Dr. Patricia Farrell on Medika Life

Dementia Remains One of Our Most Serious Mysteries

The body still retains its mysteries, but research soldiers on in trying to solve one, in particular, dementia

Years ago, I was involved in a national protocol for a new medication to treat Alzheimer’s. As a result, I am always interested in new findings regarding Alzheimer’s, and today, several things came across my computer screen. Therefore, I am passing it along because I know many of you may be interested in it.

Alzheimer’s is a terrible disease or disorder, whichever way you wish to categorize it. The current thinking is that unless someone finds a cure, treatment, or some way to address the cognitive decline associated with this neurologic disorder adequately, we will be swamped, drowning in effect in Alzheimer’s patients who require 24-hours-a-day care. It is known as the Silver Tsunami.

There is no question about it. As we improve our ability to live longer, thanks to advances in medical technology, we also decrease our ability to pay trillions of dollars for care worldwide. Too many questions are still involved in this complicated area, but one thing we know is that whoever finds the goose that lays the golden egg will be assured to be a billionaire.

Racing to find ways to address Alzheimer’s or other forms of cognitive decline has proven to be an area of intense interest. We have no idea or a limited idea regarding what causes Alzheimer’s, what neurobiological elements are involved in it, and when Alzheimer’s might first present itself.

Testing, whether paper and pencil and active questioning, serologic testing, or even dermatologic testing, have led us to too many blind alleys. The thinking had been that we nailed down the culprit, and it was a material called tau produced in cells in the brain and even in the skin.

Is tau truly diagnostic of Alzheimer’s, or is it something that is produced naturally in everyone’s body and varying levels of it may not be diagnostic of a cognitive declining disorder? When not involved in brain tissue entanglements, tau is natural and serves a good, supportive purpose in brain cells.

Today, I came across two interesting studies. One was that tea and coffee might, somehow, be involved in forestalling cognitive decline. My antenna immediately went up since it seemed that this was yet another attempt by someone to promote their product, namely coffee or tea.

We know that tea has specific properties that may help maintain our health. If you want an example, you might look at countries like India, where people drink tea exclusively and have numbers of citizens living over the age of 100.

I had seen an article about a woman who was 104 who had just learned to read. If anything, that is an outstanding accomplishment, but the fact that she was over 100 and learning to read was astonishing. Was it due to her drinking tea all of her life?

Findings from some research studies may prove interesting but not diagnostic. Another study that came to my attention was of persons with alopecia Arriaga (AA), a hair loss problem. The investigators found that persons with AA were more likely to develop any dementia such as Alzheimer’s or unspecified dementia than the control group.” While this may seem shocking or exciting, please keep in mind that it may only point to the immune system having an active role in our developing certain types of dementia and depression.

Therefore, anyone with a disordered immune system may develop varying types of dementia. Dementia is wide-ranging and often difficult to nail down, even in clinical practice.

Many dementia misdiagnoses have been written in stone in charts, and then the patients have been treated accordingly. I suppose you think this is unacceptable or unethical. In that case, I agree with you, but I would also suggest that we need more robust testing, and we also need persons who are aware of their own biases when they test. Too often, older patients suffer from being the recipients of this ageist bias.

And it’s not restricted to dementia. A physician once told me he was asked to consult on a patient in a hospital. When he met the man, he asked one question: Has your hat size increased? After reviewing the man’s chart, the physician thought he might have gout, and an increase in head size would be potentially diagnostic. He was correct, and the man then received the proper treatment. Previously, they diagnosed him with hearing and cognitive deficits. Was it because he was elderly?

Allow me to provide a small bit of insight regarding testing. Psychiatrists are not trained the way psychologists are in psychological testing, yet they are expected to use cognitive testing in their practice, primarily in hospital settings.

The internet provides many tests from pharmaceutical firms to test for various psychiatric/psychological disorders. The tests may, in my estimation, not be as adequately validated as we might wish. Validation of test administration is also problematic. And they are not used by test-production companies that make them available for licensed mental healthcare personnel and detail the qualifications needed. Anyone can download them, even those tests that indicate they are not for clinical use.

I sat and watched a psychiatrist attempt to administer a cognition test for Alzheimer’s, and he did the one thing all of us are trained not to do. He led the patient in her responses. “You don’t know the city we’re in, do you?” was his first question. He was supposed to ask her (the list of questions was right in front of him) what city they were in, not offer that she didn’t know the name of the town.

Providing that kind of opening indicates to the patient that they are not likely to know the answer to the following questions that will be asked. It was a significant mistake, but the patient was obviously impaired and wouldn’t have gotten a good score regardless of how the task was administered. That is not the point, however. If someone is going to do psychological testing of any type, they should be adequately trained. The guidelines are online.

Intelligence testing is another area of contention, and I have seen too many psychologists administer them improperly. I recall a professor telling a student, “This is the Wechsler Adult Intelligence Scale, not the Wechsler Adult Intelligence Scale with Smile.” Smiling is not permitted in the rigid protocol.

A significant example of this related to a licensed clinical psychologist who was picked up on a highway on the West Coast of the US. She had abandoned her car and was in distress. The officers took her for an evaluation to the nearest hospital. It happened to provide care for persons with mental deficiencies. They administered an IQ test at the facility, and she scored less than 50, placing her in an impaired group.

The woman had a doctorate and, after a month, someone thought to look into her background and discovered facts that immediately indicated she needed to be transferred. Once at another facility, she was diagnosed with bipolar disorder, treated, and returned to her home on the East Coast. It is a stunning example of testing under the wrong conditions and with a person who is not in a condition to be tested for intelligence.

Remember that no one is perfect regardless of where they went to school or work. We all make mistakes, but in medicine or healthcare, the errors can be life-threatening or result in isolation and a major restriction of liberties. Power must be used with this knowledge.

Always question authority.

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Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

DR PATRICIA FARRELL

Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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