The focus of this attention was an 85-year-old retired college professor, a seemingly healthy long-term patient of Lipman’s. In all the years she had been seeing him for routine examinations and an occasional infection, she had provided him with few or no clues that she might be slowly developing Alzheimer’s, a disorder that affects 5.5 million Americans.

For each of the incidents that troubled her daughter, she had an explanation: “If you had eight grandchildren, you’d get them mixed up, too.” “The reason I showed up at the wrong house for your birthday was that it was dark and the street signs were hard to read.” “The pot boiled over and ruined the kitchen floor because the timer didn’t ring.”

Her physical exam was completely normal, as it always had been, except that she asked what her blood pressure was on several occasions during and after the exam. She could name only 11 animals over a 60-second time span. (With normal recall, she should have been able to name at least 14.) As part of a mini-cognitive assessment, she could recall only one of three unrelated nouns mentioned to her. Then, having been asked to draw a clock with the hands at 11:10, she drew it wrong, indicating 10 minutes before 11.

Minding the mimics

Lipman answered the daughter’s question with a qualified “yes.” But to be more certain, he had to rule out several potentially reversible Alzheimer look-alikes.

Low levels of Vitamin B12, or folate, or thyroid hormone could produce the cognitive problems commonly seen with Alzheimer’s disease, but tests showed her levels were normal. She didn’t have the urinary incontinence and gait abnormalities seen in normal-pressure hydrocephalus. Her normal blood pressure, absence of obvious heart disease and lack of a smoking history made multiple mini-strokes unlikely. She wasn’t on any mind-clouding sleep medication, tranquilizers or antihistamine-like drugs. And she had no symptoms of depression. Therefore, she fulfilled the criteria for Alzheimer’s disease, which accounts for up to 80 percent of cases of dementia among the elderly.

The greatest risk factor for dementia is age. By the eighth decade of life, the prevalence of dementia is about 5 percent, increasing to 37 percent in nonagenarians. But recent research has challenged the notion that dementia is a disease of only the very old. A study in the journal BMJ in January clearly showed that cognitive decline in those destined to develop Alzheimer’s disease can begin as early as the fifth decade of life.

Prevention and treatment

Definitive steps to prevent Alzheimer’s disease have yet to be identified. But since Type 2 diabetes and many of the risk factors for heart disease have been linked to the eventual development of dementia, it makes sense to eat right and stay fit. Intellectual activities and social contacts probably don’t do much good, though they may be helpful in other ways.

What intrigued Lipman most about his patient was that her dementia, which must have been developing over a few years, was a complete surprise to him. As is common in people with Alzheimer’s, she had not complained about any cognitive problems. More often than not, it’s someone close — a son, daughter or spouse — who notices something is wrong and seeks a diagnosis. In contrast, people with non-Alzheimer’s age-related memory loss constantly complain about forgetting names, but their cognitive and other reasoning abilities remain intact.

It’s important for everyone to execute advance directives. These include a living will, which documents a person’s desires related to end-of-life medical decisions, and a durable power of attorney, in which someone is appointed to make healthcare decisions if the person is no longer able to do so, due to either a physical condition or reduced mental capacity.

It’s especially important for people with Alzheimer’s to have these documents prepared if they don’t already have them. This should be done early in the course of the illness, when a person is still mentally competent to make such decisions.

When people with Alzheimer’s have not executed advance directives and are unable to make end-of-life healthcare decisions on their own, the caregiver will need to make the decisions for them. These include several different issues over time, such as the use of CPR, antibiotics, hospitalization, a ventilator or feeding tube and, ultimately, engaging hospice care services.

As described in Come Back Early Today: A Memoir of Love, Alzheimer’s and Joy, my soul mate, Ed, did not have advance directives in place, and so I had to make all of the decisions regarding his end-of-life care. I knew nothing about it at the time, and thus did a lot of research and talked to several healthcare providers before making the decisions. Here’s what I found out:

CPR: Doing CPR on an elderly, debilitated Alzheimer’s patient may do more harm than good. Risks include broken ribs, collapsed lungs, brain damage and permanent need for a ventilator. “The chance that it would even work for such a patient is extremely low. The chance that it would return the patient to his or her former quality of life is practically nil,” Doug Smucker, MD, a professor of family medicine at the University of Cincinnati Health Sciences Center, told me. If the caregiver decides against CPR, it’s necessary to ask the patient’s physician to put a

DNR (Do Not Resuscitate) order in the chart.

