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Is it alzheimer's or AIDS?

Is It Alzheimer's or AIDS?

The Centers for Disease Control's requirements for an AIDS diagnosis have recently been changed to include a brain dementia that is being increasingly noted in patients with no other clinical manifestations of AIDS or AIDS-related complex (ARC). Dementia is a condition of deteriorated mentality characterized by marked decline from the individual's former intellectual level and often by emotional apathy. Dr. Richard W. Price of the Memorial Sloan-Kettering Cancer Center and Cornell University Medical Center in New York has been studying what he calls ADC--the AIDS dementia complex--for several years. He has published extensively and is consulted by the Centers for Disease Control as a respected authority on AIDS dementia. In one recent study, Dr. Price and his colleagues have found that 25 percent of the patients showed symptoms of dementia before having any physical complaints. Although nearly two-thirds of the overtly demented patients in this autopsy series had AIDS before they became clinically demented, in 13 percent of patients AIDS and dementia were diagnosed simultaneously. For 9 percent of the patients, AIDS dementia complex was the only serious clinical manifestation of HIV (AIDS) infection before death.

In a book entitled AIDS and the Nervous System to be published in 1988, Dr. Price wrote, "With the growth of the AIDS epidemic it has become increasingly important to consider a diagnosis of AIDS even if the risk factors are uncertain. Blood transfusion is now diminishing in importance as a means of transmitting the virus, but many persons have already been infected by this route. In such cases, AIDS may not be suspected, and the diagnosis may be partially obscured by the illness that necessitated the transfusion. Transmission of HIV infection through heterosexual sexual contact is of growing importance, and in those who are infected by this means the history may provide no clue to their exposure to the virus. Depending on whether the symptoms are predominantly motor, behavioral, or cognitive, the illness in such cases may be confused with multiple sclerosis, Parkinson's disease, Alzheimer's disease, or even schizophrenia.' Dr. Price emphasized that it is, therefore, important to search explicitly for risk factors for AIDS in all patients with dementia and to follow through with serological screening (as with the ELISA test) for evidence of exposure to HIV. He said, "In the very small minority of patients with HIV infection who are seronegative [negative on the ELISA and Western blot tests], attempts to isolate the virus either from blood or CSF [cerebrospinal] fluid may be helpful.' He further pointed out that determination of T-cell subsets may also be of value if serological studies cannot be performed or are negative.

At the Society, we are attempting to investigate the likelihood of AIDS dementia patients' being mistakenly thought to have Alzheimer's. A patient over 40 years of age who contracted AIDS in a blood transfusion and developed the AIDS dementia might well be relegated to the Alzheimer's "catchall' scrap heap unless his vigilant doctor gave him an AIDS test. It is now estimated that 10 percent of AIDS patients are over 50 years of age, and the population of patients falling into the older age groups will be significantly increased in the coming years.

The dementing illness caused by the AIDS virus has been called the most serious pitfall for the misdiagnosis of Alzheimer's disease in those over 50 years of age by Dr. Thomas D. Sabin of Boston City Hospital. He further pointed out, "Despite rapidly advancing basic information on Alzheimer's disease no widely available definitive diagnostic test is available.'

We believe every Alzheimer's patient who has had a blood transfusion in the past ten years should have the benefit of a simple AIDS screening test. If the result is positive, it should, of course, be followed by a confirmatory Western blot test.

Many things can be done for a patient diagnosed as having AIDS. For example, you wouldn't want to continue the patient on drugs that are immunosuppressive, such as corticosteroids and some antibiotics. Because even aspirin is mildly immunosuppressive, an AIDS patient should be given Tylenol or another acetaminophen-containing drug instead. You also wouldn't want to give the patient live vaccines. Recent studies, however, offer hope that AIDS patients can be routinely immunized against influenza and pneumonia, which are often fatal to them, because those vaccines are killed or inactive.

Dr. Price points out that AIDS patients with neurological disease should be rigorously examined because certain disorders, perhaps most notably cerebral toxoplasmosis, may respond well to therapy.

