"Doctor, thank you for your hard work!" This is the first sentence when Aunt Zhang entered the door. I was very happy to let this sensible and kind aunt sit on the clinic chair.
"Doctor, thank you for your hard work". After learning about the medical history, hearing this sentence again made me feel a little heavy. When I was inquired about
, Aunt Zhang, now 64 years old, repeatedly said that she had no other problems, but she couldn't sleep at night, had a bad memory, and couldn't explain clearly what the specific part was bad...
turned to Aunt Zhang's lover next to her, and then she understood more clearly what Aunt Zhang had experienced since 2013.
Aunt Zhang's family has been living a happy life, everything is so natural. The grandson was born in 2009, and the family is harmonious and beautiful, and everyone envies it.
It was not until the day in 2013 that her son suddenly told her that she was divorced. This change made Aunt Zhang stunned. Aunt Zhang, who is handsome and traditional, often shed tears when she watched her grandson cry. Her temperament changed drastically. She, who loves fun and plays mahjong, became unwilling to go out of the house or talk, and was unable to get out of the predicament for a long time. Finally, her family saw obvious problems. In 2019, the depression was diagnosed in the psychology department, and it was improved only after drug treatment.
Hearing this, Aunt Zhang sighed and lowered her head...
Her lover continued, "Shortly after taking the medicine, her mood improved. She was gradually willing to go out and can play mahjong. However, during the COVID-19 pandemic, she was locked up at home for a while and now she can go out. We found that she seemed to have changed, she couldn't play mahjong she liked, her thinking was incomplete, and her memory was very poor. What's going on with the doctor? What should we do?"
After the depression was cured, it gradually showed obvious memory decline, and it was not good after treatment for so long. I was alert. It seems that this depression is not simple!
I comforted the patient and the family and told me: First, let’s see if antidepressant treatment needs to be adjusted. In addition, we must clarify brain function. First arrange a special psychological assessment for the aunt, and then come to me after doing it.
Soon I received Aunt Zhang's neuropsychological test results: MMSE 19 points. Judging from the scale results, Aunt's recent memory, attention, computing power, and executive function were all damaged. These situations alone cannot be explained by depression.
I checked Aunt Zhang’s recent head magnetic resonance, which is just some common brain changes and cavity infarction. But Aunt Zhang is only 64 years old and has no family history. So, I suggest that the family members, if possible, make an appointment to do an accurate test for Alzheimer's disease - brain AV45 PET test, and follow-up visit a month later.
A month later, Aunt Zhang came to my clinic with a report, and as soon as she entered the door, she asked anxiously: "How is the test result? Is there any rescue?"
As sure, Aunt Zhang's PET result showed that amyloid deposition positive , which is consistent with the diagnosis of 3Alzheimer's disease . This is a typical case of depression in old age and finally diagnosed with Alzheimer's disease.
This is also a problem that we elderly psychiatrists have always faced: depression that occurs in the elderly is pure depression or the prodromal manifestation of cognitive impairment .
It is sometimes really hard to do this. It requires careful observation, comprehensive evaluation, regular follow-up, and testing of the relevant biomarker . Of course, more importantly, clinicians should be alert to detect the root cause of problems in the early stage.
Looking back on the recent years, it is not difficult to find that there are many elderly people who have been diagnosed with dementia in our Shanghai Mental Health Center memory clinic. They have been diagnosed with depression, anxiety or sleep disorder in our hospital or other hospitals. But as the course of the disease progresses, the real cause of the disease surfaces.
For this type of elderly patients who have both emotional problems and cognitive decline complaints, we recommend visiting psychiatrics in the elderly who are good at both diagnosis and treatment of cognitive impairment and emotional disorders!
We hope that those patients in the early stage of Alzheimer's disease can be discovered in a timely manner, with early intervention, and more reduce the pain of patients and their families.
1. Depression is a risk factor for dementia
Many clinical studies have confirmed that depression in the elderly is an important risk factor for Alzheimer's disease. Once standardized antidepressant treatment is performed, the patient's cognitive ability is still declining or has obvious defects compared with the previous level, and it is necessary to pay close attention to whether there is cognitive impairment.
2. Functional depression will also improve cognitive function as the condition improves.
Depression can lead to cognitive dysfunction, which is a very sure conclusion.
Because depression not only has continuous depression, decreased interest and fatigue, it will also affect the reactions of normal people and affect the understanding and judgment of normal people.
Secondly, patients with depression generally describe their brains as like a ball of paste, chaotic and very unconscious. They often say that their memory has decreased and their concentration is more difficult, which is why it is so difficult to distinguish between depression and cognitive impairment.
Therefore, if you are a patient with pure depression, after treatment, the cognitive function of in patients with depressed depression will be significantly improved.
Aunt Zhang’s problem has been clarified: Alzheimer’s disease.
"Never too early, never say late!" is the theme slogan of in 2020 World Alzheimer's Day.
is self-evident. Alzheimer's disease emphasizes that early diagnosis is conducive to early intervention and delaying the course of the disease.
Aging is a process that everyone cannot avoid. When this process is installed on an "accelerator" by cognitive impairment, for everyone, it is a test that is immersed in every detail in life.
But it is too sad to be unfavorable to patients and their families. What's more, in my daily medical treatment, I have indeed seen the importance and effectiveness of early diagnosis and intervention of the disease. With timely and reasonable intervention, there are still many warm, touching and happy stories.
So, I prescribed a prescription for cognitive drugs and brain health lifestyle suggestions for my Aunt Zhang.
A month later, the patient's lover said happily, "Doctor Yue, after taking your medicine, it seems that he is feeling better. We now ask her to continue exercising based on your suggestions. She is also very cooperative. Thank you!"
Yes, Alzheimer's disease prevention and treatment is never too early, never late, actively treating it, even if you suffer from cognitive impairment, your life can still be wonderful!
Author | Yue Ling and Jiang Xuehong
Pictures and texts | Bai Li
Review | Wang Jinghua
Proofreading | Qian Shixing
Some pictures are from the Internet, please delete if infringement!
Special statement: This article was edited and published by the Geriatric Department of Shanghai Mental Health Center. Please leave a message to contact us if you reprint it!
