When Forgetfulness Needs Medical Attention
In Pat Summitt's 1999 book Reach for the Summit, what comes through about the legendary University of Tennessee women's basketball coach is her singular toughness.
Summitt, 59, announced yesterday that she has been diagnosed with early onset dementia caused by Alzheimer's. Her grit, it seems, remains intact. She said she will continue coaching as she begins treatment.
After Summitt experienced repeated bouts of forgetfulness, she was diagnosed by neurologists at the Mayo Clinic in Rochester, Minn. Shots caught up with Robert Stern, director of the Alzheimer's Disease Center Clinical Core at Boston University, for more on how that kind of diagnosis is made. Here are highlights from our conversation, edited for length and clarity.
Q: What are some early signs of the disease?
Stern: Early onset and later onset Alzheimer's are very similar in terms of what's going on in the brain. The most striking initial problem is one of learning new information: for example, being told something and an hour later forgetting it completely. The brain's ability to store something new is hurt because parts of the brain responsible for that storage are damaged. Whether you read it, hear it on the radio — anything that you have experienced may not have a way to stay in brain. But memories for things that happened long ago are for the most part completely intact.
Another symptom is the inability to come up with correct word for something. It's that tip-of-the tongue feeling. Other problems that can exist early on include planning and organization and multitasking. Also there can be issues with spatial functioning, judging distance, and perceiving visual information. But every case of Alzheimer's is unique and individualized.
Q: Is it easy to confuse Alzheimer's symptoms with symptoms of other conditions?
A: Yes, especially early on. Sometimes when people are having initial problems with memory they may think it's due to poor attention or depression. Sometimes medications or medical or surgical procedures can impact cognitive functioning. But that's why it's important to seek a formal assessment. It could be another form of dementia that's reversible, so you want to get to it right away to reverse it. Even if it is Alzheimer's, it's important to know because there are medications that can provide some temporary relief in some patients.
Q: How are dementia and Alzheimer's different?
A: Dementia is not an illness or disease — it refers to that clinical presentation of memory and other difficulties that are severe enough to get in the way of life. It's similar to having a fever; it tells you you're sick, but doesn't say what caused it. Some dementia diseases are reversible, but most of the time, it refers to degenerative or progressive dementia that can be caused by several different diseases. Alzheimer's is the most common cause of dementia — accounting for perhaps 75 percent of all cases of dementia.
Q: How does a doctor diagnose Alzheimer's?
A: The only true way to test is by postmortem exam of the brain. But in the last several years, we've had a tremendous gain in our ability to detect disease using biological markers, including spinal fluid measurements of specific proteins and advanced neuroimaging techniques. So with those objective measures along with a good clinical exam and history, the diagnosis now can be very accurate, but not completely accurate.
Q: What are some important factors that could contribute to someone getting Alzheimer's?
Scientists have been looking at many potential risk factors for Alzheimer's. Some of them — like aluminum -- have yet to be found scientifically valid or consistent. We do know that age is the biggest risk factor: 50 percent of people 85 and above have the disease. But that doesn't mean that getting old causes it. Aside from that, some other potential risk factors include being a woman, and being overweight and inactive earlier in life. African Americans are also shown to possibly have increased risk.
Family history and genetics are also part of it. Having a first-degree family member (a parent, sibling or child) with dementia increases your risk a few fold, regardless of age. And there are some specific genes that are very rare that can also cause it.
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