Alzheimer's or "Just" Old Age?

Q: My mother is 71, and she has been forgetful for years, but it seems she is getting worse and repeats herself all the time. Is there a way to distinguish between Alzheimer's and just old age? Is there a test or something? 


A: When memory loss and other problems of brain function occur, it is important to secure a comprehensive evaluation by an internist, geriatrician, neurologist, and/or psychiatrist. It is necessary to rule out various treatable brain conditions that can mimic Alzheimer's disease. Examples of disease that can be mistaken for Alzheimer's include Lyme disease, certain metabolic disorders, and even depression. There is specific testing for Lyme infection; if the test is positive and treatment allows for troublesome cognitive symptoms to disappear, one could rule out Alzheimer's. Tests can be performed for metabolic conditions such as thyroid dysfunction. Psychiatric evaluation includes the use of specific depression scales such as Beck Depression Inventory to further differentiate Alzheimer's disease from other mental conditions.

A final, unequivocal diagnosis of Alzheimer's, unfortunately, can only be made by the direct pathological study of the brain after death (on autopsy). There are no specific tests for Alzheimer's disease, so one should be wary of claims of any specific mental or physical test. For example, there is a high association between apolipoprotein E-4 and Alzheimer's, but this association only defines susceptibility. It is neither specific nor predictive of who will develop the disease.

You may soon hear about a new imaging test that can diagnose Alzheimer's disease at an early stage, but the test is not yet available in the clinic. It entails injecting radiochemicals, which are agents that bind to targeted abnormal tissues — in this case regions of the brain associated with Alzheimer's. The radiochemicals light up and can be seen on a magnetic resonance imaging (MRI). This new kind of imaging tool is very valuable for research purposes. It allows researchers to follow the disease course and to test proposed new drug therapies. I consider the testing potentially very advantageous, as it would allow us to diagnose and introduce treatment early. But we do not yet have effective treatments and the testing is very expensive, so it is not clinically useful at this time. It is hoped that in the not-too-distant future the diagnostic imaging test will move into the clinic and we'll have more effective therapies to offer patients

An expert in Alzheimer’s disease, Dr. Robert N. Butler was a gerontologist and a professor of Geriatrics and Adult Development at Mount Sinai Medical Center before passing away from acute leukemia at the age of 83