Richard L. Bruno is chairperson of the International Post-Polio Task Force and director of The Post-Polio Institute at Englewood Hospital and Medical Center. Please e-mail questions directly to him at ppseng@aol.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: Do polio survivors usually have progressive memory loss? When I am very fatigued or stressed I will totally forget the word I was going to use. I'm frightened. Am I getting Alzheimer's disease?

You are experiencing word-finding difficulty, a problem for polio survivors that has nothing to do with memory loss or Alzheimer's disease. In our 1990 National Survey, 79 percent of polio survivors reported difficulty "thinking of words I want to say." Thirty-seven percent reported frequent, moderate-to-severe word-finding difficulty.

In the July 2000 issue of the American Journal of Physical Medicine and Rehabilitation, we describe testing polio survivors and finding that they do indeed have the "tip-of-the-tongue" experience--knowing the word you want to say but not being able to say it. Polio survivors have difficulty with naming objects and sometimes even people they know well. Our results indicated that word-finding difficulty was not associated with memory or thinking difficulty--symptoms of Alzheimer's disease--but was related to trouble focusing attention, a characteristic symptom of post-polio fatigue.

We also found that difficulty with word-finding and focusing attention were related to polio survivors' brains making less dopamine. Low dopamine is the cause of Parkinson's disease, and we found that word-finding difficulty was identical in both polio survivors and Parkinson's patients, even though polio survivors do not experience the tremor and rigidity of Parkinson's. In 1996 we published a study showing that bromocriptine, a dopamine-replacing drug, reduced word-finding difficulty, attention problems and fatigue in polio survivors. However, medication is not necessary to treat word-finding difficulty or any PPS symptom. Reducing physical and emotional stress decreases all PPS symptoms. So don't worry that you have Alzheimer's disease. If you're having trouble thinking of a word that you want to say, try to "talk around" the word by describing what you're trying to name. If you are forgetting your friends' names, try calling everyone "Buddy" or "Honey."

Q: I had one spinal tap on the first day I was hospitalized for polio in 1931, and it was negative. Last week a neurologist told me that, even though it was only a first-day result, a negative spinal tap indicates that I couldn't possibly have had polio. He thinks I should see a muscle doctor. I had something back then, with a stiff neck and muscle pain but no paralysis. For more than 10 years I have proceeded on the basis that I have post-polio syndrome, since I have fatigue and muscle weakness today. Could I have not had polio? What do I have now?

A negative spinal tap on your first day in the hospital does not rule out polio. Spinal tap results would have varied depending on your symptoms at the time of the tap and where the poliovirus was in your body. If the poliovirus was growing in your intestines or had entered your bloodstream, but had not yet entered your brain and spine in large numbers, the spinal tap would have been negative. Most people don't realize that a spinal tap only measured the number of white blood cells in your spinal fluid--an indication of infection--not whether the poliovirus was in your spine. A positive spinal tap back then could have meant that you had either meningitis or polio, since a stiff neck is a symptom of both.

Even if your spinal tap had been positive and you definitely had polio, PPS is still a "diagnosis of exclusion." Make sure that you don't have another condition causing your fatigue and muscle weakness today. Do you need to see a muscle disease specialist? Without knowing the details of your symptoms, I can't say. But after treating hundreds of polio survivors over 17 years, we have never seen a polio survivor with new muscle weakness that was due to muscle disease. If all other conditions are ruled out, you could very well have PPS, since at least 25 percent of those who had "nonparalytic polio," having had only a stiff neck when they were ill originally, have PPS symptoms today.