Excerpt from Live Now, Age Later by Isadore Rosenfeld M.D., plus links to reviews, author biography & more

• Brain tumors, which either originate in the brain itself or have spread to it from a distant site (a metastasis), are a much less frequent cause of dementia than are strokes or subdural hematomas. However, always think of a tumor in someone with otherwise unexplained neurological symptoms or behavioral changes. I remember a successful businessman in his middle fifties who was sent to a mental hospital with a diagnosis of Alzheimer's disease because he was becoming more and more irrational. Only at autopsy was the malignant brain tumor---the real cause of his symptoms---discovered.

• Hypothyroidism: The thyroid gland is the body's energy thermostat. When less thyroid hormone is produced (hypothyroidism), overall metabolism slows down: Your energy level decreases, your speech is less spontaneous, and your mental functions are not as sharp as they used to be.

Hypothyroidism can occur at any age, and it is not uncommon among the elderly. Unfortunately, even though it is easily diagnosed by means of a simple blood test, doctors and patients don't think of this possibility often enough. You have no idea how many patients I've seen over the years with typical complaints of hypothyroidism---inability to lose weight, constantly feeling cold, constipated, no energy, depressed, even confused---who went untreated for years because their mental sluggishness was mistaken for Alzheimer's. Always suspect thyroid underfunction in any older person who has slowed down both physically and mentally for no apparent reason. It's amazing how thyroid supplements will cure most of their symptoms, including their "dementia."

• Alcohol and substance abuse: Longtime alcohol use and abuse can damage the brain and cause behavioral changes that resemble. Alzheimer's disease. It doesn't have to be excessive drinking, either. The amount of alcohol that can alter personality varies from person to person. You can recognize brain damage due to booze by other evidence of alcohol toxicity, such as a florid face and, in men, manifestations of feminization such as enlarged breasts, diminished facial hair, and loss of libido. However, when the same individual has both chronic alcoholism and Alzheimer's, it's not easy to tell which condition is causing what symptoms. None of the treatments that occasionally improve the symptoms of Alzheimer's (see below) have any impact on alcohol-induced dementia.

• Polypharmacy means taking a lot of drugs. Americans over seventy years of age consume an average of six or seven different pills every day, both over-the-counter and prescription (not to mention herbal remedies.) That's because doctors too often recommend a quick fix for whatever ails their older patients. Trouble sleeping? Take this sedative. Tired? Try this "pick-me-up." Have a cold? Use this antibiotic. Suffering from arthritic pains? These painkillers will help. No appetite? Here are some great multivitamins. Anxious? This tranquilizer will help relax you.

Sedatives, sleeping pills, tranquilizers, and painkillers are the agents most likely to affect behavior. However, any drug or combination of drugs taken for any purpose can produce personality changes and memory loss. For example, you wouldn't think that a drug to treat urinary incontinence could impair memory. Yet in one study, 10 milligrams daily of oxybutynin chloride (Ditropan), widely prescribed for this disorder, affected language and mental performance. Since incontinence most commonly occurs in older persons, you can imagine a scenario in which someone using Ditropan might be thought to have early Alzheimer's. Identifying and withdrawing the offending agent, whatever it is, can result in a miraculous cure of "Alzheimer's"!

• Malnutrition is perhaps the most common cause, aside from Alzheimer's, of behavioral changes in the elderly. Every organ in the body, including the brain, can malfunction when you don't eat nutritious foods for whatever reason: because you've lost your teeth and can't chew; you're alone, depressed, or just can't be bothered to cook for yourself; you can't afford to buy the food you need; or some medication you're taking is killing your appetite. Normal mental function has been restored in countless older people with "Alzheimer's disease" after they were given nutritious meals and vitamin supplements. (That's why I prescribe a multivitamin supplement to every senior citizen who lives alone.)

From Live Now Age Later: Proven Ways to Slow Down the Clock,by Isadore Rosenfeld. © June 1999, Isadore Rosenfeld. Used with permission.