Expert: Mary Gordon - 2/12/2009

Question
My grandmother is in her 70's. She has a very mild cognitive impairment, I'd say as a normal older adult. In about august last year she suddenly lost the ability to swallow properly and within a few months she lost 80 pounds. She lives in Czech Republic and the doctors there diagnosed her with AD because they couldn't find anything else wrong with her. She is now very depressed and frustrated because people are telling her she has AD. When I talk to her she is very unhappy and seems very sane to me. Also, because of her muscle wasting she is developing contracture. Is it at all possible for my grandma jump over certain stages of AD and have these serious symptoms which are normally seen in later AD? Thank you.

Answer
Hi Lucie,

There are a number of neuromuscular diseases that can cause muscle wasting in older people, and some of these cause forms of dementia.

Dementia is just a word that describes cognitive impairment - and Alzheimer's is just one cause. Alzheimer's does cause loss of muscular coordination over time, but doesn't present with early dysphagia (her problems with chewing and swallowing that likely led to her dramatic weight loss). Doctors don't know any better sometimes put a label of Alzheimer's on anyone with a dementia.

I doubt very much if what is going on with her is Alzheimer's. People with Alzheimer's do develop dysphagia, but it's generally at the end stage, when they are also extremely demented (i.e. can't walk or talk, don't know where they are, are incontinent and helpless to do anything for themselves.

That is not to say there is anything that can be done for her to reverse or halt what is going on. She likely has some sort of progressive neuromuscular disease that has also caused some cognitive impairment. You would have to speak to her doctor to know what his assessment included.

Just to give you an example - she may have a bulbar onset polymyositis (bulbar means the muscles of the mouth and throat) or a motor neuron disease. Some causes of myositis can involve wide spread inflammation, which can lead to strokes and other causes of brain damage.

Hope this helps

Mary G.