Knowing the different forms of Alzheimer's crucial for proper treatment

You know Alzheimer's. It's the disease that steals your loved ones away, one memory at a time. You watch for faltering memories and "senior moments" in your loved ones. In yourself.

But memory loss is just one face of Alzheimer's, according to Dr. Nicole Absar, medical director of the Senator William and Ellen Proxmire Memory Clinic at Integrace Copper Ridge in Sykesville.


Maybe you don't know Alzheimer's as well as you think you do.

"As the neurology has been evolving so much in the past few years, we now know there are at least two or three different forms of Alzheimer's disease," Absar said. "A lot of our folks, unless they have the traditional Alzheimer's disease, many primary care physicians may not even think they have Alzheimer's disease because they don't have the traditional memory complaints."


The most common form of Alzheimer's disease starts with memory loss as the first presentation, that is the one we all know about," Absar said. It can come in two flavors: early onset, where symptoms begin in a person's 40s or 50s, and late onset, where they begin in a person's 70s or 80s. Early onset is mainly a genetic disorder, according to Absar, while late onset, which she calls the "garden variety," is not purely genetic.

"The gene is one factor but also vascular disease, diabetes, blood pressure, cholesterol, physical activity and nutrition; these are all contributing [factors]," she said.

The second major form of Alzheimer's first appears as problems with visual and spatial processing rather than memory, according to Absar.

"A lot of these folks are going to the eye doctors for years before they go to neurologist because they think their problem is their eyes," she said. "They start to have difficulty with their geographic directions, like going south instead of north, and even having difficulties reading and understanding a map. Then they start having difficulties with balance and the start to fall."

This type of Alzheimer's is called the posterior cortical atrophy variant of the disease, Absar said, since the loss of brain tissue first manifests in the back, or posterior, of the brain, which is responsible for visual processing.

"As the disease progress, they also have lapsed memory and all the other symptoms that other forms of Alzheimer's disease have, but initially their presentation is so different that they do not get diagnosed properly," she said.

A third form of Alzheimer's that is now better characterized is called the frontal variant, according to Absar, because it affects the frontal regions of the brain, those associated with language and behavior. Those then are the areas of life where the symptoms first begin to show up.

"These types of Alzheimer's disease start with the behavior — a personality change as the first presentation," Absar said. "Or losing language, like finding difficulty with words, sentence completion."

Many people with the frontal variant of Alzheimer's may go see a psychiatrist, while those with the posterior cortical atrophy variant may go see an eye doctor, according to Absar.

"The best doctor that can monitor this is the primary care physician," she said. They are the gatekeepers for our folks. They should be able to screen them and send home a health questionnaire for spouses or families."

That can only happen, however, if families are aware of the difference forms of Alzheimer's, according to Absar

"The family should be aware that memory loss is not the only problem for cognitive disorders," she said.


If your loved one has trouble managing money, trouble expressing themselves, trouble with directions and is getting lost in familiar places or, Absar said, has problems with their eyes but nothing can be found during an eye exam, it could be a sign of Alzheimer's.

If you have had any of those symptoms," she said. "This is grounds to start having a conversation at an annual check up."



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