Hi Steve,

All questions aside, if your Dad's friends and loved ones are
commenting on changes, crushing his ego should be the least of your
concerns.  Once my Dad was lit up by a copper who followed him for a
couple kilometers doing 80 or so in a 60 km/h.  He was confused by the
flashing lights and fortunately got off with only a speeding ticket.
Just prior to this, our family physician had submitted paper work to
the minstry of transporation to have his license suspended (or revoked
or whatever) but the ticket provided an easy way out.  Taking away his
license did bother him but it was a small price to pay for peace of
mind.

Dunno about DMV's.  :-)

Honesty has been the policy that's worked with my Dad and to a lesser
extent, my Grandmother.  

In terms of supplementation, Vitamin C (500 mg), Vitamin E (400 IU)
have been associated with reduced incidence of AD.  Daily NSAID (e.g.,
aspirin) use may be associated with a decreased risk but the jury is
still out.  Omega-3 fatty acid levels are lower in sufferers of AD and
can be supplemented with flax seed or fish oil capsule.  Eat lots of
fruits (especially blueberries) and vegetables, and a diet low in
saturated and trans-fatty acids.  Green Tea may have some useful
compounds and many other supplements or foods look good in the test
tube but a link with dietary intake has not been established (e.g.,
curcumin from tumeric might be useful but little if any is present at
sites distant from the GI tract).  Excercise, laughing and smiling
can't hurt.  

Mary G wrote a wonderful synposis of heridity and AD a while ago...

----------
Irrespective of family history, about 5 in 100 people have Alzheimer's
at age 65. By age 80, these odds increase to 1 in 5. By age 90, nearly
half of all people have some symptoms of dementia, so just being lucky
enough to live to an advanced age is the biggest risk factor, never
mind your genes. Only 3% of all cases of Alzheimer's have a proven
hereditary link.

The two basic types of AD are familial and sporadic. Familial AD (FAD)
is relatively rare affecting less than 10 percent of AD patients - it
often gets called early onset Alzheimer's. It is associated with gene
mutations on chromosomes 1, 14, and 21. FAD is the result of a certain
inheritance pattern called autosomal dominant. In this pattern, all
offspring in the same generation have a 50/50 chance of developing AD
if 1 of their parents had it - so its similar to Huntington's disease.
FAD occurs in younger people - usually before age 60 - so it is a form
of dementia that tends to hit people in middle age. If this was in
your biological relatives, you would likely be hearing stories about
people who went downhill while still in the theoretical prime of life
- their 40's, 50's or 60's, not just in their senior years. At least
forty percent of people who develop early-onset Alzheimer's have a
family history of the disease.

Garden variety onset AD is usually refered to Sporadic AD and usually
occurs later in life, is far more common than FAD, and appears to be
related to the apoE gene found on chromosome 19. ApoE comes in several
different forms or alleles, but three occur most frequently. People
inherit one allele (apoE2, apoE3, or apoE4) of the apoE gene from each
parent. People with both apoE3 and apoE4 alleles (E3/E4) are affected
by both alleles. Having one or two copies of the E4 allele increases a
person's risk of getting AD. Having the E4 allele is a risk factor for
AD, but it doesn't mean a person is doomed to get it -some people with
two copies of the E4 allele (the highest risk group) don't get AD and
others with no E4s do. So, the jury is out on the exact degree of risk
of AD for any given person based on apoE status.
----------

Take care,
Darryl.

My dad was *really* pissed* when we took his car away. Too bad, better than
someone getting killed. I'd also guess that in your litigous society, you
might well be liable? If you are posting using your real name, the evidence
is here for all in a court too see that you knew he might be dangerous yet
did nothing about it.

I would hope so, maybe before he kills someone :-(

Depends how aware he is, can you come right out, say you are worried about
his memory and that you'd like to get him checked out since there are
medicines that work well (such as aricept) if taken early? If he doesn't
want to go, IMHO chances are higher he has it, denial is not a river in
Egypt but a common state of mind of Az sufferers. Then you have a real
struggle on your hands. But why is it shaming?

FWIW my mother insisting got my dad to go to be tested, is your fathers
relationship with your mother such that that would work?

