Medical Forum / Diseases and Disorders / Alzheimer's / September 2004
Underdiagnosed?
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Rose - 25 Aug 2004 17:42 GMT Does anyone else here feel that Alzheimers and maybe other dementias are underdiagnosed, and that the percentages of seniors with these illnesses are higher than the statistics say?
Considering that Alzheimers is hard to detect in early stages and that denial is common among patients and family members, doesn't it seem likely that a lot more people are in the early stages of Alzheimers than indicated by statistics?
___ Rose: Up to the minute postings, fair and balanced.
Tumbleweed - 25 Aug 2004 18:32 GMT > Does anyone else here feel that Alzheimers and maybe other dementias are > underdiagnosed, and that the percentages of seniors with these illnesses are > higher than the statistics say? Yes.
 Signature Tumbleweed
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Rose - 27 Aug 2004 05:16 GMT >Subject: Re: Underdiagnosed? >From: "Tumbleweed" thisaccountneverread@yahoo.com [quoted text clipped - 7 lines] > >Yes. lol, thanks for being concise! :) :)
___ Rose: Up to the minute postings, fair and balanced.
Evelyn Ruut - 25 Aug 2004 20:26 GMT > Does anyone else here feel that Alzheimers and maybe other dementias are > underdiagnosed, and that the percentages of seniors with these illnesses are [quoted text clipped - 3 lines] > is common among patients and family members, doesn't it seem likely that a lot > more people are in the early stages of Alzheimers than indicated by statistics? Absolutely. There are still a great many people who attribute memory problems to aging, period and they don't even want to consider it could have a cause other than that. Meanwhile my father is 91 and his memory works perfectly.
 Signature Regards, Evelyn
(to reply to me personally, remove 'sox")
Dennis P. Harris - 26 Aug 2004 04:05 GMT > Does anyone else here feel that Alzheimers and maybe other dementias are > underdiagnosed, and that the percentages of seniors with these illnesses are > higher than the statistics say? certainly! and many doctors badly need updated education in this area! one clue is that if the doctor attributes memory problems to "aging" --- then it's time to find a new doctor ASAP, since the correct response is a referral for a full neuro-psychiatric evaluation.
> Considering that Alzheimers is hard to detect in early stages and that denial > is common among patients and family members, doesn't it seem likely that a lot > more people are in the early stages of Alzheimers than indicated by statistics? yes again. denial is common with doctors, too.
Rose - 27 Aug 2004 05:16 GMT >Subject: Re: Underdiagnosed? >From: NO_SPAM_TO_dpharris@gci.net (Dennis P. Harris) [quoted text clipped - 20 lines] >> >yes again. denial is common with doctors, too. I read a review of a book...can't recall the title. The review said that one point the book makes is that since about half of elderly over 85 have Alzheimer's it's a "statistically normal part of aging." I think, as others in this thread said, that more people have Alzheimers than the stats suggest. So it's even more "normal" by that definition.
Don't get me wrong. I'm not saying Alzheimer's is "normal" therefore not a problem. It is a momentous problem. If you define normal as "free of disease" then no, Alzheimer's isn't normal, but if you define it as "very common for a certain demographic" then I think one can argue that it IS.
Here is why I think this is important. Far from saying people shouldn't be treated because it's normal, I think maybe if people saw Alz. as normal, they'd be more likely to be treated. If Alz. can be called "normal" then maybe people will be less apt to blame others or themselves, and Alz. patients will be and feel less stigmatized.
Maybe normal is the wrong word. Perhaps "very common" or "typical" or some other word that makes it seem less like something visited on a few marginal folks who "ate too much read meat" or "didn't learn a new foreign language after age 65" or whatever they're saying these days that increases the risk factor.
I'd compare it to something less awful, menstrual cramps. Not all women get them, and they are not necessary to menstruation, and those of us who get them want to get rid of them either through prevention or treatment with pain pills, but they are not "abnormal." I don't have to feel stigmatized for telling my doctor I get cramps. (Tho there was a time when there was a stigma...we were just being hysterical and resentful about being women instead of men.) Women shouldn't have to suffer from bad cramps and old people shouldn't have to suffer from Alzheimers, but I think it's better to think of both as normal maladies for which we should seek help.
___ Rose: Up to the minute postings, fair and balanced.
Dennis White - 27 Aug 2004 08:32 GMT > >Subject: Re: Underdiagnosed? > I read a review of a book...can't recall the title. The review said that one [quoted text clipped - 19 lines] > after age 65" or whatever they're saying these days that increases the risk > factor. I like the term "typical" when referring to the incidence of AD in the elderly. Or I should say I like it better than terms like "normal". But the fact is (as far as I can tell) AD *is* very much part of the aging process. People were not built to live to the ripe old age of 85. There was a time not that long ago (historically) that 40 was a ripe old age. As medicine and technology and better economic and social conditions improve longevity has increased. Our goal now should be to find ways to accommodate an aging population and keep them in good health. This is why research is so important.
