Delayed Alzheimer's diagnoses common, troubling - Macon Telegraph (blog)

SACRAMENTO, Calif. -- Claire Schooley tried for several years to get doctors to diagnose what was going on with her husband, David, now 57.

He would ask her the same questions again and again, never remembering the answers. He would grow confused. Two years ago, on a trip to San Jose with their kids, now ages 6 and 12, he drove 60 miles in the wrong direction from their hotel, insisting the whole time he knew where he was going.

Maybe his memory loss was the result of depression after two job losses, most recently in 2009, doctors told the Sacramento couple. Maybe it was stress.

He was growing silent and distant, increasingly lost in his own world.

“I’d see him sitting in front of the TV at home,” said Claire Schooley, 45, a network engineer. “He’d say he was taking a break, but he’d forgotten what he was doing or what room he was in.

“He never was like this before. We were having a tough time. I knew in my heart there was something wrong.”

Two days before Thanksgiving 2012 -- and almost two years after he sought help from his primary care physician -- David Schooley finally was diagnosed with Alzheimer’s disease. For people with the degenerative brain disease, delays in diagnosis can exact a steep cost.

Without timely diagnosis, people with Alzheimer’s lose valuable months when medications can most effectively slow their memory loss. The delay in diagnosis robs families of the chance to enjoy their time together and make financial and legal plans for the future.

Alzheimer’s is now the nation’s sixth-leading cause of death, with 5.4 million people affected. Even so, physicians can be slow to identify the disease in the elderly, despite the fact that old age is the greatest risk factor. And doctors can be even more reluctant to diagnose people younger than age 65 who suffer from the rare, early-onset form of the illness.

“Honestly, it’s a routine thing that families in general try to get the person seen by a knowledgeable physician for more than a year, even a couple of years,” said neurologist Dr. Charles DeCarli, director of the UC Davis Alzheimer’s Disease Center.

The U.S. Centers for Disease Control and Prevention estimates that only 4 percent of Americans with the disease are younger than 65. But with the aging of the baby boom generation -- and the coming Alzheimer’s epidemic, projected at 14 million cases by 2050 -- the hard numbers behind that younger-onset percentage continue to rise.

Typically, experts say, families end up frustrated in seeking help, because primary care physicians aren’t looking for dementia in people still in the prime of life.

For many patients, diagnosis is delayed because a comprehensive assessment of dementia requires a detailed clinical history and neurological exam, said DeCarli. The process takes an hour, and most primary care physicians, who can see up to 40 patients a day in their practices, don’t have the time.

“It’s a challenge for primary care physicians,” he said. “I tend to see them adapting a number of strategies. When someone has memory complaints, they get a brain scan and get the patient on memory-enhancing drugs.

“The other strategy is to minimize the complaint until the situation gets more severe.”

The average person with dementia comes into contact with the health care system four times more frequently than patients without dementia, DeCarli said.