In search of Alzheimer's disease

Does the diagnosis of dementia come years too late? There's plenty of evidence that the processes leading to Alzheimer's disease and other dementing illnesses begin as early as age 30 or 40. Moderate dementia, according to the standard Clinical Dementia Rating Scale, implies difficulty performing acts like dressing, bathing, and toileting. And yet it's estimated that more than two-thirds of people with Alzheimer's disease are already moderately demented by the time they receive a diagnosis, and more than half of those now suffering from dementia have never been diagnosed by a physician.

Some may wonder whether it matters, since as yet there is no way to cure or prevent the most common type of dementia. Fortunately, though, research is producing both more potential ways to recognize the symptoms at an early stage and more reasons for wanting to do so.

Looking at the symptoms

For now, the diagnosis still depends mainly on familiar changes in memory, mood, and behavior. The Clinical Dementia Rating Scale, for example (see Resources), evaluates everyday thinking and behavior with detailed questions about memory, orientation, judgment and problem-solving, community activities, home and hobbies, and personal hygiene. Five stages of impairment are counted, from none to severe. The Alzheimer's Association provides a briefer list of warning signs (see box below).

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