Dennis
Rose - 27 Aug 2004 22:00 GMT >Subject: Re: Underdiagnosed? >From: "Dennis White" dennybop@comcast.net [quoted text clipped - 41 lines] >People were not built to live to the ripe old age of 85. There was a time >not that long ago (historically) that 40 >was a ripe old age. To be fair, it's not so much that 40 was old -- white hair, lots of wrinkles, etc. -- but that it was average because the number of infant deaths brought the average down. The average age of people who lived past age 5 was much higher than 40, as I understand it.
Also, life expectancy over the years, and even now, has varied from region to region depending on the conditions. People age faster in poor conditions.
In the 19th Century Charlotte Bronte in her novel Jane Eyre referred to 35 as "past youth but not yet middle aged" which is pretty much how 35 is viewed now. On the other hand, Rochester referred to a woman in her 50s as "an old lady."
But I agree that people probably were meant to live to around 75 or so, and therefore the very very old ages they are living to reach often come with severe health problems.
___ Rose: Up to the minute postings, fair and balanced.
Dennis White - 28 Aug 2004 01:05 GMT > >Subject: Re: Underdiagnosed? snip....
> In the 19th Century Charlotte Bronte in her novel Jane Eyre referred to 35 as > "past youth but not yet middle aged" which is pretty much how 35 is viewed now. > On the other hand, Rochester referred to a woman in her 50s as "an old lady." I wonder what the average life expectancy of the growing "middle-classes" of the 18th and 19th Century as opposed to the vast majority of the impoverished? It seems we hear so much more about the very few wealthy than the poor masses...probably because the wealthy (and later, the middle classes) had the luxury of time to sit and write about themselves and their peers. I am a direct ancestor of an Englishman who was known as "Edward the Long Liver" He is said to have lived almost 150 years (which I very much doubt). I am sure he lived to a very,very ripe old age, but not as advertised! I often wonder if he suffered dementia for having lived so long. BTW, I cannot read the name "Long Liver" without chuckling while envisioning a very long thin internal organ! Dennis
> But I agree that people probably were meant to live to around 75 or so, and > therefore the very very old ages they are living to reach often come with > severe health problems. > > ___ > Rose: Up to the minute postings, fair and balanced. Robert E. Lewis - 28 Aug 2004 02:47 GMT <snip>
> I am a direct ancestor of an Englishman who was known as "Edward the > Long Liver" He is said to have lived almost 150 years (which I very much > doubt). I am sure he lived to a very,very ripe old age, but not as > advertised! I often wonder if he suffered dementia for having lived so > long. BTW, I cannot read the name "Long Liver" without chuckling while > envisioning a very long thin internal organ! You're an ancestor of a man who lived almost 150 years?!!!! Wow - I am impressed!!!
<G> -- sorry, couldn't help it; knew what you meant.
Dennis White - 28 Aug 2004 03:53 GMT > <snip> > [quoted text clipped - 9 lines] > > <G> -- sorry, couldn't help it; knew what you meant. Darn it!!!! Not thinking tonight. Thanks for picking that one up! BTW, the current notion among other family historians working on my (deVernon) line is that Edward the Long Liver <g> was probably, in fact two very long-lived men, father and son, who's lives became conflated somehow.
Dennis
Tumbleweed - 28 Aug 2004 08:03 GMT > > >Subject: Re: Underdiagnosed? > snip.... [quoted text clipped - 12 lines] > the middle classes) had the luxury of time to sit and write about themselves > and their peers. It was often quite low as they went off and got killed in wars, in those times the generals etc actually led from the front :-)
There is a famous picture from here in the UK which shows a young boy, maybe 10-12 or so, attired in an immaculate suit and wearing a top hat (he went to Eton school), alongside a couple of scruffy street urchins. You might think he is the one destined for a long life. However, a few years after the picture was taken, the 'toff' was dead, killed in WWI leading a charge.
-- Tumbleweed
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Dennis White - 28 Aug 2004 16:02 GMT snip...
> There is a famous picture from here in the UK which shows a young boy, maybe > 10-12 or so, attired in an immaculate suit and wearing a top hat (he went to [quoted text clipped - 4 lines] > -- > Tumbleweed Yes. The sad fact is that Britain lost a whole generation of it's finest minds and potential leaders. The rush to defend Britannia and the glory then associated with war caused many of the upper and middle classes to rush off to join-up ASAP. I believe (IIRC) WWI caused far more deaths than all other wars, but I;m not ready to defend that position! But I still think that throughout history that the great masses of people usually died at a much earlier age due to malnutrition and difficult living situations, lack of sanitation. Of course I am talking about the course of thousands upon thousands of years. At any rate I wonder how many were affected by AD etc. as opposed to dementia's brought on by other illnesses.
Dennis
Dennis
Jo Ann Malina - 12 Sep 2004 19:14 GMT Dennis White <dennybop@comcast.net> is alleged to have said:
> Yes. The sad fact is that Britain lost a whole generation of it's > finest minds and potential leaders. The rush to defend Britannia and the > glory then associated with war caused many of the upper and middle classes > to rush off to join-up ASAP. I believe (IIRC) WWI caused far more deaths > than all other wars, but I;m not ready to defend that position! Actually, World War II is the leader in that category so far. The fighting in WWI took place in and around Europe, but WWII had a Pacific theater as well, including the Japanese invasion of China in the 1930's. Also, weapons of mass destruction had progressed by the 1940's -- tanks, bombers, firebombing of cities, V-2 rockets, the atom bomb. And the Holocaust.
