressants kill neurons and shrink glia in the hippocampus - the very focal point where Alzheimer's pathology commonly begins. [Thus, it is not "just" ECT which creates hippocampal scar tissue and degeneration in the temporal lobe.]
Not until allopathic medicine awakens to the tragedy of "target organ toxicity" [i.e., mitochondrial damage, endocrine disruption, and chemotherapy effects caused by statins, antidepressants, neuroleptics, anticonvulsants, etc] and prioritizes alternative interventions will the "fight" against dementia become real.
Until that time, dementia patients and their families will be encouraged to accept more and more chemicals whose target organ toxicities have been dismissed or uncharacterized.
What is needed? A return to basic science and a new priority in neuropsychiatry which will be dedicated to the prevention, mitigation, and rehabilitation of chemical and electrical brain injury.
Grace E. Jackson, MD
Posted by: Grace E. Jackson MD | November 28, 2009 12:01 PM
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Kudos to you and I hope these findings will appear in the news (on-line, on TV and on paper). I want this because of personal experience where I am experiencing the tragedy of this hideous disease.
My 87 year-old mother has dementia and my 90 year-old father has dealt with this condition as caretaker for a very long time (around 10 years). They are now in an excellent assisted-living facility. The contentious discussion (between me, my dad and the excellent administrator of the facility) has to do with moving my mom to the "memory unit", a locked facility that connects with the assisted living unit.
I understood the situation about 5 years ago. My father is currently moving from denial into anger and I am now at acceptance (Kübler-Ross model stages of grief). My father has adequate resources to support him in this excellent (not cheap) environment.
It would have been very helpful if the (in my opinion, excellent) psychiatrist who has been treating my mom for around the past 6 years had felt comfortable in being more forceful about his diagnosis. After a year of observation and ECT treatments for the depression (ECT being successful for two prior intensive depression incidents, the first dating back 50 years from my recollection), he dropped the hint. My dad blew it off. I denied it, didn't forget it and started investigating a thing called dementia and the various causes for the condition.
Posted by: foxfire | November 23, 2009 10:24 PM