Losing Sue: A Story About Alzheimer's Disease
The DoctorThe Doctor, Alan R. Jacobs, MD
I initially suspected that Sue had early-onset Alzheimer's because of her symptoms: It didn't seem like the normal kind of forgetfulness that some women experience around menopause. I gave her a series of tests, one of which involved having her memorize a list of words. Then I distracted her for a while and afterward she couldn't remember them as well as she should have. It was clear that she had MCI, mild cognitive impairment, which can be the first sign of Alzheimer's.
There's no specific diagnostic test for the disease. An MRI really can't tell you much. All it does is take a picture of the brain and, in the early stages of Alzheimer's, everything usually looks normal. I sent Sue for a PET scan, which allows you to see the brain in action. The scan showed a pattern of cell activity that is consistent with the disease. This, the results of her memory tests, and her history all led me to the diagnosis.
Alzheimer's is extremely rare in someone Sue's age. You mainly see the disease after age 65. Typically, Alzheimer's progresses in stages, each lasting about four or five years. Memory is the first thing to be affected. Then patients lose language and spatial-processing skills, such as the ability to judge height and distance. Then the higher brain functions, like reasoning, start to go. Eventually the disease progresses to a point where patients can't recognize their surroundings or do things that involve multiple steps, like get dressed or brush their teeth. At the end stage they can't do anything but lie in bed.
Alzheimer's is always an awful disease and there's no cure yet. But what's especially tragic about Sue is the fact that she's so young. At this point in her life she should be taking care of her family, but instead she is the one who needs a caretaker. That's what makes her situation so heartbreaking.