Expert: Mary Gordon - 9/18/2009

Question
QUESTION: hi Mary,

Something is concerning me about my dad rather suddenly. Three things I must share as an interest of full disclosure before I get into my question.

A) My dad is only 58. Granted my dad has has substance abuse problems for most of my life. He managed to stop using freebase cocaine after being addicted for several years (this was about 15 years ago). But he still smokes a little weed (how little I don't know) and he also is what you'd call a functioning alcoholic. He's an overgrown hippie, what can I say lol?

B) My paternal grandfather lost a long battle last year with Alzheimer's at the age of 81. He'd been diagnosed maybe 7-8 years prior.

C) I lost my mom -- to whom my dad was married for almost 38 years -- in February of this year.

now I know that AD is hereditary and I pray that I don't live my golden years in the kind of hell that my grandfather did. And I know that years of drug use CAN cause memory loss so I don't know how much that might have to do with this or the continuing grief from losing the love of his life at the all-to-young age of 59 (last Tuesday would've been her 60th birthday.)

This is all in set up to my problem. In the last two weeks I've noticed that his short term memory is next to nothing. I had like a 10 minute phone conversation with him this afternoon in which I told him something and he swore I didn't tell him. This one example of many.

He mentioned something about this a few weeks ago and also mentioned that he would ask his doctor about a prescription to Aricept (sp?). He said he'd been noticing that he'd been blanking on words "It's right on the tip of my tongue" sort of thing.

First of all, Could medication like Aricept help that? Second, isn't he too young to be experiencing this? MY grandpa wasn't diagnosed until his 70's. And third, do I need to be worried and could I just be tilting at windmills here?

Thank you for your time.

ANSWER: Hi Ryan,

Your dad is doing the right thing in seeing the doctor. Given his age, it is unlikely that he has Alzheimer's. However, the brain is a delicate thing and there are a lot of health issues and lifestyle concerns that can result in cognitive impairment. What you are seeing could even be from stress and severe depression, which wouldn't be surprising in a man who has just lost his life partner.

His drinking may be a factor - long-term or excessive drinking can and does cause damage to the brain -- neurological damage and memory loss. Some damage can repair itself, but some can become permanent. Chronic alcoholics can develop Wernicke’s encephalopathy or Korsakoff’s psychosis, both of which cause short term memory impairment. Cocaine use damages the brain as well - in part by destroying a protein involved in memory and learning. Who knows what kind of damage he did to himself in the past. And on top of the drinking and past cocaine use, he still smokes marijuana, which is notorious for causing short term memory problems which can persist for some time after use - particularly in an older person (i.e. his body can't process drugs out of his system as fast as a younger person). His past substance abuse alone might be gaining up on his brain.

Sounds to me like overall, he has not been looking out for his own health. The doctor will probably do a full physical to rule out all kinds of health concerns that can impact memory and cognition.

Aricept is a drug very specifically used for Alzheimer's. Although Alzheimer's has a genetic component, you should realize that if you are lucky enough to survive into your 80's, irrespective of family history, you have a 50/50 chance of developing some cause of cognitive impairment - whether it be Alzheimer's, strokes, or any of the dozens of other causes of dementia (i.e. Pick's disease, and other frontal lobe dementias, Parkinson's, Lewy Body, Binswanger's, vitamin deficiencies, normal pressure hydrocephalus, thyroid problems, diabetes etc. etc. etc.).

There is a relatively rare form of early onset Alzheimer's that runs in families. It tends to hit people very young - as young as in their 30's or 40's. If this was in your family, you would know about it because you would have a pattern of relatives becoming mentally impaired and dying young. I don't think this is what is going on with your dad.

I doubt very much the doctor will prescribe Aricept. I hope your dad will listen to the doctor's advice, whatever it is - I'm sure you would like to have your dad around for a few years yet, and he needs to start looking after himself - which may mean making some lifestyle changes. I know you love him want to make sure he is still able to enjoy life and stay independent as he enters his senior years.

Hope this helps..See what the doctor has to say. Hopefully he or she can get to the bottom of what is going on.

Mary G.



---------- FOLLOW-UP ----------

QUESTION: Something that I've been wrestling with over the past few days, how do I bring this sort of subject up with him?

As an addict he makes a lot of excuses. "I'm a functioning alcoholic" he says. I want to get him thinking but I don't want to come across as being nagging and paranoid. My sister plays that role so much better lol.

he's a great father despite his flaws. I've gained more respect for him after mom's death and also following a health scare of my own. He can also be a little intimidating.

I'm not asking about family psychology here, but more along the lines of your knowledge and expertise on Alzheimer's and other brain illnesses.

Answer
Hi Ryan, I know the dilemma - I also had a father who was pretty much a force of nature, and who was not someone who took too receptively to suggestions about what he might want to do.

At the end of the day, he really may not be able to stop himself - and as the adult child of a substance abuser, you know that. All you can do is all you can do - it's really up to him to want to look after himself. With the loss of your mother, he should have stared his own mortality in the eye - but it's not everyone who realizes that mortality is a concept that applies to them personally.  He's got to want to be around for the next two decades.  Your best hope is to see what the doctor has to say, and follow that up with a few words along the lines of - I love you. We've lost Mom. I don't want to lose you. I need you in my life! Please look after yourself, if not for yourself, then for my sake.

You might WANT to scare the heck out of him by saying to him that since your mother has passed you are worried about something happening to him. Ask him if he has his powers of attorney ready to go for financial and personal care decisions - and that someone he trusts knows where everything is. Has he updated his will and insurance policies etc?

At least he is aware his short term memory is impaired. That is a plus. Many people with brain impairment are not self aware. They have no insight into their own challenges, and often will deny there is anything wrong with them.  Quite often, they genuinely cannot see what is obvious to others, and no amount of reasoning, arguing, logic, confrontation etc. will change that.  It makes getting them to a doctor that much harder. So you have that - he knows something is up.  

Would he be receptive to someone coming with him to the doctor? I ask because he may or may not be able to adequately describe what is happening, or recall what he is told in sufficient detail. If he wants to go alone, he might want to write out what is going on (perhaps with your help) and give that note to the doctor so he or she gets the full story to help guide investigations. In turn, your dad might want to ask for any results in writing as well. Nothing worse than you waiting on tenterhooks for the outcome of an appointment, and him not really being able to recall if he told the doctor all the important facts, OR recall what the doctor's opinion and recommendations might have been.

Failing that, one approach many people take with cognitively impaired relatives is that they write a note to the doctor and mail or fax it to the office prior to their loved one's appointment. The doctor may not be willing or able to discuss your father's case with you, but if you tell him what you are observing in detail, he WILL read it and take it seriously.

If the doctors do close in on any diagnosis involving permanent impairment of any kind, it's worth suggesting to your father that he undergo some comprehensive cognitive assessment. We had that done with my mother in law. It was very similar to what they put a kid through when they are looking for learning disabilities. The outcome was pretty shocking to our family, but it was extremely useful to all of us. At the time, my mother in law's only noticeable symptom was short term memory problems. However, when they did some testing, the impairments were much more extensive than we had realized -i.e. she had all kinds of perceptual problems, issues with logic and reasoning, understanding sequences and numbers etc. If you had met her in a social setting, you would not have thought there was anything wrong with her. She was charming and could carry on a very good social conversation. So, the utility of the assessment was that we got a realistic picture of exactly what was going on, and could make better plans from there on. It's always better to deal with some concrete information than vague fears and alarms.

I think you will feel better when you know what you are looking at. You've had a very rough couple of years. At the end of the day, don't beat yourself up too much. You may not be able to do much more than love him.

Hope this helps.

M.