In fact, more people died in the 1918 influenza pandemic than in the war. But I think WWI amazed Europeans more -- they had been pretty much at peace since the Napoleonic wars a century before. They just weren't expecting to lose a whole generation of young men. It was like the US Civil War -- everyone expected both to be over in a few weeks when they started, and life to go back to normal.
What America got out of WWI was that it was hard to keep 'em down on the farm after they'd seen Paree. And, to tie it back to the newsgroup, my uncle was in World War I. He was stationed in the Presidio of San Francisco. When he learned I lived near San Francisco, he would mention this. About every 10 minutes or so, since he was sinking into some kind of dementia or another (I never heard Alzheimer's mentioned, and don't know that that's what he had). The last conversation we had when I visited him in his nursing home was about the Presidio.
My Dad was in WWII. He didn't want to talk about it.
 Signature Jo Ann Malina, make spamthis best to find my address Everything, everything in war is barbaric...But the worst barbarity of war is that it forces men collectively to commit acts against which individually they would revolt with their whole being. -- Ellen Key
Robert E. Lewis - 28 Aug 2004 02:32 GMT > >Subject: Re: Underdiagnosed? > >From: "Dennis White" dennybop@comcast.net <snip >
> >I like the term "typical" when referring to the incidence of AD in the > >elderly. Or I should say I like it better than terms like "normal". But the [quoted text clipped - 17 lines] > therefore the very very old ages they are living to reach often come with > severe health problems. I happened to see a statistic on this in a back issue of Prospect magazine today -- an unusual and slightly puzzling to evolutionary theory -- feature in human females is their longevity past menopause, that in other primates (and many other animals) the end of childbearing ability is usually followed fairly shortly by the end of life, while a human woman who reached the age of forty-five or so could, throughout history (and estimations in prehistory) expect to live another twenty years or so. (This was followed by some speculation of ways 'grandmothers' could be valuable to social groups from the Homo erectus period on.)
I just hope medical science doesn't advance catty-whampus to the point that someday soon we may all look forward to living well into our senility.
Mary Gordon - 28 Aug 2004 16:28 GMT Thought you would be interested in this table http://www.infoplease.com/ipa/A0005140.html
What is really interesting is the effect that very high infant and child mortality have on the stats - you will notice that life expectancy at birth in the early data (say 1850 or so) is LOWER than life expectancy at age 10 - so in other words, a big whack of the skew towards a shorter life was those childhood danger years.
I found elsewhere that in 1750, life expectancy in western societies was 33 for men and 37 for women, and by 1830, it was 43 for men and 47 for women.The reason wasn't wars - it was mostly from infectious diseases.
If you think about it, if very few people are surviving into what we consider old age, they wouldn't have seen many cases of Alzheimer's disease - something else would get them long before they got AD.
Mary G.
Robert E. Lewis - 28 Aug 2004 20:29 GMT > Thought you would be interested in this table > http://www.infoplease.com/ipa/A0005140.html Very interesting, thanks.
<snip>
> I found elsewhere that in 1750, life expectancy in western societies > was 33 for men and 37 for women, and by 1830, it was 43 for men and 47 [quoted text clipped - 4 lines] > consider old age, they wouldn't have seen many cases of Alzheimer's > disease - something else would get them long before they got AD. Or even mild dementia might have fatal consequences before it was noticed that there was anything really wrong with their memory. Forget to clean your teeth, and soon you have trouble eating, with a sharp decline after that. Forget you need a coat in winter, devlop bronchitis and fatal pneumonia.
I remember seeing something on The Learning Channel a few months back, that , after childbirth, a leading cause of death for women in the 16th and 17th centuries was burning. Everyone here worried about a LO with AD fiddling with a microwave or electric range -- imagine is they were tending an open fire all day. It would take only minor cognitive impairment before that became very dangerous.
Science fiction author Robert A. Heinlein wrote a number of stories starting with a premise in a short story called Methuselah's Children, in which a subset of people had been bred with much longer than nromal lifespans. One of his premises was that longer-lived people would tend to be more intelligent, and thus better to recognize and thus avoid potentially fatal situations. There's a ring of truth to that -- throughout history, impaired reasoning ability could turn deadly very easily in a dangerous world.
 Signature Robert
OcnGypZ - 28 Aug 2004 19:59 GMT >Subject: Underdiagnosed? Without a doubt, and it's not only Alzheimer's disease......but other dementias as well.
The hardest.... those that have to do with personality changes......but the ADL are still there.....so you can't get the patient to another doctor.. because they refuse to go by themselves, refuse to go with you, etc.
There's nothing you can do except wait..and by then it's too late.
The various health care systems are useless... the court systems.. useless in these cases. Friggin courts.......are the worst.
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