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Alzheimer's Disease

What is Dementia?

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Dementia is not a specific disease but is a general term used for a collection of symptoms involving impairment of mental functions, such as thinking, memory, reasoning, speaking or moving. With dementia, these symptoms are severe enough to interfere with a person's daily life and relationships.

While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory and reasoning -- are significantly impaired. Although it is common in very elderly individuals, dementia is not a normal part of the aging process.

Alzheimer's Disease is the Most Common Form of Dementia

Alzheimer's disease is thought to be responsible for at least half of all cases of dementia. However, there are as many as 50 other known causes of mental decline. Although many diseases that cause dementia are not curable, some forms may improve greatly when the underlying cause is treated. For instance, if vitamin or hormone deficiencies are causing mental decline, the symptoms may resolve once the problem has been corrected. Thus, it's essential to seek medical advice when dementia-like symptoms occur in order to avoid potentially reversible conditions, but also to intervene early in all forms of mental decline. The frequency of reversible causes of dementia is thought to be around 20%.

For instance, if vitamin or hormone deficiencies are causing mental decline, the symptoms may resolve once the problem has been corrected. An often preventable condition that can cause dementia is the build up of atherosclerosis in the arteries leading to the brain.  This is a common cause of stroke and resultant dementia.  Although genetics play a role, atherosclerosis is often preventable with a good diet, regular exercise, and cholesterol control.  Thus, it's essential to seek medical advice when dementia-like symptoms occur in order to treat potentially reversible conditions, but also to try and prevent further mental decline.

Other causes of dementia include the following:

  • Stroke This is the second most common cause of dementia. In this type of dementia, a series of small strokes or changes in the brain's blood supply may result in the death of brain tissue. The location in the brain where the small strokes occur determines the seriousness of the problem and the resultant symptoms. Sudden onset of dementia-like symptoms, versus the gradual onset of Alzheimer's symptoms, is characteristic of this kind of dementia.  In this case the patient is likely to show signs of improvement or remain stable for long periods of time, then quickly develop new symptoms if more strokes occur.
  • AIDS
  • Traumatic brain injury
  • Multiple sclerosis
  • Parkinson's Disease
  • Pick's Disease, Huntington's Disease
  • Liver failure,
  • Kidney failure
  • Diabetes
  • Reversible causes such as: medication reactions, thyroid disease, depression, infections, certain vitamin deficiencies, fluid and electrolyte disorders, tumors and blood clots in the brain and other metabolic diseases. 

Diagnosis of Alzheimer's

Healthy brain and brain with severe Alzheimer's To date there is no single test that accurately diagnoses Alzheimer's disease. Using all the tests combined, Alzheimer's can only be diagnosed with about 80 to 90 percent accuracy.   

The diagnosis of Alzheimer's is made based on the symptoms, and by ruling out other conditions that mimic the disease.

A thorough diagnostic evaluation by your doctor will likely involve several types of evaluations. Your doctor will ask questions and perform a physical examination.  A test commonly used by physicians to help screen for significant memory problems is called the MiniMental State Examination (MMSE). Further testing may include blood and urine tests to check overall health and to rule out other conditions that may be causing the symptoms.  A brain-imaging scan, such as a CT or MRI scan of the brain might be ordered as well. 

(Image courtesy of Alzheimers Disease Education and Referral, from the National Institute of Health). The brain on left is a healthy normal brain, the brain on right is from a patient with severe Alzheimer's Disease.)  

 

Treatment of Alzheimer's

There is still no cure for Alzheimer’s, and a lot that we don't know about the disease, but we do know that having a healthy lifestyle greatly optimizes the mental function of the brain.  Regular exercise, mental stimulation, a good diet and the control of chronic diseases like diabetes and high blood pressure —all play an important role in preventing or slowing cognitive decline.

Early recognition of mental decline and diagnosis of Alzheimer’s disease or other disorders causing dementia is an important step to getting appropriate treatment, care and support services.  

Medications for Alzheimer's: In the early and middle stages of Alzheimer's disease, the drugs  donepezil (Aricept), rivastigmine (Exelon), or galantamine (Reminyl) are frquently prescribed. They do not cure the disease, but they have been shown to delay the worsening of some of the disease's symptoms.  Namenda is a newer drug and can be used in conjunction with one of the above medications.  These medications do not cure the disease, but they have been shown to slow the progression of Alzheimer's and improve and preserve thinking skills.  Optimally, these medications should be started early to help the patients live fuller lives and stay active and independent longer.  Often times additional medications are needed to help manage co-existing conditions such as depression, anxiety, and possible behavior problems.  

Many people think the early symptoms of Alzheimer's are signs of normal aging so Alzheimer's is often not diagnosed or treated early. Studies show that early diagnosis and treatment can help.  See your health care provider if you think you or your loved one has a serious memory problem.

Preventive Measures

As we get older, it’s even more critical that we work hard to stay healthy so we can enjoy our lives to the fullest. Here are some important lifestyle habits that will contribute to a healthy brain:

  • Avoid exposure to viruses--Stress, fatigue, and illness temporarily affects our intellectual functioning more as we get older
  • Manage current medical conditions (HTN, Diabetes, etc.)
  • Stay active physically & mentally
    • Regular exercise program that is enjoyable--ask your health care provider to get started.
    • Stay active socially
    • Read books, play mentally challenging games, pursue stimulating hobbies
  • Good nutrition
    • Include good fats in your diet and limit saturated fat and trans fat in the diet (walnuts & fish)
    • Eat 4-5 cups of fruits and vegetables per day
  • Don’t smoke
  • Get enough sleep: Accidents are much more likely to happen when somone is sleep deprived, especially with increased age.
  • Minimize stress: With increased age, stress and fatigue can have a significant adverse temporary affect on memory and attention span.
  • Be organized, plan ahead, write everything down, be consistent about putting things in the same place, make photo albums and frame pictures with dates in plain view on each picture to help memory.
  • Work harder to remember names, dates, events, appts. Repeat out loud, several times, something you want to remember. Practice names out loud ahead of going to a party, for instance.

