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October 14, 1999 (Los Angeles) -- Subtle changes in a person's everyday activities could be early warning signs of Alzheimer's disease, warns an expert at the Ninth Congress of the International Psychogeriatric Association in Vancouver. Often these changes become apparent to friends or family members before they can be detected on a screening test.

"It's hard to make a diagnosis without knowing what a patient used to do," John C. Morris, MD, tells WebMD. Morris is a professor of neurology at Washington University in St. Louis. "Early detection of Alzheimer's disease represents the appreciation that an individual is changing in relation to what they were once able to do."

For example, says Morris, some tests assess current mental function by having the patient read a paragraph and then recall what he or she read. "But they don't tell us how that performance relates to what that person once did. So someone who is well educated and bright could lose a substantial amount of intellectual ability and still do well on a screening test." Morris, who is co-director of the university's Alzheimer's Disease Research Center, recalls one patient in his 80s who had always prepared his own tax return. The man's wife suspected something was wrong when he began turning the task over to an accountant.

When is a change in behavior truly a danger signal? For example, perhaps the man described above simply grew tired of doing his own taxes after all those years. "Diagnosis is sometimes difficult," Morris admits. "We must weigh all the potential factors. Sometimes, when I'm not sure, I ask the patient to come back in a few months for reassessment," he says.

Other early warning signs include repetition of questions, statements, or anecdotes; misplacement of items more than usual; and uncertainty or hesitation when driving, even to familiar places, according to Morris. Someone with early Alzheimer's disease may forget if he or she must turn right or left to reach a certain destination, says Morris.

Early detection is important because drugs are available that can slow the patient's decline, at least temporarily. "There is no dramatic intervention and no cure, only a modest benefit, but that is still important," Morris warns. "These drugs allow the individual to maintain their cognitive and functional abilities longer than usual, so they should be initiated when function is still relatively good." Cognitive function refers to someone's ability to plan, remember, and exercise good judgment.

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Another way to preserve as much function as possible is to "use it or lose it," says Morris. "Have the patient engage in as many activities as possible, but under supervision. For example, they can continue to prepare meals, as long as someone makes sure the burners have been turned off afterward." Some patients in the early stages of the disease can even continue driving -- but Morris emphasizes that they must undergo a thorough evaluation first. "I have early-stage patients who deliver meals on wheels. The main issue is the individual's safety and security."

People who look after Alzheimer's patients must also take care of themselves, Morris says. "It is very difficult for some people to appreciate how the stress of caring is affecting them, but studies have shown that the physical illness of the caregiver may be adversely affected." For those who fear that it seems selfish to tend to their own needs, he says, "If they don't take care of themselves, it is also bad for the person they're caring for." Early diagnosis and a supportive environment are important because, he says, "Alzheimer's is a treatable disease."

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