1)   Am I now avoiding social or physical activities that I used to enjoy…especially if they are in the evening?

2)   Am I less coordinated now? Am I falling, running into objects, or dropping things more than my old self?

3)   Do I have disturbed or changed sleep patterns?  Am I routinely more tired in the morning than before?

4)   Am I getting sad, anxious, upset, angry, startled, or fearful more often than before?

5)   Am I more defensive about criticism, more irritable, or less patient with others than before?

6)   Am I less able to stay on task at work or in household roles?

7)   Are supervisors or peers expressing concerns about my work performance?

8)   Is it harder and taking me longer to do tasks that I used to do easily without much thought?

9)   Do I have trouble keeping track of time and get so absorbed in things that I forget my other duties?

10) Do I have more trouble finding my words now? Do I lose my train of thought more often?

11) Is it harder to pay attention, especially if there is noise or commotion around me?

12) Am I more worn out by conversation and group activity than before?

13) Am I more tired and in pain from physical activities like walking?

14) Am I having a harder time remembering details from long ago?

15) Do I have more trouble remembering recent things like where I parked or put my keys?

16) Is it harder to learn a new activity now than it used to be to learn a new activity years ago?

17) Is it harder to make decisions, multi-task, lead groups, or give instructions now?

18) Am I feeling overwhelmed or over-loaded more than I used to?

19) Do I compensate through more reminders to myself or working longer hours?

20) Am I bothered by heat or coldness, by odors or scents, by cleaning supplies or food additives?

21) Am I getting new, more, or worse headache, tremor, dizziness, bright light aura, pain, gazing off, or weakness?

22) In summary, do I notice any subtle physical, mental, vocational, emotional or social changes in myself?

To help physicians determine the source of these changes did some appear after a fall, operation, illness, stroke, concussion, greater stress, menopause, or medication change?  Which ones?

Finally, write down any low or high blood pressure, low or high cholesterol, and any blood sugar issues.

__ Now share your answers with loved one(s). Sincerely ask for feedback on any changes they notice.

__ Organize any of these concerns in writing, noting dates and frequency.

__ Write a personal and family history of dementia, neurological, or chronic conditions like diabetes, ALS, substance

           abuse or  mental illness.

__ Write down the times you may have experienced toxic contamination (i.e. lead, pesticides, war service)

__ Before proceeding, consider obtaining the best health insurance, public benefits, disability insurance and long-

           term care insurance that you still can.

__ If you have a trusted family physician, start with an appointment there. Be aware that not every doctor

           understands memory challenges or handles subtle early signs well. A second opinion may be needed.

— Go to the appointment with a loved one(s). Consider bringing an additional, note-taking advocate.

__Give one copy of your concerns to the doctor, one to your note-taker, and keep one in front of you.

__ Informed physicians will speak to you directly. They will ask loved ones about their impressions and may order

          blood tests. The physician may give a mini-mental exam or other short screening device, even knowing these

         tools are not sensitive to early changes. They will make sure you are not dehydrated. They may work with you

         on depression issues, knowing Alzheimer’s also brings its own chemical depression.

__ A referral to a neurologist or memory clinic shows your physician understands his/her limitations. Ideally you will

         maintain your primary care physician for overall health issues and have him/her receive reports from any

         specialists. But if your physician dismisses all your concerns out of hand, you need to locate a physician or

         neurologist who listens. Even some neurologists specialize elsewhere and do not handle cognitive issues well.

__ Schedule a neuropsychological assessment through a neurologist, memory clinic, or veterans or university

         hospital. These often last two to three hours. The earlier you have a neuropsychological, the more helpful it

         will be as a baseline for the future.

__ Afterwards a psychologist will explain the assessment results or send them to your doctor. Ask for a written copy.

         It compares you to average persons at your age and years of education. It may show weak areas and

         strengths. An exam two years later may show if there is cognitive decline. Often even a tentative diagnosis is

         not given until a decline is seen among your “neuropsychs“. How you do on a particular “neuropsych” may

         depend on the time of day and how you are feeling that day.

__You might be referred for an MRI, other scans, and/or EEG. Ask to keep a copy at time of scan.

__ Now comes the most unpredictable time in your diagnosis process. Some physicians will order just one

        “neuropsych”, attach the label Alzheimer’s disease without ruling out other possibilities, and quickly prescribe a

         well-known Alzheimer‘s drug. Others seem to attribute everything to depression and ignore family history and

         Parkisonian or seizure symptoms. Still others will not use the term Alzheimer’s until an autopsy after death and

         may merely annually monitor gradual decline into advanced dementia. A second opinion may be helpful.

__We in forMemory advocate for early interventions to reduce our symptoms. We seek ways including nutrition and

         life style changes to improve quality of life and manage our own unique set of symptoms. We may coordinate

         with our neurologist both Western medicine and integrative alternatives to help reduce tremor and sleep

         disturbance.

___We advocate for help such as balance physical therapy and specific medications for pain and falling. All doctors

        recognize that regular physical activity is essential for Alzheimer’s patients. But many forget that it is hard to

        exercise when there is pain and fear of falling. Medical intervention is required in these cases. Some

        neurologists are now prescribing the Selegiline Patch for those with  Parkinsonian-type symptoms because it

        reduces these symptoms, while it manages chemical depression and is neuro-protective.

__ Neurologists who follow current research know that seizure activity may be causing cognitive damage well before

      seizures are clinically apparent. The EEG’s they routinely order indicate whether there is seizure activity that

      would warrant medication. 

If there is a showing of cognitive decline consider joining forMemory’s database at www.formemorydatabase.org

Anywhere along this long diagnosis process, feel free to contact forMemory, a network of persons with early-onset cognitive challenges. The toll free number is 1(877)288-2148. You may wish to purchase our book, “Traveling with Hope: Sharing Our Experiences with Memory Challenges” .

The website HopeofAlzheimers.com may provide an understanding firsthand of what others have gone through.

Consider local support groups and education for you or family members. There are local Alzheimer’s organizations that provide support. Especially in South West Wisconsin consider the newly renamed Alzheimer‘s & Dementia Alliance of WI at (608)232-3400 and website www.alzwisc.org.

Consider joining a registry or clinical trial if you are eligible. But remember these trials are for research and you might not get any results for your use. While in a study you still need your own neurologist and treatment plan.

Regardless of your neurological status, consider arranging for a Brain Bank to autopsy your brain upon your death to help research. This can be an important gift for your children, future generations, and all communities.

If you have concerns about others, you might suggest that getting a neuropsychological assessment is good for a baseline.