Expert: Mary Gordon - 10/25/2007

Question
Just wondring if you have heard of this. My dad has been in the hospital for about a month, appeared he had a stroke although drs said test revealed he had not.  We were told last night that he had acute alzheimers, was very rare but does happen, when the end stage comes first.  He knows nothing, can't swallow and we have to decide to take him off the feeding tube or not.  Had never heard of this before and was found your site this morning and wondering if you had.  Thank you so much.

Answer
Hi Paulette,

The thing is....Alzheimer's isn't a disease  with an acute onset. As you may know, it is an illness that results from the gradual accumulation of a protein called beta ameloid. No one really knows what kicks off the process, but it takes time. Here is some information about how it works:
http://alzheimers.about.com/od/caregivers/a/alz_brain.htm
Its a slow and insidious process. Its not like the person goes to bed entirely fine and wakes up - bam - instant disability.  By its very nature, AD takes a while, since the beta ameloid has to accumulate to kill brain cells.

If you have been seeing your father regularly, and know him well, the development of Alzheimer's would have been something you would notice. Sometimes people think the onset of AD is dramatic in a person when they live far away, and haven't been up close to see the little clues that something is going on (i.e. such as when the person is good at hiding their impairment during phone calls, and the family comes for a visit and are shocked to see the real situation). Doesn't sound like this is your situation at all.

And yes, AD can progress fairly rapidly, but again, its not an overnight thing.

This is not to suggest that he can't have Alzheimer's AND something else going on. However, the "something else" is the part most likely to have created a dramatic change. Strokes, infections, brain bleeds, tumors, the onset of epilepsy, changes in fluid pressure in the brain, a metabolic disorder, some sort of poisoning, drug side effect, oxygen deprivation. Something big has happened if he went from okay to big trouble that rapidly.  Could be lots of things. The one thing it can't be is...what most doctors mean when they use the word "Alzheimer's."

I'm wondering if the doctors are using the word "Alzheimer's" to mean "dementia". Dementia is a term that describes a symptom - it just means cognitive impairment.  When a doctor says someone has dementia, its like saying a person has a fever. It describes their symptom, but not what is causing the symptom - so its not a diagnosis.  It may be that your father's doctors think they can't do anything for him, and that they believe he has something irreversible and progressive. Even if that is so, you deserve a more complete and accurate description of what has happened.

Incidentally, the second most common cause of dementia in the elderly is called multi-infarct dementia, and it is caused by strokes - and it can be endless tiny blockages that show no outward symptoms, as well as larger strokes and blockages.

I don't know what kind of specialists they have involved in his evaluation, but I would ask to see a neurologist with a speciality in dementias. I'm sure they have done a brain scan of some kind - so get the specialist to sit down with you and tell you exactly what he thinks has happened and what evidence he used to come to the conclusion. The Alzheimer's brain on MRI has a distintive appearance. Don't let them put you off. If he or she will not spend the time to carefully discuss what is going on to your satisfaction, I would ask for a second opinion.

Hope this helps. Sometimes doctors are not as thorough as they should be with the elderly, particularly when the person appears unlikely to recover. This may or may not be the case here - but this is your dad, and you don't want to have guilty doubts in years to come. You need to feel confident that they know what is wrong, and that the right things are being done for him. You may also want to know for sure what has happened to him, just in case there are implications for the health of other family members who may share his genes.

He's lucky to have you there to ask the questions.  

Mary G.