Reassurance

By Dale Bredesen, M.D., Chief Science Officer for Apollo Health

We all like reassurance — reassurance that things are going to work out, that the guy your daughter is dating is a responsible and decent human being, that the chicken you just ate is not carrying Salmonella or laced with arsenic. Doctors spend a great deal of time offering reassurance — that the lump you felt is just a benign lipoma, for example.

But lately, reassurance has become one of my least favorite words. A celebrity was reassured by her physician that she “only” had MCI, not dementia. Of course the physician did not bother to tell her that MCI is the third of the four stages of Alzheimer’s and that she should seek optimal treatment immediately. Charles presented with dementia, which typically occurs after 10 years or so of SCI followed by a few years of MCI, and when I asked him whether he had had symptoms 10 or even 15 years earlier, he said yes, but his doctor had told him they were normal. Bill, a physician himself, had had several years of decline, but was told by his neurologist that it was “normal aging,” which led to his delaying the MRI that showed he had normal pressure hydrocephalus, a very treatable condition in its early stages. Robert had been a hedge fund manager and brilliant mathematician, but when he was well along in his decline, a neuropsychologist “reassured” his wife that he was scoring in the 50th percentile in his cognitive testing, so he was fine. Of course she knew that he had lost his brilliance, and in fact was well into the dementia phase of his Alzheimer’s. Hank’s symptoms were diagnosed by a neurologist as “pseudodementia”, which means that he had depression that mimicked dementia. This delayed his treatment for two years, when it was finally determined that his genetics included ApoE 4/4 (something that should have been checked originally), and he did indeed have dementia.

In each of these cases, the physician’s “reassurance” led to delays in treatment, often with tragic consequences. Reassurance must never be used in place of “I have nothing to offer you.”

We must convince more people, and ultimately everyone, to begin active prevention at 40, and to seek optimal treatment at the onset of cognitive symptoms. If someone tells you it’s “not Alzheimer’s,” ask them what test ruled it out? We are now able to identify the process earlier and earlier so that dementia can be avoided in the vast majority of cases. If we all do the right things, we can be genuinely reassured that we shall keep our cognitive abilities, and things will indeed work out.