Brain autopsies in Hawaii are revealing that some cases of severe dementia and Alzheimer’s have been misdiagnosed before death. Misdiagnoses increased with older age and also reflected non-specific manifestations of dementia, a very high prevalence of mixed brain lesions, and the ambiguity of most neuroimaging measures.
Four hundred twenty six Japanese American men who were residents of Hawaii, and who died at an average age of 87 years were examined post mortem. Of those, 211 had been diagnosed with a dementia when they were alive, most commonly attributed to Alzheimer’s disease. However, about half of those diagnosed with Alzheimer’s disease did not have sufficient numbers of the brain lesions characterizing that condition to support the diagnosis.
Brain lesions are areas of the brain which have been damaged by disease, congenital malformation, trauma, or other causes. While the thought of brain damage may be rather frightening to many people, the severity of brain lesions actually varies considerably. Some are not a major cause for concern, while others can indicate the presence of a serious problem, and they can vary in size and composition. Being diagnosed with a brain lesion, in other words, is not an immediate cause for panic.
Lesions, such as abnormal protein plaques and tangled fibers, proliferate in the brains of people with Alzheimer’s disease, which affects more than five million Americans. Dementia, a condition marked by cognitive decline that interferes with daily life, is most often caused by Alzheimer’s.
In the brains of people who had experienced gradual memory decline, the researchers found tangles and clumps of proteins. People who had stokes or protein clumps called Lewy bodies in their brains also had nearly double the rate of gradual memory loss of those without these lesions.
Lon White, MD, MPH, with the Kuakini Medical System in Honolulu continues:
“Diagnosing specific dementias in people who are very old is complex, but with the large increase in dementia cases expected within the next 10 years in the United States, it will be increasingly important to correctly recognize, diagnose, prevent and treat age-related cognitive decline. Larger studies are needed to confirm these findings and provide insight as to how we may more accurately diagnose and prevent Alzheimer’s disease and other principal dementing disease processes in the elderly.”
Here are the Alzheimer’s Association’s 10 warning signs of Alzheimer’s:
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, at work or at leisure
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
The rate of progression for Alzheimer’s disease varies widely. Alzheimer’s tends to progress more slowly in those who are diagnosed at a younger age and in those who don’t have other serious health issues.
On average, people with Alzheimer’s disease live four to six years after diagnosis, but some survive as long as 20 years. Pneumonia is a common cause of death because impaired swallowing allows food or beverages to enter the lungs, where they can cause an infection. Other common causes of death include complications from urinary tract infections and falls.
Source: American Academy of Neurology
Written by Sy Kraft, B.A.