Antibiotics, Hospitalization, Ventilator: It’s probably best to make decisions about these issues at the time of need rather than in advance. The decisions should take into account the patient’s general condition at the time. Is the patient alert and responsive? Is he or she in pain? What is the person’s quality of life? Is the patient likely to recover from whatever is causing the need for the antibiotic, hospitalization or ventilator? For example, if a frail patient has pneumonia, you can try antibiotics and a ventilator if needed, but if the person’s condition continues to worsen, you can then withdraw the medication and ventilator and allow the person to die in peace.

Nasogastric Tube Feeding: “During the natural process of dying, the body is shutting down and no longer wants food,” says Darby Morhardt, a social worker at Northwestern University Alzheimer’s Disease Center. The use of nasogastric tube has potential negative side effects, including pain and infections.

Percutaneous Endoscopic Gastronomy (PEG) Feeding: Using PEG feeding (feeding through a tube inserted into the stomach or small intestine) “can result in back-up to the esophagus, increasing the risk of aspiration pneumonia,” states Dr. Steven Post, a professor of bio-ethics at Case Western University School of Medicine. He adds that it also prevents the patient from walking, and can result in weeks of unnecessary suffering. On the other hand, he points out that “cessation of food intake results in the release of endorphins, which reduce pain.”

Hospice: Hospice care focuses on providing comfort at the end of life rather than using heroic means to prolong it. If caregivers start hospice services, then change their minds, they can sign their loved one off (or back on) hospice care at any time. However, the Alzheimer’s Association Ethics Advisory Committee has concluded that “all efforts at life extension in the advanced stage of Alzheimer’s create avoidable suffering for patients who could otherwise live out the remainder of their lives in greater comfort and peace.”

Symptoms that Qualify the Patient for Hospice Care: Gregg Warshaw, MD, Director of Geriatric Medicine at the University of Cincinnati and former president of the American Geriatric Society, told me it may be time to consider using a hospice service if the patient is showing any of the following signs:

Two or more episodes of pneumonia or other serious infections within a 6-month time frame.
Difficulty eating and swallowing, even with feeding help, that results in weight loss of 10% or more over the preceding 6 months.
One or more skin pressure ulcers that are not healing.

No one wants to even think about placing a loved one with Alzheimer’s in a facility. Period. But I had no choice. I had a full-time job and was spending every free moment caring for my soul mate, Ed. Yet he needed so much more care than I could possibly provide.

I tried having professional caregivers come in to help but that was a disaster. Ed needed much more care than even two people could provide. Day care didn’t work any better. They told me his dementia was too advanced for them to handle.

He was walking around his apartment naked most of the time. I was terrified he’d leave the apartment with a cab driver, which he’d previously done on a regular basis. I worried he’d get lost and not be able to find the cab driver to go back home. I was afraid he’d be lost forever.

Plus, he was drinking prodigious amounts of vodka, starting before noon and ending at 3:00 a.m.. I tried in vain to get him to drink less. He had fallen several times — probably due to the alcohol and/or his advancing dementia. Fortunately, he hadn’t injured himself but I knew it was just a matter of time. And he wasn’t eating well. He was 5’8″ and weighed only 115 pounds. I couldn’t get him to eat more, either.

As I describe in Come Back Early Today – A Memoir of Love, Alzheimer’s and Joy, I was distraught at the very thought of putting him in a facility. He’d come to this country with little more than the shirt on his back as a political refugee, fleeing the brutal communist regime in Romania. And there I was, fixing to admit him to an institution where he’d be in a secured unit. The very thought broke my heart and always left me in tears.

So there I was with this 92-year old man who desperately needed to be in an Alzheimer’s care facility. The only thing was, he adamantly refused to go. He said he’d die first. He always said he’d die first. Always.

I was under intense pressure from his doctor, his lawyer, his close friends, my lawyer, several other professionals I had consulted and all my family and friends to get him into a safe place and to do it quickly, even if I had to take him against his will. That idea scared me to death. I was sure he’d never speak to me again. Not a fitting end to a 30-year relationship.