If my father were in a nursing home with an Alzheimer's diagnosis and had had a blood transfusion in the past ten years, I would ask his doctor to give him an AIDS antibody test to see if it could be AIDS dementia instead of Alzheimer's. Because an AIDS patient has no protection against infections, he shouldn't be exposed to children with bad colds any more than an advanced emphysema patient should be exposed to an upper respiratory infection, which could become life threatening. Physicians, dentists, and other health-care providers would want to take necessary precautions in caring for the patient.

Dr. Sabin pointed out some of the subtle differences between AIDS dementia and Alzheimer's in a recent issue of the Journal of the American Geriatrics Society: "Acquired immune deficiency syndrome dementia begins with early behavioral and memorial difficulties. The behavioral change consists of a loss of interest in social and occupational activities that may ultimately progress to overt apathy. The patient may handle the usual bedside mental status examination with considerable accuracy but will show marked slowing of responses, and failures may be limited to those tests which require a synthesis of data or sustained attention such as the serial subtraction of 7s from 100. This progressive constriction of the personality is associated with an increasing reliance on daily "memory lists,' then an overt inability to recall recent events with good retention of old information. In the early phases these symptoms are often attributed to depression, but progression results in a definite subcortical dementia with marked apathy, chronic confusion, and severe memory loss.

"This constellation of clinical features in AIDS contrasts with Alzheimer's disease in several diagnostically helpful ways. The irritable euphoric apathy of frontal lobe dysfunction does not appear in Alzheimer's disease until the triad of memory disorder, constructional-spatial difficulty [problems with perceiving and ordering space], and nominal aphasia are clearly established. The nominal aphasia is a fluent-language disorder with intact comprehension and repetition, but a difficulty in finding the exact word. This aphasia is manifested by the frequent use of circumlocutory phrases [roundabout expressions] as substitutes for the "lost' words. Aphasia of any sort has been remarkably infrequent in AIDS dementia.

"In early Alzheimer's disease there are no elementary neurologic findings but AIDS dementia is often accompanied by ataxia [failure or irregularity of muscular coordination], leg weakness, nonspecific tremors, or signs of peripheral neuropathy [disease of the nerves].'

Dr. Sabin explained that some of these signs may be due to AIDS myelopathy (or changes of the spinal cord) that resembles the degeneration of the nervous system brought on by vitamin B12 deficiency. (Pernicious anemia, which is caused by vitamin B12 deficiency, can bring on a senility that might conceivably be misdiagnosed as Alzheimer's.) Urinary incontinence may accompany this nerve damage, Dr. Sabin said.

He further stated: "The computed tomography (CT) scan in both disorders shows widespread loss of brain volume but sequential scans of AIDS patients will document more rapid progressive atrophy than is seen in Alzheimer's disease.' According to Dr. Sabin, the mechanism of AIDS dementia is not understood. There is suspicion that disruption of the blood brain barrier may occur.

Diagnosing Alzheimer's

The determination of the presence of Alzheimer's disease is not yet an exact science. Until an autopsy is performed, there is no confirmation. After a physician has ruled out all other possible reasons for the senility, it is called Alzheimer's.

Alzheimer's may actually be several diseases with similar manifestations. Unfortunately, those affected with memory loss are not likely to take themselves to a doctor. Here is where family members can play a vital role by recognizing early signs of memory failure and taking the afflicted relative for a complete medical work-up to find out if it is Alzheimer's disease or one of the correctable causes of memory loss.

It is hoped that MRI (Magnetic Resonance Imaging) will assist the diagnostic process in the future. It is also hoped that the new genetic discoveries in familial Alzheimer's discase will lead to the development of blood tests that will greatly facilitate diagnosis. The uncertainty of diagnosis and prognosis is a major stress factor for families.

Pernicious anemia causes an Alzheimer's-like depression dementia that can be reversed with administration of vitamin B12. Hypothyroidism is another correctable problem that can cause a senility condition that can be confused with Alzheimer's.

Drug reactions often imitate Alzheimer's disease. Many medications can cast a cloud over the consciousness of older people. A drug may not be excreted efficiently by an older patient, causing a build-up to toxic levels in the blood.

Some researchers have found accumulations of aluminum in the brains of patients dying with documented cases of Alzheimer's disease. If current studies confirm this association, we may soon learn means of avoiding aluminum or even removing it from the body.

