THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
Our memory fails us from time to time – like forgetting the password of a Facebook account we created some time back, the name of an old classmate, what we read some days before when taking an exam, or even where we dropped our car keys. It can be a really frustrating experience, I know, but it is normal. We are not robots. No, our brains are wired much more complexly than robots. So, cut yourself some slack.
What is not normal, though, is memory loss that now interferes with a person’s ability to live a normal life. For instance, someone forgetting the road back to their home, their phone password, and even more scary, their children’s faces. At that point, we medical practitioners start suspecting something else, something significantly worse – dementia.
Many have heard the term before, but not nearly as many understand what it means. Dementia is a general term for a group of diseases that affect memory, language, problem-solving abilities, thinking, and reasoning. Several symptoms characterize a dementia patient, with the most common being forgetfulness and impaired social skills.
As I mentioned, dementia is a group of diseases, and Alzheimer’s disease is the most common form of dementia, accounting for up to 80% of dementia cases. While dementia is a general term, Alzheimer’s refers to a specific brain disease that causes progressive memory loss and cognitive decline.
Unfortunately, there is no cure for dementia or Alzheimer’s. They are neurodegenerative conditions, and they will worsen over time, we know that for a fact. But there are lots of things we do not know about dementia and Alzheimer’s, making it all the more unlikely that there is a cure for these conditions on the horizon. I don’t want to be the bearer of bad news, but many experts believe there will never even be a cure for these conditions.
Despite all these discouraging revelations, all hope is not lost. If these conditions are detected early, there are treatment plans that can slow down their progression. The key word here is “early.” Many times, treatment plans for dementia fail spectacularly because the condition has progressed to a critical level. Therefore, it comes as no surprise at all that there is as much research interest in techniques for diagnosing dementia early as there is in actually treating it.
While clinicians depend on biochemical tests and imaging to reach an accurate diagnosis, severe memory loss above the age of 65 is often linked to dementia. According to studies, around 70% of people exhibiting failing memory go on to develop dementia. So, seven in ten times when an older adult starts showing abnormal memory loss, you can expect them to have dementia. 70% is far from definitive, though, but 94% is much closer. Yes, there is a sign that is an even better predictor of Alzheimer’s and dementia, and it is a condition called progressive cortical atrophy (PCA).
This condition (PCA) is actually rare, occurring in about 5 to 15% of people with Alzheimer’s disease. However, if it does occur, there is a 94% chance the individual will have Alzheimer’s, per a UCSF study. The remaining 6% develop other forms of dementia. So, in theory, there is about a 100% chance that PCA will lead to dementia. Talk about convincing.
Progressive cortical atrophy is a degenerative condition that affects vision. It occurs due to a degeneration of the posterior cortex (that is, the outer layer of the back brain). While Alzheimer’s typically occurs above 65, PCA commonly occurs about five to ten years earlier. In the UCSF study, which analyzed over 1000 patients across 16 countries, the average age for PCA to emerge was 59.
Since the posterior cortex of the brain is an area responsible for processing information, symptoms of PCA revolve around poor processing of visual information. They include increased difficulty in reading a line of text, judging distances, perceiving multiple objects, distinguishing between moving and stationary objects, and identifying common objects. There may even be other mental symptoms like anxiety, hallucinations, and memory issues.
Considering the link between PCA and Alzheimer’s, it is logical to propose that clinicians be more on the lookout for this condition among people with a high risk of the condition. Unfortunately, because the condition is rare, many clinicians do not consider it a problem until it gets to advanced levels. Also, because it is a progressive condition, at the time of serious symptoms, the condition may already be at an advanced stage.
The fight against Alzheimer’s and dementia is one that we will be in for a very long time. If there’s any way we can gain an edge, we absolutely have to maximize it.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00414-3/fulltext
- https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/posterior-cortical-atrophy#:~:text=Posterior%20cortical%20atrophy%20(PCA)%20refers,of%20the%20head%20(posterior).
- https://www.medicalnewstoday.com/articles/rare-eye-condition-linked-to-alzheimers#Earlier-identification-of-Bensons-syndrome-needed