No. No doubt you may get responses here varying from eating fresh fruit,
taking antibiotics, drinking 10 pints of water a day, taking various
vitamins, not cooking with  aluminium, keeping active, keeping your mind
active, etc etc. They may work for some people, but no one *knows* if they
work, or if they'll work on *you* and there are certainly too many to try
them all.

FWIW the stats are that (IIRC) about 50% of people aged over 85-ish have it,
so if your dad had 10 siblings and only 3 got it (including him), you may be
at less risk than the average populace :-) whereas if he had 2 and both had
it, maybe thats bad news or maybe thats just coincidence.

Steve, your mother's first step should be to get him to the doctor -
and she should talk to the doctor about what she is seeing before your
father gets there, since if your father is forgetful, he may not
remember to tell the doctor, or may minimize the problems. Many people
in early AD will have no insight into their own problems and will deny
there is anything wrong with them - so if the doctor asks him how he
is, he may not tell him he's forgetting things. The doctor needs to
know before your father goes in - and he needs to be told that
whatever is going on is obvious enough to be noticed by people beyond
immediate family.

How do you get him to the doctor? You get the doctor in cahoots with
you, or you book the appointment and you put a "spin" on the reason.
You tell your dad he needs a full physical for insurance reasons, or
you get the doctor to call your dad in for a blood pressure check or
whatever it takes. You don't have to tell your dad the primary reason
is his memory - but before your dad goes in there, the doctor has to
be primed about the issue so he's alert and looking for problems right
off the bat.

First step will be some simple in-office mental status tests, a full
physical, a review of medical history and medications, blood tests
etc. to rule out all kinds of other causes of confusion and memory
loss. After that, the usual drill is being sent to a neurologist or
geriatric psychiatrist for an examination to rule out another group of
potential causes like tumours, strokes, depression etc. The exam
usually includes a brain scan of some kind. A thorough workup will
include some testing for deficits (i.e. memory and cognitive tests to
tell how impaired the person is).

Only once everything else is ruled out do they tell you that the
probable diagnosis is AD. At that point, in many jurisdictions, the
doctor has a legal responsibility to report the person to the
licensing authority. Here in Ontario, the person then gets a letter
and they have the option of redoing their driver's test to demonstrate
they are still safe to drive - which seems pretty reasonable to me,
since if you can't pass the test, you shouldn't be on the road.

I have to tell you, your father driving or not driving is the very
least of your worries. If he has AD, he has a progressive, incurable,
dementing illness that ultimately kill him, after dismantling him
neuron by neuron. In other words, if what you suspect is true, your
whole family is about to turned upside down - nothing will ever be the
same again.

You also should think about this - even you think his driving skills
are shaky, but you don't want to upset him. How do you think you or he
would feel if he is the cause of an accident, and hurts someone?
Driving is not a right - it is a priviledge predicated on being able
to do so safely - which means your eyesight, your depth perception,
your reflexes and reaction time, your ability to think fast and make
decisions and appropriate judgements, your knowledge of the rules,
your memory - all have to be intact, or you are a danger to yourself
and others.
You don't want to find out he's past it by him hitting the gas instead
of the brake and driving into a pile of school children, or through
the window of the local coffee shop.

So, you take this one step at a time - you find out what is wrong with
him, and what, if anything you can do about it. And then you deal with
what comes next, including driving, wills, powers of attorney, and
future plans for support for your mother as caregiver.

Your odds of AD are elevated a bit from the general population, but
not as much as you might think. At your father's age, about 3% have
AD, but by the time people reach 85, almost 50% have Alzheimers - so
everyone's odds go up with age.
Right now, they know that early onset AD (a form that comes on in
middle age) i is strongly linked to genetic factors, and if you have a
parent with that form, your odds are 50-50. But the kind that gets us
as seniors is much less strongly linked to genes. It appears with the
sporatic form, it is some combination of genes and environment, but no
one is sure what the triggers might be. The common sense thing to do
is take good care of yourself in general. Keep your weight down,
exercise, keep your blood pressure and cholesterol down, be active,
eat a good diet etc. etc. - you may or may not get AD, but you will up
your odds of living long enough to come into the danger years!

Mary G.

After my mom had been diagnosed and taking meds she continued to drive a
little.  After a while I talked to the Dr. and he agreed.  I took mom in for
an appointment and he told her not to drive and mom argued but he got tough
and said he would have her committed if she drove again.  I called the DMV
and they sent me a form that I filled out some and the Dr. filled the rest
and mailed it in.  Mom received a letter saying her license had been revoked
for medical reasons.  It was not easy to do but my mom would have killed
someone.  She has lost muscle control.