To make a long story short, after our third visit to the Alois Alzheimer Center in Cincinnati, he did agree to go. He adjusted quickly and was too demented to understand that he couldn’t open the door to leave his unit.

Our love blossomed once again. Once I didn’t have to care for him and worry about him every available moment, I could relax and just enjoy visiting him.

Now, what do I have to say about all this?

Shame on me for not having had the nerve to take him against his will.
There are better ways to get loved ones into a facility when they don’t want to go. For example, some people take their loved one to a facility and say, “Let’s go in. I want to visit someone.” Then when they leave they simply don’t put the person back in the car. You can imagine the patient’s initial rage, but facilities are used to dealing with this and know how to handle it.

Another method is to say, “We have reservations for dinner.” Then take the person to the selected facility at lunch or dinner time and go into the dining room and sit down and eat with him or her. Then, as in the previous method, when leaving after the meal simply don’t put the person back in the car.

It’s important to remember that we are responsible for the health and well-being of our loved ones with Alzheimer’s. If we cannot care for them adequately — for whatever reason — it’s up to us to make sure they are safe and well cared for no matter how heartbreaking it is for us. Fortunately, most patients do adjust. In fact, I’ve been told by staff at long-term care facilities that the transition is often more painful for the caregiver than for the patient.

What methods have others of you used to get your loved one into a nursing home when he or she didn’t want to go?

While work continues on those fronts, the new clinical trial will test whether the drug, Crenezumab, made by Genentech, can prevent the disease in a group of people whose genetic heritage guarantees that they will develop it. If the drug successfully prevents the loss of mental capacities as measured by a sensitive new cognitive test there is hope — but no guarantee — that it could do the same for members of the general public. As Pam Belluck described in The Times last week, the trial will focus on members of an extended family in Colombia who carry a rare genetic mutation that causes them to develop Alzheimer’s early in life. They typically experience cognitive impairment at about age 45 and dementia by 51. The trial will also include a smaller number of individuals in the United States with the same genetic mutation.

Instead of recruiting thousands of volunteers and following them for an extended period as in a customary prevention trial, the researchers in Colombia will give the drug to only 100 people with the early-onset genetic mutation. They will give placebos to another 100 people with the mutation and to 100 family members who do not carry the deadly gene.

The study will cost more than $100 million and is being financed mostly by Genentech, buttressed by $16 million from the National Institutes of Health and $15 million raised by the Banner Alzheimer’s Institute in Phoenix, which is leading the study.

The prevailing, but not universally accepted, hypothesis is that amyloid plaques in the brain play a major role in causing Alzheimer’s. Crenezumab attacks the formation of such plaques, apparently by binding to amyloid proteins and clearing them from the brain. If the drug fails to work, the trial will probably demolish the amyloid hypothesis and set researchers scrambling to find other targets to attack.

A prevention trial of a different drug that was also intended to slow formation of amyloid plaques actually made patients’ symptoms worse, possibly because it interfered with various other proteins needed by the brain. Researchers believe that Crenezumab will be safer and more effective, but again there are no guarantees. The risk is justified given that without the treatment the recipients will inevitably get Alzheimer’s in the prime of their lives. The truly big payoff will come if the drug succeeds in this group and lays the groundwork for preventing or slowing the progress of Alzheimer’s that appears late in life. The researchers will be gathering data on a variety of biomarkers — glucose activity in the brain, shrinkage of the brain, certain proteins in cerebral spinal fluid, for example — to see which if any are related to preventing amyloid plaques and the loss of mental abilities.

If the drug prevents the deterioration of particular biomarkers and ultimately sustains mental capacity, then the same markers might be useful in identifying and treating older people likely to develop the disease. And federal regulators might be willing to approve other prevention drugs based on their short-term effects on biomarkers, speeding the conduct of clinical trials.

By Sarah Shemkus
Globe Correspondent / May 20, 2012

Joanne and Everett Parhiala had a plan.

They would move from the Lexington house where they had raised their three children to a smaller Boston condo. Then, Joanne, 53, and Everett, 57, would work for a few more years before settling into retirement in the city.

But now, instead of downsizing in Boston, the Parhialas are searching for an even bigger place in the suburbs to accommodate Joanne’s aging father and developmentally disabled brother.

