What is Dementia?

Dementia is a general term used to describe a long list of chronic, devastating illnesses that affect primarily older individuals. The term implies a progressive decline in memory, judgment, intellectual function, visual-spatial skills, and adaptive ability, to the degree that symptoms interfere with a person’s ordinary activities and relationships. Dementia is usually incurable, although the rate of progression varies.

 

What is Alzheimer’s disease?

Alzheimer’s disease is ultimately the result of a neuron degenerative process. It occurs most predominately with increasing age, and is characterized by the imbalance between neuronal injury and repair. This delicate balance is affected by multiple factors: genetic, age related, and environmental. Stress, education, exercise, socialization, and nutrition are among the environmental factors that affect the risk of developing Alzheimer’s.

 

How is Alzheimer’s disease diagnosed?

Alzheimer’s disease can usually be correctly identified through a series of symptomatic screenings and supportive medical tests to rule out other possible relevant factors. It can not be definitely diagnosed until a brain autopsy shows the disease’s characteristic degenerative signs. Forgetfulness may be the first sign of dementia. Often, family members or friends are the first to notice possible symptoms. Most clinicians would recommend a blood work-up for dementia, along with a complete medical history as well as mental status and neuropsychologic testing. An initial work-up for dementia should include sither a CT scan or MRI of the brain to exclude other treatable problems, such as brain tumors, normal brain pressure, or a subdural hematoma. It is important to note that the National Institute on Aging (NIA) reports that once Alzheimer’s afflicted individuals become symptomatic, there is up to a 90% chance that physicians will accurately diagnose the disease.

 

Who is affected by Alzheimer’s disease and memory loss?

Due to advances in disease prevention and treatment, life expectancy in the United States has increased to the early 80s for women and mid 70s for men. Thus making this segment of our population susceptible to the “diseases of the aged”, with Alzheimer’s disease as the leading cause of dementia. The lifetime risk for developing Alzheimer’s disease in the United States is estimated at 255. More than 14% of individuals older than 65 have Alzheimer’s, and the prevalence increases to almost 50% in people older than 85 years. There are also rare, genetically inherited forms of Alzheimer’s disease known as “early-onset Alzheimer’s” that can affect individuals in their 30’s and 40’s. Although Alzheimer’s disease affects both men and women, women are at a significantly higher risk even after compensating for the generally higher life span of women. Many scientists believe that this is due to the loss of the neurotrophic effect of estrogen after the menopause.

 

Once Alzheimer’s disease is diagnosed, what would be the life expectancy?

After the onset of symptoms, individuals with Alzheimer’s disease live an average of 10 years, but can live for as many as 20 years or more. From the time of diagnosis and depending on the severity and onset of the disease, individuals with Alzheimer’s disease live half as long as individuals of similar age without Alzheimer’s. Alzheimer’s disease is a progressive disease without a cure, in which the patient’s ability to function gradually deteriorates. Alzheimer’s is considered to be a leading cause of death in the United States, after certain cancers and cardiovascular disease.

 

What are the other common types of Dementia?

