Expert: Mary Gordon - 5/18/2007

Question
Would you be able to help me understand something?  My Father has been diagnosed with Advanced Alzheimer's. When I read the staging of this disease I would say he is definitely at stage 6... BUT he is able to play King's In the Corner (a card game) very well on some days.  Is this really possible with Advance Alzheimer's?  or Do you think this might be a misdiagnosis?  Thank you for your answer. Carol

Answer
How was your father diagnosed? Did they do a comprehensive work up and exam? There are many causes of dementia, and most  of them do show dramatic fluctuations in abilities and cognition. Lewy Body Dementia is one that has particularly dramatic swings.

People with AD often show quite dramatic fluctuations - they tend to be at their best when they are calm, rested, fed and feeling well - the more stressed they are, the more tired or unwell, their abilities seem to dip - so they have good days and bad days, depending on how they feel and what is going on around them.

Its likely Alzheimer's with some swings - and if its Lewy Body dementia (or another of the many types of dementia causing degenerative diseases), they still end up in the same place in the end. Talk to his doctor if you have doubts about the way he was diagnosed. Typically, the person has a full physical to rule out many illnesses, a brain scan to look for strokes, tumours etc. and sees a neurologist or psychiatrist with a dementia specialty for a series of other tests, including a cognitive evaluation to have a good look at the person's deficits.

My mother in law would have days when she was quite with it, and others when she was almost in a stupor - even a little head cold would just shut down her brain.

She lost her speech almost entirely about 2 years before she died - after that point, nothing came out but nonsense and garble (random noises). However, one day we were visiting and took a photo album, which she sat and looked at.  At that point, she didn't even know her own husband in photos, but she all of a sudden pointed out MY father, and got a full clear sentence out about who he was, where the picture was taken and what he was wearing. We were gobsmacked - but then she went back to the garble. Its kind of like everything connected for a few minutes, and then back to dark again.

An injured brain is a mysterious thing, isn't it. I am surprised he can play cards, since many people with AD lose the ability to understand sequences fairly early on. However, I'd be happy if he's able to do something he enjoys.

Mary G.