In the summer of 2018, the family of a distinguished New York judge in her early 50’s began to worry about her health. She complained of feeling exhausted and frequently forgot conversations that she had had with her husband.
Initially dismissed as stress due to her demanding career, soon many of her coworkers and the lawyers in her courtroom noticed something was off as well.
It would still take more than a year and a half for her to get a diagnosis.
Eventually, she and her family would find out that she was one of the 500,000 people diagnosed with Alzheimer’s Disease (AD) in the US each year. Of those, 5% will develop the illness before the age of 65, otherwise known as early-onset Alzheimer’s.
AD is thought to be caused by the abnormal buildup of two proteins in the brain that form what are called “plaques” and “tangles”. Everyone develops these as they age, but people with AD develop many more than average, causing damage to the brain over time.
While there may be a genetic component for some cases of Alzheimer’s (meaning it can run in families), most cases are considered sporadic with no known genetic cause.
It can be tough to spot the early signs of the disease, especially for those with early onset, since they can resemble the symptoms of stress, overwork, or other common health problems.
If you find yourself or your loved one experiencing any of the following symptoms, you should schedule a visit with your doctor:
•Memory Loss: Forgetting important dates or events you usually remember or having to ask the same questions multiple times.
•Difficulty planning and problem-solving: Trouble making or following a plan of action. Difficulty following a recipe. New difficulty working with numbers.
•Difficulty completing familiar tasks: Completing routine tasks or driving familiar routes may become difficult.
•Losing track of time or place: Forgetting where you are or how you got there. Trouble planning for future events.
•Vision changes: Trouble with reading, judging distance, or determining contrast.
•Trouble finding the right words: Trouble starting or joining a conversation. Repeating yourself or losing your train of thought in the middle of a conversation.
•Misplacing items: Putting items in unusual places or having trouble retracing your steps.
•Trouble making financial decisions: Making poor or out-of-character decisions with finances. Engaging in unusually risky investments or donating money to strangers.
•Mood or personality changes: A noticeable increase in confusion, depression, or anxiety, especially when something outside of the normal routine takes place.
Currently, diagnosing AD relies on noticing the signs like those mentioned above. Your doctor will review your health history and conduct some brief testing of your memory, and problem-solving skills. They will also likely order routine blood tests to rule out physical causes of your symptoms.
Depending on the results of those tests, your doctor may refer you to a neuropsychologist for further testing. They may also order other tests such as a spinal tap or a CT or MRI scan of your brain.
There are no direct tests currently available to determine if you have AD, but researchers are studying various proteins and other biomarkers to determine if they can diagnose the condition quicker and more accurately in the future.
There is currently no cure for AD but there are several medications approved that can help slow the progression of cognitive decline. Additionally, any steps that you can take to improve your overall health will also help your cognitive health.
For most people, an average of 2-4 years will go by between when their symptoms start and when they are able to get a diagnosis. After that, patients can experience another 2-10 years of mild cognitive impairment. It is not until the final stages that actual Alzheimer’s dementia occurs, and patients become severely impaired.
It is during the initial stages that early intervention can have the most impact. Patients with only minor impairments can plan for their future care needs and make their wishes known.
Rearranging work responsibilities, preparing for a decrease in income, disability insurance, planning for changes in relationships, and possibly seeking out support groups or clinical trials are all considerations.
For the judge diagnosed with early-onset AD, she took a medical leave and eventually an early medical retirement. A review of the cases she oversaw in her early illness determined no inappropriate decisions, but some questions will always remain.
Today she lives at home with her family and caregivers. She still has good days where she can laugh and reminisce. Her husband has spoken out about her condition in the hopes of educating others about early-onset AD.
If you would like to see the story about the judge mentioned in the article: https://features.propublica.org/judge_alzheimers/brooklyn-federal-judge-mental-illness/
