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Medical Forum / Diseases and Disorders / Alzheimer's / September 2004

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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.

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Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

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

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com
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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