Expert: Mary Gordon - 1/22/2004

Question
my husband and I are seperated becasue he can't understand he needs help. He is 54. I saw the show on pbs last night and am worried sick. Is there a way to distinguish Ad from severe mental disorders? Gosh, he has all the early symptoms. But he also suffers depressiona nd ADD.  He has a tremore sometimes in his hands and sometimes his head bobs.  He has mood swings and he has some scary mememory disfunction.  he is unpleasant to me sometimes which is alwasya  sruprise to me beacase it never seems like something upsetting to me. When we had an 8 week visit ever the holidays, he was nuerotic about certain things and seemed to be suffering from paranoia.   Help!

Answer
Stephanie

What you are describing could be the early stages of Alzheimer's or it could be a lot of other things.  Confusion and memory problems can stem from small strokes (so small the person may not show other signs of stroke), drug interactions or side effects, thyroid problems, pernicious anemia, depression, tumours, liver and lung disease - and a stack of other things like forms of Parkinson's and other neuro degenerative disorders.  

Alzheimer's is only diagnosed by ruling out everything else it might be. The only truly definitive test is a brain biopsy, which is rearely done for obvious reasons. The  first step is to always to make sure the person isn't suffering from some other problem that might affect their mind - especially if the "something" might be treatable.  

Diagnosis starts with the family doctor for a full physical with assorted blood tests, a review of history and medications, and then often a referral to a neurologist or psychiatrist. Mental illness and depression have to be excluded and a proper work up usually includes a CAT or other brain scan to rule out strokes, tumors etc.

A good assessment will also check out the extent and nature of the person's deficits.  Dementias like Alzheimer's don't just affect memory. Because it affects the entire brain, reasoning, judgement and personality can be affected early in the disease. Things families notice first often include memory lapses, trouble with numbers or time, getting disoriented in familiar places (i.e. getting "turned around" on the way to the store), trouble thinking of words, asking the same question repeatedly,  getting upset easily or frustrated, changes in routine (i.e. they sometimes stop participating in things they previously loved), difficulty solving simple problems (i.e. not being able to figure out what to do when something goes wrong). It can be subtle, but if the alarm bells are going off in your head, I'd listen to them.  

If your husband does have something like Alzheimers, you will not be the only one noticing changes in him - if he does have a health issue causing cognitive impairment he will be experiencing problems with daily life, being able to do his job, have a social life, participate in hobbies. Have you tried speaking to neighbours, friends, children, other relatives or even coworkers to see if they have noticed anything amiss and might be able to express some concern and convince him to see his doctor? How about a supervisor, pastor or other trusted advisor or anyone close to him  who might be able to suggest he get himself checked out?

You are in a delicate position in that you are separated from him, and you suggesting he is losing his mind, no matter how well intentioned, may be seen as a form of bad mouthing him, or an attempt to discredit or embarrass him, or even undermine him legally  - so be very diplomatic in speaking to others about this. He is a grown man, so if he is still functioning, he can't be forced to seek help.

If you happen to know his family doctor, one very effective thing to try is to write his doctor a letter. The doctor may not be able or willing to discuss your husband with you - but he will certainly read a letter - taking the time to write things out means you really are worried.  Be very specific about what you are seeing that concerns you - give concrete examples, and detailed descriptions and explanations - how long as this been going on, is it getting worse, tell him all the physical, mental and emotional symptoms that are different and new from the man he once was. Writing it all out gives you a chance to organize your thoughts and choose your words with care - and takes away the emotional content of a direct conversation. If you send a letter like that to his doctor, the ball is then in the doctors court. if he or she is a responsible caregiver, he or she will be looking for signs of a problem next time your husband comes in for any kind of a visit.

People with mental illness or with disorders affecting their brain often can't see how they appear to others, let alone have any insights into their own problems. What seems clear to you, he may be quite oblivious to, so all the arguing, begging, and persuasion in the world may not convince him there is a darned thing wrong with him. You may not be able to help him at this stage - and I know that is a very hard thing to accept or come to terms with. Sometimes people have to bottom out before they can be helped - and your position is much more complicated by a separation.

My suggestion is to find out if others who know him have seen anything odd or different about him - if they have, even if they won't discuss it with you, solicit their help to him to a doctor. And write that letter to his doctor if he's got a GP -  beyond that, you may have to just stand by and watch and wait, painful and frightening as it may be.

My heart really goes out to you. Hope this helps.

Mary Gordon
Toronto