What is Normal Forgetfulness?

Many of us may panic at signs of forgetfulness, especially as we grow older.  It can be extremely reassuring to know what's normal yet very helpful to be aware of the signs of early dementia.

Certainly a mild degree of short-term memory loss does normally occur in the 60's and 70's. Household items are more often misplaced, familiar names and vocabulary words can become more difficult to call to mind. It's harder to learn something new, such as using a computer, especially if there's been little previous exposure to computers. Simple stress, fatigue, or illness can have a dramatic, temporary adverse affect on the intellectual functioning of an aging person.   Although these symptoms can be alarming, they can certainly be a normal part of aging. However, there are distinctive symptoms often associated with dementia that are cause for concern and should be brought to the attention of a primary health care provider.
   

When is Forgetfulness Concerning?

Alzheimer's disease begins insidiously with often the only symptom being mild forgetfulness of recent events, activities, or the names of familiar people. Early on, apathy and depression often develop and more of the following symptoms eventually become apparent:

Short-term memory loss or forgetfulness related to events, activities, or conversations that happened within the last few hours is one of the earliest symptoms of dementia. Asking the same question over and over again is a common symptom of early dementia experienced by family members. Under most circumstances, if someone can't remember what was told to them 10 minutes ago, it's usually cause for concern. A one-time occurrence certainly may only be due to the fact that the person was not paying attention or was not feeling well, but recurrent episodes of repeated, similar questions would signal a significant disorder.

Forgetting to do routine chores which have been done regularly in the past is a common occurrence in people with early dementia.

Increasing difficulty performing familiar tasks that require a somewhat higher level of thinking such as balancing a checkbook, paying the bills, cooking a simple meal, or driving to a familiar place, are symptoms of a significant disorder. Certainly as we age, it's harder to learn something new and unfamiliar neighborhoods and busy streets may be more daunting than in the past, but familiar cognitive tasks should continue to be manageable, as long as there are no physical limitations or visual impairments. It's normal to forget where you parked your car--but it's not normal to forget how to drive your car.  Misplacing your car keys can be normal; looking at the key and being unsure what to do with it, is not normal.

Familiar names and vocabulary words can be more difficult to call to mind as we get older, but a person with Alzheimer's Disease has progressively increasing difficulty with word finding as well as verbal expression of common words. Everyone has trouble finding the right word sometimes, but a person with Alzheimer’s often forgets simple words or substitutes unusual words, making his or her speech or writing hard to understand. For example, if a person with Alzheimer’s is unable to find his or her toothbrush, the individual may ask for “that thing for my mouth.” As the disease progresses, they will not only forget names, but they may forget ever having known familiar people. It's normal to forget a person's name and then remember it later.  It's not normal to forget ever having known a familiar person.

Misplacing things can be a normal, insignificant problem for some people, but a person with Alzheimer's  has increasing difficulty with misplacing important items and eventually starts putting things in unusual places, like an iron in the freezer or a wristwatch in the sugar bowl.

Disorientation to time.  It is normal to be unsure of the day of the week, or specific date of the month, especially when a person is retired and their routine doesn't really change on the weekends.  It is not normal to think it's January when it's July, or to be confused about what year it is.

Disorientation to place.  It certainly can be normal to get lost driving somewhere unfamiliar, but getting lost in your own familiar neighborhood is not normal. Another common example would be thinking they are at a friend's home when they're actually in the hospital. 

Increasingly poor judgment such as dressing without regard for the weather, wearing several shirts on a warm day or very little clothing in cold weather can be signs of a developing problem. Poor judgment about money is a common mishap made by someone living alone suffering from early dementia. The elderly are common targets of telemarketers who convince them to give away large sums of money or make unnecessary home repairs.

Personality changes, in conjunction with the above, are certainly signs of a significant disorder. The following are typical personality changes that can occur in Alzheimer's:

  • becoming silent, apathetic and withdrawn from social situations that they once enjoyed.
  • increasingly irrelevant conversation
  • acting more irritable or suspicious than usual with rapid mood swings
  • believing things that are not real (delusions). (In later stages auditory or visual hallucinations may occur)
  • dressing differently
  • loss of initiative:  loss of interest in hobbies, reading, attending church or social activities that used to be enjoyable. 

Whether these symptoms come on slowly or suddenly is important to note and convey to your doctor.


Support Groups for Caregivers

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References

  1. NIH Senior Health.  from the National Institute of Health, a comprehensive, easy to navigate website.  Has an audio tutorial about Alzheimer's Disease
  2. Alzheimer's Disease at Medline Plus, A service of the Nat'l Library of Medicine and the Nat'l Institute of Health 
  3. Alzheimer's Resource Room from the Administration on Aging, U.S. Dept of Health & Human Services
  4. Connections Newsletter from the National Institute on Aging
  5. "Alzheimer's Diagnosis Truths", Fisher Center for Alzheimer's Research Foundation
 
Written by N Thompson, MSN, ARNP, Last Updated May 2009

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