The Saturday Evening Post Society subscribes to a data-search service that enables us to monitor all the research papers on Alzheimer's world-wide as they are being published. If you know an Alzheimer's patient and would like to receive references on current research papers on Alzheimer's that you may provide to the patient's physician or health-care provider, please write to: Alzheimer's, P.O. Box 567, Indianapolis, IN 46202. Any physicians or AIDS researchers wishing to obtain reprints of papers on the subject of AIDS dementia should write to: Dr. Richard W. Price, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.

Double Trouble

Dear Dr. SerVaas:

Sisters are sisters and that's close of kin. But there's a closer union when your sister's your twin.

I felt like part of my body was missing too when she had her first mastectomy.

The surgeon had told us that when they operated, if it was benign the breast would not have to be removed, but if it was malignant they would perform a mastectomy.

We waited very anxiously for word from the surgeon, who later came down and told us of the removal of the breast. I was waiting with her husband, and he asked me if I would relate to her the results when she came to, for he didn't think he could do it.

When she came down from recovery and was able to talk, she called me over to her, and she said, "Tell me, did they?' I was trying to be brave and asked the Lord for wisdom in relating to her the results.

As we are very close, I said to her, "Between us two we now have three,' and she smiled and dozed off again.

Three months later we went through the same procedure, and once more she said, "Tell me, did they?' and again I answered, "Between us two we now have two.' Again she smiled and dozed off again to sleep.

She recovered with lots of tender loving care and understanding and a wonderful attitude.

A few years passed by, and now I was the victim of the same surgery. She and my husband were waiting patiently for the verdict that I hoped they could say they saved my breast.

When I opened my eyes she was standing over me and I said, "Did they?' Remembering the words I related to her, she said, "Between us two we now have one.'

At the time of this writing I am getting ready for the removal of my right breast, and I can hear her say, "Between us two we now have none.'

I recall these words that went between us:

Between us two we now have three.

Between us two we now have two.

Between us two we now have one.

Between us two we now have none.

We still have life, and we live it to the fullest every day, for we know the One who gives and the One who takes. Blessed be the name of the Lord.

We do not have the same doctor, but we do have the same wonderful surgeon, Dr. Clifford Wiethoff.

Please excuse my writing. I've written in such a hurry, but Monday morning at 8 a.m. at the Jackson County Schneck Memorial Hospital in Seymour, Indiana, I will undergo surgery again.

I feel like mammograms have helped to prolong our lives.

Keep telling the women how important they are.

Zelma Croucher

Seymour, Indiana

Skin Tags

Dear Dr. SerVaas:

I have just finished reading page 98 in the August issue of The Saturday Evening Post. I can't tell you with what shock and dismay I read the article on skin tags and colon cancer! My first thought was that my wonderful husband's life may have been saved if only we had known the skin-tag relationship to colon cancer.

My husband died of colon cancer on the right side of his body. He seemed to have no symptoms until too late to stop the cancer, which had escaped the colon and was already into the peritoneum.

Also, my husband was about the size of the man pictured with the skin tags. Floyd, my husband, had lots of skin tags, and they were on his upper body, especially around his neck. He had one large one under his arm.

Nothing was done about these, and I am certain his doctor saw these. Why are doctors ignorant of these small signs which might save lives if the patient could be alerted to them?

My husband did not eat fiber. I urged this, but he told me he did not like bran, etc. His whole diet was faulty all his life. He was a farmer and ate lots of meat, potatoes, bread, and a few vegetables but none of the so-called cancer-preventive ones. He liked sweets, too. There was no record of cancer in his family. He was the first. Oh, yes, neither did he use dairy products--only hard, yellow cheese and a little ice cream.

Thank you for publishing such a helpful magazine. I couldn't resist writing you to further reinforce the skin-tag idea. Too late to help my wonderful husband of 44 years!

Mrs. Frances Farmer

Gibson City, Illinois

Glad to Help

Dear Dr. SerVaas:

I was recently informed about your organization and am interested in learning more details about your operation and receiving sample copies of your education materials.

I have been working for the past two years on a state-funded, community-based Cancer Awareness Risk Reduction Program in four northern California counties, focusing on nutrition and smoking cessastion. We have just been awarded 1 of 11 grants sponsored by the Kaiser Family Foundation for a broader community-based cancer project in Solano County. We will be developing educational materials; making healthful changes in cafeterias, grocery stores, and restaurants; and stimulating community mobilization to identify health promotion as a major community concern.