“We had kind of pictured ourselves living in a small place in the city,’’ said Joanne Parhiala. “But now we’re moving further out in the suburbs. It’s not where we thought we’d be.’’

As baby boomers head into their golden years, many are finding they not only have to plan for their own retirement, but for the care of their aging parents as well. Americans are living longer, which also means they face more physical and mental challenges. More than one-quarter of people 80 and older experience three or more physical limitations, according to the National Center for Health Statistics, and the Alzheimer’s Association expects the number of dementia cases to double over the next 40 years.

“The fact that parents are living longer makes it more and more likely that children are going to have to have some presence,’’ said Bob Mauterstock of Brewster, a retired financial adviser who has written a book about planning for the care of aging parents. “The adult children may have to help them financially, or to pay for care. In some cases, the children may feel obligated to provide care themselves.’’

Just as the Parhialas are footing the bill for a new house, adult children may find themselves budgeting for costly health care for their parents at a time when they were hoping to trim their own expenses and save more for retirement. The costs can be staggering. Fidelity Investments estimated in May that a couple retiring this year can expect to spend $240,000 on health care through their golden years.

And the time demands of dealing with an aging parent can make retirement planning even more difficult.

“If they have to drop out of the workforce or reduce work hours to take care of an aging parent, it reduces the amount of money they can put aside for retirement,’’ Mauterstock said.

The so-so economy is not helping. Older employees may be reluctant to ask for time off or changes to their work schedule to deal with caring for their parents, said Jennifer Lane of Compass Planning in Newton.

“It’s hard to ask their employer for more balance when they’re concerned about their jobs,’’ she said.

Ultimately, the children of aging parents must see to their own needs first, and it may be impossible for most people to assume responsibility for their parent’s care in addition to their own retirement, planners said.

“It’s feasible for children to help in certain ways, but not to be responsible for their parents,’’ said William Driscoll, owner of Driscoll Financial in Plymouth. “We’ve got to make sure that we’re in financially sound condition, before we try to get someone else in the same place.’’

However, Driscoll and other financial planners said, there are steps adult children can take to prepare both themselves and their parents for the future: meeting with elder care specialists, making sure legal documents are in order, and considering long-term-care insurance.

As families undertake this process, communication is by far the most important consideration, planners said.

“You need to really assess what’s going on and sit down at the kitchen table and find out what they need, what they want,’’ Lane said.

These conversations can be difficult; many older parents are from a generation that was private about money matters, financial planners said. They also might question their children’s motives for asking such detailed financial questions. Nonetheless, several planners suggested boomers get these conversations going by the time the parents are in their early 70s.

“It’s critical that parents get together with their children while they’re still healthy,’’ Mauterstock said. “Most families don’t address it until Mom falls and breaks her hip or Dad’s diagnosed with Alzheimer’s.’’

These meetings may reveal that the older generation is well prepared; if they are not, a financial planner can help the family determine the best plan of attack. Lane said it is essential to find a financial planner who provides broad-based planning services, rather than just investment advice, and who works on a fee-only basis, so the possibility of commissions will not compromise the guidance he or she gives.

Parents and children should also make sure that all necessary legal documents – wills, trusts, health care proxies, powers of attorney – are in place and up-to-date, Driscoll said. Attorneys who specialize in elder law can help ensure the dizzying number of financial and legal matters are smoothly coordinated.

If adult children want or need to contribute financially to their parents’ care, long-term-care insurance can be a good option, Driscoll said. Such coverage can prevent nursing home or assisted living bills from quickly swallowing all of a parent’s assets, he said.

“It’s a much cheaper way to help them than trying to cover the cost of the care itself,’’ he said.

Driscoll speaks from personal experience: He and his siblings paid for a portion of their own mother’s long-term-care insurance, which allowed her to remain financially secure until her death two years ago, he said.

Long-term-care insurance, however, has its critics. Premiums are often quite high, making it less likely that the investment will ultimately save money, Lane said. “I see people struggling with it,’’ she said. “Often times people believe that that’s the panacea – it’s not.’’

Despite its difficulties, working out a plan for your parents’ care can bring peace of mind.

Joanne Parhiala acknowledged feeling wistful at times for the retirement she once planned. A psychiatric nurse, she expects to work night and weekend shifts to make time in the week for her father and brother.

In the end, though, she is glad she and her husband, an electrical engineer, are able to support her family. Both are planning to work for about 14 more years and they expect to have paid off their mortgage by then, freeing up more money for other expenses. Throughout the years, they have contributed to their retirement plans and participated in pension programs, giving them a pool of savings from which to draw.

In the waiting room, he stood up and asked a receptionist where his wife had gone. Then he left. Nobody stopped him, perhaps because he was, in a way, wearing a disguise. He looked perfectly normal.

So did the 81-year-old Korean War veteran who, on Feb. 28, slipped out of the apartment he had kept for three decades on West 25th Street. And the 72-year-old mother in Forest Hills, seen in March ambling along Queens Boulevard. And another retired professor who, in police parlance, is “known to local coffee shops,” and prone to bolting from restaurants he finds to be too crowded.

They are among the dozens of elderly New York City residents who, in various stages of dementia, disappear into a city that, long home, is now strange to them. Their disappearances prompt no small turnout of police officers and a rush to broadcast a bulletin that, as in other cities and states, is called a silver alert.

On Tuesday about 11 a.m., Adrian Gonzalez, 80, left his apartment near Prospect Park in Brooklyn to buy his favorite Puerto Rican newspaper and, for his wife, The Daily News. He did not return, and his wife, Daphney, called the police.

The professor known to coffee shops slipped away one afternoon in January. It was the third time. The other two times, he had come back right away, so his wife waited a couple of hours before she called the police. She asked that their names be withheld — “There’s a stigma with these situations,” she said.

This time, someone found him in a subway, looking out of place, without a coat — and yet, intelligent, distinguished — and took him to the police. Now, his wife makes him carry an electronic tracking device. “Every time we go out he asks me, ‘What’s this for?’ ” she said.

If there is a silver lining to the silver alert, it is this: they generally end well. They differ from other missing-persons cases in that the missing are not hiding from anyone, and are not being held. They drift toward parks, or to the subway. They are usually found in less than 24 hours, said Lt. Christopher Zimmerman, commanding officer of the New York Police Department’s Missing Persons Unit. There have been more than 50 silver alerts since the program began in New York in 2011, but most cases are closed before reaching Lieutenant Zimmerman’s office.

Mr. Goffman had not returned to the doctor’s waiting room when his wife, Nancy Larkin, 67, returned to it and feared the worst. He had difficulty following a conversation. “If you spoke to him, it might take you a moment to realize most things that he said didn’t make sense,” she said. She ran to a nearby police precinct, and became irritated when an officer instructed her to go to their former home in Greenwich Village and call 911 from there. Lieutenant Zimmerman said this was standard procedure, as missing people are more likely to be found near their homes.

The police arrived — three officers, their sergeant and a detective. “I felt kind of guilty, because I could hear coming over the radio, ‘Robbery on East Sixth Street,’ or things like that, more draconian than this,” Ms. Larkin said. She and a friend searched entrances to Central Park, benches near the Museum of Natural History, and Starbucks.

Early Thursday, a little more than 12 hours since Mr. Goffman had walked off, an officer found him sitting in the 72nd Street subway station. Some kind stranger must have swiped him into the subway. We’ll never know; he has no idea. Officers took him to an emergency room, where detectives were waiting when Ms. Larkin arrived. “The female officer was crying,” Ms. Larkin said. The officer said, “Your husband’s such a nice man.”

Ms. Larkin found him, and he looked at her and said, “I’ve been looking for you.”

E-mail: crimescene@nytimes.com

More than one in two (55 per cent) said they would talk about the future needs of their parents and care when the time came to do something, suggesting many will be forced to react to events rather than plan ahead for them.

Twenty-three per cent said their parents were too proud to ask for help and 15 per cent were worried they might upset their parents if they brought the subject up.

Fourteen per cent didn’t think it was for them to start the conversation and nine per cent admitted they had put it off as it would upset them too much to raise the issue.

Karl Elliott, director for the engage with you community website said: “With an ageing population, care provision for the elderly is becoming one of the big issues of the day. For some time the default setting on this issue has been debate over care homes, but our research among British adults shows that for the majority it simply isn’t a choice or an option.

“Across Britain today around seven in 10 adults are providing regular help to elderly parents and around one in four give a level of support that effectively classifies them as carers, whether they define themselves as this or not.

“Whilst it is good that so many adults are supporting their elderly relatives it is a huge concern that so few have sat down and had the big discussion on the future, putting a long term care plan together that is practical, workable and affordable.”

Research showed those with busier lives were less likely to have had the care conversation.

Martin Rosenfeld had called too many times — confused and frustrated — from a parking lot outside his synagogue, after driving there in the middle of the night for services that wouldn’t begin for hours.

Once a meticulous pattern-maker in the clothing industry, he now nodded off mid-conversation. Spilled things. Mumbled.

“We’d be getting calls all night long. He’d say, ‘What time is it? Can I get up now?’ ” said his daughter, Shelley Rosenberg, whose husband, Don Rosenberg, chairs the Alzheimer’s Association — Greater Michigan Chapter.

Rosenfeld’s confusion, which turned out to be caused partly by sleep apnea, reflects what the head of Wayne State University’s Institute of Gerontology worries is a growing trend in the number of Americans being wrongfully assumed — even medically misdiagnosed — with Alzheimer’s, the most common form of dementia and perhaps the most feared disease of old age.

“It’s a real problem. If you’re older and you get a label of Alzheimer’s — even a hint that you have Alzheimer’s — there’s no more critical thinking about it. You’re written off by a lot of people,” said Peter Lichtenberg, head of the institute and a clinical psychologist who has testified in several probate cases in which a person’s mental capacity was at issue.

Lichtenberg, in a December paper for the journal Clinical Gerontology, highlighted two case studies: in one, a man’s bouts of confusion and agitation in his late 70s were caused by illness and painful cellulitis, not Alzheimer’s; in the other, an 87-year-old woman, who seemed suddenly confused, was suffering from depression.

Lichtenberg’s paper builds on research elsewhere that suggests that the difficulty in pinning down Alzheimer’s makes misdiagnosis too easy. The research is based mostly on small studies but also on an ongoing, long-term study supported by the National Institute on Aging, which is part of the National Institutes of Health. In cases reviewed so far, about one-third of Alzheimer’s diagnoses were incorrect, according to the lead researcher, Lon White.

“The diagnosis was dead wrong one-third of the time, and it was partially wrong a third of the time, and it was right one-third of the time,” White said.

The project, called the Honolulu-Asia Aging Study, has been under way since 1991 and focused on the precise brain changes linked to Alzheimer’s disease and other types of dementia. Pathologists examined the brains of 852 men born between 1900 and 1919, about 20% of whom were diagnosed with Alzheimer’s.

In the cases carrying an Alzheimer’s diagnosis, two-thirds of the brains exhibited the types of lesions closely linked to Alzheimer’s. Half of those featured other problems, as well, such as scarring on the hippocampus, the part of the brain responsible for memory, White said.

That didn’t mean that those without the Alzheimer’s lesions were otherwise healthy, “but what we’re calling Alzheimer’s is very often a mixture of different disease processes,” White said.

Lichtenberg said his concerns about misdiagnosis in no way lessen the enormity of Alzheimer’s impact.

“I don’t know how vast a problem it is, but I see it too often,” Lichtenberg said.

The Alzheimer’s Association estimates that 5.4 million Americans are living with Alzheimer’s. Lichtenberg’s grandmother had the disease. A picture of her, dancing, sits in his office at Wayne State.

But understanding how often Alzheimer’s and other dementia are misdiagnosed is hard to quantify. Sometimes, that’s because loved ones have not yet noticed a decline; sometimes, they don’t want to face the possibility, Lichtenberg said.

Rosenfeld’s most pressing problem was severe sleep apnea that had aggravated the more manageable symptoms of undiagnosed Lewy-body dementia. Lewy-body dementia causes a visual processing disorder, disrupts the ability to organize, plan and focus and can causes sleep problems and hallucinations.

A breathing machine at night made a dramatic difference, said Shelley Rosenberg: “I’m thrilled. He is what he used to be. I have my father back.”

Some too quick to judge
It’s a difficult balance for the Alzheimer’s Association: trying to raise awareness and boost early intervention efforts for Alzheimer’s and other dementias, while also cautioning families and clinicians not to jump to conclusions.

Diagnosing Alzheimer’s is tricky and is done, in part, by ruling out other health problems, such as an undetected stroke or brain tumor.

Even well-meaning doctors can be too quick to judge, especially when confronted by worried loved ones listing Mom’s memory lapses, said Jennifer Howard, executive director of the Alzheimer’s Association — Michigan Great Lakes Chapter.

An expert evaluation by an interdisciplinary team that includes a geriatrician and neurologist is crucial, she said.

“The brain is not just a physical structure. It’s this incredible computer. It’s constantly computing where resources are needed and redirecting, depending on energy is coming from and what task you need to do,” said Rhonna Shatz, director of Behavioral Neurology at Henry Ford Hospital in Detroit.

For that reason, a common urinary tract infection, a sudden change in blood pressure or depression are all stresses on an older brain that, combined with other problems, can quickly short-circuit it, Shatz said.

The result is acute confusion or delirium that, to an untrained eye, may look like Alzheimer’s disease.

“Pulling these things apart and the need for a real diagnosis — that’s important so people can live the best quality of life as possible for as long as possible,” said Howard at the Alzheimer’s Association.

Other factors missed
In the case of Al Edelson, a former Wayne State professor and cancer survivor, the confusion was really the result of a regular cocktail of 18 medications prescribed for a variety of health issues.

In his mid-70s, the once sharp-witted, effervescent professor of instructional technology began to withdraw, family members said. For years, he and his wife traveled frequently, but he began to be more comfortable remaining near his family’s Huntington Woods home.

In the hours before their 5 a.m. departure for a trip to Britain aboard the Queen Mary 2 several years ago, Edelson was wide awake, anxious.

“He said, ‘I think I need to cancel this.’ It was 2 a.m. I said, ‘I will never forgive you,’ ” his wife, Joanna Edelson, recalled, chuckling.

But the change had become undeniable: Usually at ease dancing with his wife or leading group conversations, the now-retired professor was awkward and withdrawn on the ship, Edelson said.

Eventually, a doctor gave the diagnosis of Alzheimer’s.

“The problem is that when you’re older and you have a lot of medical conditions, no doctor speaks to the other doctor, and that’s basically what happened,” said Edelson, a retired teacher.

After consulting with other doctors, family members scaled back Al Edelson’s drugs. They were amazed.

“It was like he came out of a coma,” his wife said.

When he died in December, having just turned 80, the cause was pneumonia, Joanna Edelson said: “Dementia did not kill my husband.”

More Details: Is it Alzheimer’s?

Unlike delirium, which usually comes on fast and sets off alarm bells for loved ones, Alzheimer’s disease moves through the brain slowly, seemingly shutting off switches one by one.

Diagnosing it isn’t easy. There is no blood test, no telltale brain scan. Even the brain anomalies common in an Alzheimer’s patient — plaques (abnormal clusters of a protein called beta-amyloid) and tangles (twisted strands of a protein called tau) — are shared by those who have no symptoms at all. That means diagnosing Alzheimer’s is about ruling out other problems and relying on changes observed over time.

Among the conditions that might bring on temporary, but dangerous, delirium:

• Urinary tract infections

• Medications

• Stroke or vascular disease

• Fever, illness

• Depression

• Blood pressure changes

• Surgery

• Drug or alcohol use

• Tumors

For more information, go to www.alz.org or call 800-272-3900.

More Details: Common terms and what they mean

Sorting through confusion begins with understanding that some changes may be temporary.

Terms to know:

• Delirium: Temporary but acute mental confusion. Can be life-threatening. Involves a sudden onset of symptoms — anxiety, disorientation, tremors, hallucinations and incoherence — and can be caused, especially in elderly people, by illness and infection, changes in blood pressure, reactions to medication or vitamin deficiency.

• Dementia: More permanent medical condition that disrupts brain function. Includes Alzheimer’s disease, but also vascular dementia (from a stroke or blood vessel disease in the brain), severe alcoholism, depression, delirium, Huntington’s disease and inflammatory diseases such as syphilis, tumors and Parkinson’s disease. Symptoms include anxiety, paranoia, personality changes, lack of initiative and difficulty acquiring new skills.