Question: How do physicians diagnose someone with Alzheimer's versus typical senile dementia? I have read that the only way to be sure, based on current definitions, is post mortem...as you look for the tau and neurofibrillary tangles. But in someone who is living, how does one distinguish? is the rapidity of onset? I know that people who display symptoms earlier in life, say in their 60's, are more likely to be diagnosed with Alzheimer's. I ask because my grandmother was a very sharp person at the age of 88. Starting about a year ago, she has become so forgetful, that she doesn't even remember if you visited her or what she had for lunch. She asks the same questions over and over again. She is now considered a patient with dementia. The thing that has always bothered me is that it was a very abrupt onset. Within a matter of months she went from someone who remembered everything (especially anything related to numbers) to someone who had the memory problems I described above. She was very intelligent. As I understand it microvascular changes happen gradually over time. Could it be she had a small stroke in a particular area of the brain? One other thing I wonder about: there was a period when she was so much pain that they gave her Demerol on a prn basis. But, after a while, they began giving to her at regularly scheduled doses. (she's in a nursing facility). Once they began that, with a GRF of about 30, I assume the metabolite accumulated and she had a seizure. She's been on Keppra ever since. However the dementia-like symptoms did not start then. It was several months later. I am curious to an experts opinion of what is going on with my grandmother. By the way, I am a pharmacist, so I do have some knowledge in the area.

Yes, I understand what you are saying. It is the very fast nature of the onset of her dementia symptoms that concern me. It was not a gradual process that would be typical of someone in their late 80's. She had a very good memory at age 88. She could do calculations in her head. She knew everyone's birthdates and anniversary dates. (probably 50 or so in the extended family). Then it seemed like within a month she went to where she could not retain information. i.e. asking the same thing over and over again. She still has the ability to think, reason, read, etc., but cannot retain it. I assume from your previous response you do not think this is Alzheimer's, but it is curious to me as to why it came on so suddenly. She has been to the hospital after that time period, but there is no indication of a stroke or other pathological change. What do you think?

Thank you. This helps a lot. I always thought that dementia, without any obvious pathological change, was a gradual process as the person ages. But, you say it can happen suddenly. And, indeed it is short term memory loss she has the most trouble with. She can still reason, calculate in her head, and carry on a coherent conversation. But 5 minutes later, she has no memory of it. So, do you think the medications you mentioned would improve her memory, or just slow the progression of her dementia?