I would appreciate any materials you could provide to aid us in our endeavors.

Ilana Schatz, M.P.H., R.D.

Coordinator of Nutrition Programs

North Bay Health Systems Agency

Petaluma, California

Patching up the Problem

Dear Dr. SerVaas:

The recent article in the SatEvePost was of great interest to me--the one you wrote about estrogen skin patches. I am enclosing a letter I sent to a local doctor, trying to get one to put me back on hormones, and my reason why. When my old doctor died, I asked a new one to adjust the strength to see if my headaches would stop. He said I didn't need them and still does. So did the gynecologist I consulted here.

After three years off hormones, my body aged badly. I began having lots of brown spots on my arms and face. I had weight problems, and my blood pressure has gone up. Now my memory is getting to be a problem. To every complaint the doctor gave this answer: "Old age.' If I hadn't had those headaches I would have felt 25 all these years, but I've been feeling like I'm going to pieces for the past few years without hormones.

Where can I find a doctor who will prescribe them? I had a radical hysterectomy, and the doctor told me at the time to take hormones the rest of my life. Any information would be very helpful. I have a sister with a severe mental breakdown. She has many health problems--heart disease, had lung cancer, hysterectomy, and is almost blind and deaf (also is a diabetic). She is 70. I wonder if the problems the women in our family have could be caused by hormone imbalance.

I realize that writing and research like Dr. Fillit does must be trying in the face of doubting medical doctors. I'd rather try a cure than do nothing.

Thank you for the message. How can local doctors catch up with those like you and Dr. Howard Fillit?

Nell Thomas Compton

Bowling Green, Kentucky

Editor's note: I'm sending your letter to the CIBA company that manufactures the skin patch. Their representatives may know a physician in your area who would be able to help you determine whether or not you should be using this new method of delivering estrogen.

Coffee Bad for the Bean?

Dear Dr. SerVaas:

A few days apart I read the following two reports:

1. More coffee is drunk by women than men.

2. More women suffer from loss of memory.

Made me wonder if there's any connection. Anyone checking this out? Be worth checking into?

Helen Hartleb

Merrimack, New Hampshire

Cigarette Run-around

Dear Dr. SerVaas:

Keep up the work against smoking. I tried to do my part but didn't get anywhere with it.

Wrote Mr. Sam Walton, founder of the Wal-Mart stores, suggesting the Wal-Mart stores move their cigarettes from the checkout counter area. The local manager called me concerning the letter, but in so many nice words I got the run-around. The cigarette rack is still there. I'd think they would consider the nonsmokers' business ahead of the smokers'--inasmuch as two-thirds are nonsmokers.

The grocery stores are just as bad. Maybe you can help in getting them moved?

Rex B. Owens

Monett, Missouri

Elizabeth Taylor and AIDS

Dear Dr. SerVaas:

Bravo! Bravo, and were you here, you could see I'm giving you a standing ovation. It's high time a respectable American magazine gave an appropriate honor to dear Elizabeth Taylor for her selfless and untiring fight against our nation's--no, our world's nightmare--AIDS. Thank you also to the French people for honoring her with the Legion of Honor Medal for her work against this disease.

What I'd like to know is, why were the French first? Outside of a few small entertainment organizations, I don't recall any American award being given her. Could it be most Americans still see AIDS as "the gay disease'?

If there were more people with the caring, determination, and courage of Elizabeth Taylor, not only could we beat this ugly enemy, but we would all be better people for it. God bless you, Elizabeth, and thank you again, Saturday Evening Post.

Allan Trivette

Nashville, Tennessee

Photo: Dr. Richard W. Price first described ADC (AIDS dementia complex) after he and his colleagues discovered that this brain deterioration can lead to death without any of the opportunistic diseases usually found in AIDS patients.
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Title Annotation:testing requirements
Author:SerVaas, Cory
Publication:Saturday Evening Post
Article Type:column
Date:Oct 1, 1987
Previous Article:States of Chihuahua & Sinaloa; Chihuahua al Pacifico RR.
Next Article:New options for the aging.

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