MEMORY LOSS IN ALZHEIMER’S DISEASE
Memory loss occurs in all cases, but it can sometimes be difficult to detect as people cover it up very well. The most recent memories go first and only much later and in severe disease does the past memory get really affected. The things we’ve done in the last few hours, days, weeks and months are placed in our short-term memory. It is this recent storage that seems not to work properly in Alzheimer’s disease. Because memory loss is an important feature of the condition and can be tested for, it forms part of every assessment. One common test is to ask the person a variety of questions covering short- and long-term memory. Ten questions are asked.
• How old are you?
• What is your date of birth?
• What is the day today?
• What month are we in?
• What year is it?
• When was the First World War?
• What is the name of the Prime Minister?
• Where are you now?
• Remember an address, e.g. 24 West Register Street and ask the person to repeat it after 5 minutes.
• Count backwards from 20 to 1.
As long as the person is cooperative (and has been asked in a nice way!) this test is easy to perform. A score out of ten is achieved.
The importance of the test is that it gives a quick guide to the areas where there might be problems. The questions test short-term and long-term memory as well as orientation. A low score by itself never means that the person has dementia. It is only a guide that something is wrong. Someone with mild to moderate dementia will usually get the short-term memory questions wrong and won’t be able to remember the address. They will, however, usually know their birthday (the year might prove hard) and questions about the War. The question about the Prime Minister causes a lot of debate. Mrs. Thatcher was there so long and was so influential on the public in one way or another (and indeed still is) that some assessors feel it is only fair to give a point if her name is given. As a rule a low score that goes up as the weeks go by usually indicates that the initial poor performance was due to an acute confusional state. A persistently low score over many months is much more indicative of a dementia (as long as all the treatable causes of chronic confusion have been ruled out).
Psychologists are experts in the field of memory testing and use much more sophisticated tests than the modified Northwick Park test given above. When testing someone they use a whole range of different types of test so that they get a very accurate picture of where the serious memory losses are occurring. It has been shown that in mild to moderate cases of Alzheimer’s dementia the sufferer can remember something (often a picture) if asked about it immediately. If the person is asked to match one picture with an identical one they can do it if shown them one immediately after the other. Problems begin to occur if a delay is introduced. Indeed after only ten seconds some people cannot match the pictures or remember what they were shown. In other tests where the psychologist tries to get the person to learn something new and then remember it, there is good evidence that a dementia sufferer can do it, can learn something new and remember it, as long as they are given long enough to do it. It seems that they forget things at the same rate as everyone else; their main problem is in learning and retaining. Computers are now being used to help test memory and other aspects that the psychologist is interested in (reaction times – the time taken for the person to press a button when asked to do so or on seeing a certain picture).
In a social setting the loss of short-term memory can be easily missed. Evasive answers to a direct question – ‘It’s slipped my mind’, ‘I’m awful with dates’, ‘It will come to me’, are very common and it’s surprising how you can start a sentence, get stuck, look at someone and they will help finish it for you. However, a stage is reached sooner or later that cannot be concealed from carers. Memory for recent events gradually gets worse and worse, whereas the sufferer can recall childhood situations and young adult life easily. This short-term memory loss can have practical implications in that kettles and ovens can be left on, etc., and people may forget that they have eaten. The sufferer may go out on an errand and a few yards out of the house have forgotten where they were going and occasionally not be able to find their way home again. In the advanced severe stage the person may forget the names of their nearest and dearest, often a very distressing state for the carers. Finally the sufferer may forget their own name.
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FDA Approved Prescription Drugs.
General Health
EYE CARE CONTROVERSIES: STRUGGLE AMONG EYE CARE PROFESSIONS
While optometrists are sparring with ophthalmologists on the right to administer dilating drugs, they are also arguing with opticians about the right to fit contact lenses. There is nothing in most state regulations to prevent an optician from fitting contacts. Many state opticians’ licensing examinations include whole sections on contact lenses. Some opticians don’t choose to fit contacts and have asked that the lens part of the test be reserved for those practitioners who choose to go into the field. That way, an optician failing the contact lens portion, but not the eyeglass portion, of the test won’t have been deprived from taking a job or opening in an optical shop where eyeglasses are manufactured and sold.
In contrast, optometrists think that opticians do not have the training to fit hard and soft lenses directly on the eye. They say that all opticians should be prevented from doing the detailed work. They suggest that of the soft contact lenses alone, with more than two dozen manufacturers making them in a dizzying variety of shapes, widths, thicknesses, and materials, more knowledge is needed than available to the less-trained opticians. Some optometrists say, “Opticians don’t know which end is up” about contacts. Dr. Ross said, in referring to opticians fitting contact lenses, “It is a violation of the laws of medicine and optometry?
But opticians who do choose to fit contact lenses point to their success with patients. They question the economic motives of the optometrists’ efforts to restrict opticians’ practices. It’s strictly a matter of greed, they declare. An optician who asked not to be named said, ”A optometrist has a major stake in contacts, but the ophthalmologist can prescribe them too. It hurts the optometrist’s business to have the job handled by the ophthalmologist and the optician. It cuts him out.” In some cases, the ophthalmologist prescribes the correction and the optician manufactures and sells it. The optometrist is like a
barnacle on a boat slowing down the patient’s passage to better sight. Opticians agree among themselves that the optometrist appears to be an unnecessary professional addition.
There is more politics mixed up with money and lenses. Ophthalmologists don’t usually sell eyeglasses and contact lenses, so they declare themselves above the conflict between eye care professionals and obvious economic interests where lenses are sold. Optometrists point out that this attitude smacks of cover-up.
For instance, optometrists claim they do not push unneeded lenses on patients, even though they sell the products. The ophthalmologists doubt this statement, Optometrists, in turn, claim that some ophthalmologists art not above making a profit on lenses, because they do, in fact, have affiliations with lens stores or opticians. Some eye surgeons have lens dispensing sections right in their offices, and they are not entirely truthful about not profiting from the sale of visual aids.
Finally, the opticians routinely complain that some ophthalmologists and optometrists are slow to furnish prescriptions to other specialists when it becomes clear the patient is going to shop around for the eye care products.
This interprofessional infighting goes on among opticians, optometrists, and ophthalmologists in almost every community in the United States. There is little love lost among any of them. Ophthalmologists are concerned about an ongoing power grab at the top rungs of the eye care ladder by optometrists. Optometrists are trying to get maximum mileage out of their training so as to enhance their income by an increased sale of services. With ever-present political resistance from both professions, vision-impaired people become the losers.
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General Health