Parkinson’s disease is seen in 4-8% of people with dementia and may be an additional disorder in other dementias like Alzheimer’s and Multi Infarct Dementias. Movement symptoms include resting tremor, progressive slowness of movement, limb and trunk rigidity, impaired posture and balance, poor coordination, and gait and swallowing problems. In late stages, walking, talking, and doing simple tasks often becomes severely impaired. Depression, sleep disturbance, and excessive sweating are also common. In the later stages, dementia may be seen. Parkinson’s may develop over 20 years or may progress more rapidly. Lewy Body Dementia is rather like Parkinson’s disease in reverse. Both diseases have Lewy Bodies seen in the motor neurons but Lewy Body Dementia presents with an initial dementia with the parkinsonian movement disorder coming later in the progression of the disease—just the opposite of Parkinson’s disease. Lewy Body Dementia is virtually indistinguishable from Alzheimer’s disease in the early stages. The diagnosis of Lewy body Dementia is often made later in the course after an initial diagnosis of Alzheimer’s disease has been made. Diagnostic criteria include fluctuations in cognition, impaired alertness and attention, visual hallucinations, and, finally, increased motor tone, gait disorder, and postural instability. Falling, syncope, loss of consciousness, delusions, and other hallucinations are also seen. It is usually differentiated from Parkinson’s disease because of the lack of dramatic tremors. Many dementia patients may have a combination of Alzheimer’s, Parkinson’s, or Lewy Body Dementia. Multi-Infarct or Vascular Dementia is a progressive step-wise decline in mental functioning caused by the cumulative effects of small, periodic strokes in the brain. Vascular dementia may occur independently but often is co-existing problem in many individuals with Alzheimer’s (35%of cases have evidence of stokes on pathological exams) and Parkinson’s disease. Hypertension, diabetes, smoking, periodontal disease and cardiovascular disease are all risk factors for dementia. Pick’s Disease, a form of dementing illness that typically affects individuals between ages 40 and 60, involves the frontal temporal lobes. Like Alzheimer’s disease, Pick’s disease in progressive, but patients’ experience a more rapid decline than in Alzheimer’s. It is also often accompanied by psychiatric symptoms. Creutzfeldt-Jacob disease (Mad Cow Disease Variant) is a very rare dementia. This disease may take years to develop and is initially indicated by subtle mental changes and slowness that rapidly progresses to severe dementia. Huntington’s disease is a genetic disorder that attacks the caudate nucleus of the basal ganglia, resulting in a subcortical dementia. Prominent symptoms include chorea movement (more in upper extremity), gait change, personality change with disinhibition, psychotic delusions and hallucinations, decreased motivation, poor executive planning and organizational abilities, and decreased spontaneous speech. AIDS Dementia Complex results from invasion of HIV into the white matter (cortical axons) of the brain. Symptoms include apathy, ataxia, incontinence, mutism, progressive leg weakness, and painful myopathies and neuropathies. Dementia Pugilistica or ‘punch-drunk dementia” is a progressive decline in mental function in 40s through 60s seen in boxers and others who have had multiple head traumas or concussions. Declines in cognition, emotional functioning, and movement can all be seen. Alcohol Dementia Syndrome is most commonly linked to long-term heavy drinking, yet in some cases it develops after consumption of as little as three drinks a day for a period as brief as three years. Stroke can be ischemic or hemorrhagic. Stroke will result in varying types and severities of dementia depending on the location and size of the area of the brain affected. Generally, strokes impair more specific brain functions but can be very devastating in some cases. Traumatic Brain Injury is also a treatable dementia that improves over time in most patients. This dementia is seen after moderate to severe head trauma with loss of consciousness and significant amnesia.

 

Which medications can slow down the progression of Alzheimer’s?

There is still no cure and no treatment that can stop Alzheimer’s disease. There are, however, many medications that can be used to delay and mitigate Alzheimer’s symptoms. A variety of pharmacological interventions have been useful in the management of AD, but their impact is often modest and temporary and does not prevent the eventual deterioration off patients. As of 2004, the United States Food and Drug Administration (U.S. FDA) has approved two classes of drugs for the treatment of cognitive decline and other behavioral symptoms of AD. The first class of drugs approved and commonly prescribed for the treatment of mild to moderate AD is the ACHEase inhibitors. These are the following: . Reminyl .Aricept .Exelon .Cognex AD patients differ in their AD symptoms, and the way they react to different medications. One drug may work better than another, depending on the particular patient. In 2003, the U.S. FDA approved a second class of drugs, NMDA receptor antagonists, for the treatment of moderate to severe AD symptoms. Namenda is the first AD drug of this type that is prescribed in the U.S. Because the mechanisms of action between these two classes of drugs differ, physicians often prescribe the two drugs together for a more comprehensive treatment of AD cognitive and behavioral symptoms.

 

Are their non-pharmacological options which help with behavioral problems associated with Alzheimer’s disease?

Other than the use of medications to help with behavioral problems, some suggestions could be made that are proven to be very effective: Light Therapy: The distressing symptom of “sundowning” (early evening confusion) has often frightened patients with dementia and frustrated their caregivers. Increased exposure to sunlight or high intensity indoor lux in the mid-to late afternoon may help control this troubling symptom of dementia. If weather permits, the most effective option seems to be exposure to natural sunlight. But artificial light or the use of indoor skylights can be helpful. Generous use of night lighting can be extremely useful in calming anxiety, reducing confusion, and preventing nighttime falls and accidents. Exercise: Daytime somnolence and nighttime wandering are frustrating problems but may improve with regular physical activity and exercise. All too often, demented patients lie in bed or sit in chairs dozing though out the day. Adequate levels of physical activity and exercise can help regulate sleep/wake cycles and reduce agitation. The best results seem to follow exercise done in the mid-to late afternoon. A Soothing Environment: A noisy and chaotic environment can adversely affect any person’s mood. A calm environment and appropriately selected music can benefit even severely demented persons. Slow, soft classical music and sacred music may calm the agitation and anxiety associated with dementia. A combination of soothing sounds, colors, plants, familiar objects, and a generally comforting environment cannot be over emphasized.