I am sorry you are experiencing this.  I went through it and I know exactly
how you feel.  This is the most difficult thing I have ever done.  I will
pray for you.

Greg F

If the doc is doing her/his job, they will notify DMV of *any*
driver that would be unsafe on the road.  Most will do it because
they can be sued if they knew about any condition that impairs
driving and don't do anything and someone gets hurt or killed.

And that's the point.  Don't worry about "crushing his ego".
Worry instead about how you would live with him injuring or
killing someone when you or your mother *could* have prevented
it.

Talk to his doc.  Have him come in for an eval of his meds for
some other condition like his heart.  Tell the doc in advance
that you want to have him referred for a complete neurological
and psychiatric evaluation by specialists (Medicare will pay for
the tests but he'll need the referral).  The specialists are
usually much more well informed on diagnosis and treatment for
dementias.

Pussyfooting around is NOT going to solve the problem.  Denial is
not a river in Egypt.  He needs to be evaluated NOW so that he
caan get the meds that will slow the progress of his dementia,
which could be due to causes other than AD, including strokes,
hypozia, thyroid problems, medication problems, or other reasons.

Do it, and soon, since every day he's on the road is a day that
the lives of others are at risk.

Steve, just to reinforce with you how vital it is to get the person to
the doctor is this list I've pasted below of a number of other things
that can cause memory loss and cognitive impairment. Don't assume at
this point its AD. Just be alarmed that he is displaying symptoms and
get him to the doctor. It could be something else, and it does need to
be checked out - you would never forgive yourself if it later was
found to be something treatable like a thyroid problem or a B12 issue,
and diagnosis was delayed because you didn't want to upset him by
insisting he get medical help.

Just to give you an example, a coworker of mines dad was really
experiencing some memory issues - very confused - couldn't remember
his adult childrens names, would forget they didn't live at home etc.
From his description, I thought it was AD, but it turned out to be
hypoxia. He was experiencing periods of low oxygen levels from a
medical problem, and it was affecting his mind.

Its always worth finding out. After all, if your dad was 45 instead of
71, your mother would be freaking out and would have already dragged
him off to the doctor. Its not normal, and you can't know what can be
done about it unless you have a proper examination and diagnosis. If
he was having chest pains, and was balking about the doctor because he
didn't want to be told he had a heart problem, you'd have found your
spine on the issue PDQ, and this should be no different.

If he does have AD, the drugs that can slow down the progress do the
most for the person in the early stages, when they have the most to
preserve - i.e. that is the stage when you really do want to buy them
more time.

Mary G.

Differential Diagnosis (and these are just the biggies, there are tons
of other things that can cause apparent mental issues).

Differential Diagnosis Of Dementia
Degenerative

Alzheimer's Disease
Parkinson's Disease
Dementia with Lewy Bodies
Progressive Supranuclear Palsy
Multiple System Atrophy
Huntington's Disease
Pick's Disease
Frontotemporal (chromosome 17) Dementia
Corticobasal Ganglionic Degeneration
The Parkinsonian Dementia Complex of Guam
Dementia Lacking Distinctive Histological Features

Vascular

Multiple Infarction Dementia
Strategic Infarction Dementia
Lacunar State
Binswanger's Disease (Subcortical Ischemic Encephalopathy)
Vasculitis
Subarachnoid Hemorrhage

Infection

Fungal Meningitis
Syphilis
AIDS Dementia
Creutzfeldt-Jacob Disease (and other Prion diseases)
Post Herpes Simplex Encephalitis

Psychiatric

Depression
Alcohol abuse
Drug use or abuse
Personality Disorder
Anxiety Disorder

Toxic/Metabolic

B12 deficiency
Thyroid deficiency
System failure including liver, renal, cardiac, respiratory
Heavy metal toxicity
Toxin exposure e.g. glue sniffing
Medication side effects or interactions

Trauma

Subdural hematoma
Closed head injury
Open head injury
Pugilistic brain injury
Anoxic brain injury

Tumor

Glioblastoma
Lymphoma
Metastatic tumor

Other

Symptomatic Hydrocephalus (Normal Pressure Hydrocephalus)