8 conditions often mistaken for Alzheimer’s Disease:

06May13

There appears to be trend of Americans being misdiagnosed with Alzheimer’s Disease. While it is true that Alzheimer’s Disease is the most common form of dementia and perhaps the most feared disease of the aging. Many conditions and the medications used to treat them can mimic a condition that looks like dementia. Following are 8 conditions that can often seem to look like Alzheimer’s Dementia:

  1. Sleep Apnea: is a sleep disorder that is characterized by abnormal stops in breathing or very low breath rates while sleeping which causes the person to suddenly wake up to restore breathing. This pattern of  waking up can occur up to 30 times per hour and go completely unrecognized by the patient. This results in poor sleep leaving the patient feeling tired and less alert with slowed cognitive function and memory impairment during the day.
  2. Infections: a common urinary tract infection, skin infection known as cellulitis, pneumonia can cause elderly people to appear as if they have declined cognitive abilities which can be often mistaken as dementia. When these problems are treated the person is often restored to normal brain function.  Unfortunately in our fragmented health care system in which often people present to specialists who only know the patient in a sick role these common reversible conditions often get missed.
  3. Dehydration: a condition in which the person does not have adequate fluid in their blood vessels to maintain normal bodily functions, (i.e. vital organ perfusion). This fluid deficit can cause a cumulative effect overtime and the person may appear to have progressively declining cognitive function which can be misdiagnosed as dementia.
  4. Depression: The changes that often come in later life—retirement, the death of loved ones, increased isolation, medical problems—can lead to depression. Depression is a mental disorder that has been described as an all encompassing low mood lasting more than 2 weeks which can cause disorders of thought process that can be inaccurately labeled as dementia.
  5. Medications: Many prescription and over the counter medications used to treat multiple conditions can have undesirable adverse effects on cognitive function. This cognitive decline can also be made worse when the patient is taking multiple medications, a condition known as polypharmacy. The problem is compounded as a patient sees many doctors that do not speak to each other, or when a patient changes primary care providers without arranging for records to be transferred.
  6. High Blood pressure: a sudden change in blood pressure either going

     up to high or being brought down to fast or to low can cause the individual to have a change in cognition that can often be mislabeled dementia.
  7. Stroke: Not all strokes are marked by paralysis or slurred speech. Some mini strokes can happen without the patient or loved one even knowing it. It can happen while the patient is sleeping, but the only symptoms may be a gradual decline in cognition. Over time this decline may be inaccurately labeled Alzheimer’s Disease
  8. Brain Tumor: sometimes people will develop a brain tumor in a particular part of the brain that will impair cognition and without proper diagnosis this condition could be written off as Alzheimer’s Disease. Other times a condition of a pseudotumor can occur which is sometimes called normal pressure hydrocephalus in which the brain acts like there is a tumor but in reality there is too much fluid around the brain. Draining this fluid can often times reverse the cognitive decline.

Consider the following not so uncommon case of the perfect storm for a wrong diagnosis of Alzheimer’s Disease:

An 84 year old woman living in an apartment in Manhattan with a diagnosis of rate controlled atrial fibrillation, hypertension, hypothyroidism, urinary incontinence, generalized osteoarthritis, obesity, congestive heart failure is brought to the ER for “altered mental status”. While shopping a concerned person called the police because the woman appeared to be dazed and wondering. The patient is a “poor historian” because she cannot recount all of her medications and all the doctors she is seeing. She is not able to tell the police where she lives. The ER evaluates her and finds her to have a urinary tract infection after 8 hours lying on a stretcher. During that time she has not taken her regular medications, her pain is flared up, she has not eaten or drank anything because she does not want to bother the nurses who appear to be too busy.  The medication she normally takes to control her heart rate and blood pressure get missed and her vital signs become gradually abnormal. Meanwhile her character label in the health care system for the time being is “old lady found wandering with a UTI waiting for a bed”. The stage has been set for declining cognition due to various other factors which could be easily labeled Alzheimer’s Dementia by the untrained eye.

It is important for people to have a relationship with a primary care provider particularly as they get older that knows them when they are well and over the course of illness.  Many of my patients avoid going to the doctor’s office because they say “he never really listens to me, or they always find something, or at my age surviving is  good enough, or I can’t wait all day for him in the office for a 5 minute visit.”

As a board certified primary care provider with extensive experience with the elderly I have seen many misdiagnosed patients admitted to the hospital or discharged from the hospital with a label of Alzheimer’s Disease only to find out it is a delirium that is taking longer to resolve than expected.

Raymond Zakhari, NP

Hospitalist in internal medicine at The New York Presbyterian Hospital Payne Whitney Clinic during the day, and Residentialist by evening at Metro Medical Direct a web based primary care medical house call’s practice in Manhattan

 



One Response to “8 conditions often mistaken for Alzheimer’s Disease:”


  1. 1 Palliative Care as a bridge to hospice | The Informed Patient

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s


%d bloggers like this: