Behavioural changes call for checkup

DEAR DR. ROACH: My wife, who is 66, has been leaving cupboard doors and some dresser drawers open for the past year or so. Is this a sign of anything to be concerned about?

ANSWER: It sounds like this is a new behaviour for her, and I would indeed be concerned about it.

Changes in behaviour or memory can result from many different medical issues. In fact, the list of possibilities is so long that it’s almost impossible to name them all. However, evaluation starts with her regular doctor and includes a good general physical examination, a careful history and judicious laboratory evaluation. It is possible that her issues are due to: infection (a series of untreated bladder infections or indolent lung disease could possibly be behind it); metabolic (low sodium levels from a diuretic is a common cause); medications (many medicines can adversely affect memory and judgment); or some other issue.

Unrecognized depression probably is the most common condition I see mistaken for dementia. However, the slow nature of its coming on does make me think about primary memory disorders, especially Alzheimer’s dementia. This is an importantenough condition that I want to spend a minute on it.

Alzheimer disease (the preferred name) is a disease of aging: It is rare before age 60, and the chance of developing it roughly doubles every five years after age 65. Memory problems, difficulty making decisions and trouble with spatial relations are common early findings. Personality changes and language trouble tend to occur later. The memory disorder in Alzheimer disease particularly affects recent memories — memories of more distant events are preserved until later in the course of the disease.

I would caution you not to jump to the conclusion that your wife has Alzheimer disease. Your observations do make me concerned about it, but there are many possibilities. I can really just begin to talk about this complex condition, and I would recommend that you read more from many good sources. One that I use frequently is the Alzheimer’s Association at www.alz.org.

Getting a diagnosis early allows for more effective treatment.

DEAR DR. ROACH: I am in my early 70s and have been experiencing back pain, numbness and tingling in my legs, especially my ankles and feet, for the past three years. A MRI showed that I have a slight protruding disk around the L3 and L4 areas, but the neurosurgeon stated that the protrusion should not be causing the numbness and tingling. If I am just walking around or doing chores at home, the discomfort is minimal, but sitting in any chair or driving a car really aggravates the numbness and tingling, causing great discomfort. My neurosurgeon has ordered an EMG test, but I have been told by all those who have had the test that it is extremely painful and not worth it. My brother had the test and walked out in the middle of it, saying that he would rather live with the discomfort than continue the test. Of course, doctors tell me that the discomfort from the test is minimal, but testimony on the internet supports my brother’s and friends’ opinions. Can you shed some light on the subject? I tend to believe my brother before the doctors, as they probably have not experienced the test first hand.

ANSWER: I haven’t had the test personally, but have talked frankly with patients and family members who have. I would say that your brother’s experience is not unheard of, but it is distinctly not the norm. Further, the information gained from the EMG is sometimes critical in finding out the underlying cause of the pain. I advise you to try getting the test done, and be frank with the technician performing it that you are nervous about the pain.

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