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Resource Description: 
During January of 2004, PBS presented an in-depth look at Alzheimer's called The Forgetting, based on the book of the same name.
The Alzheimer's Association is an excellent source of information and advice. There may also be a local chapter of the Association in your own area, with its own, separate website.
Episode number: 
101

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Transcript: 
Dementia (transcript)

In this episode of Second Opinion, you'll learn about the different forms and causes of dementia, the difference between dementia and Alzheimer's disease, and how the effects of dementia may be slowed down by medical intervention. 

Dementia is cognitive impairment greater than can be accounted for by the aging process alone, by another disease process, or toxic influence.  We all age differently, but dementia is not an inevitable part of the process. Dementia, a general term for a decline in mental abilities, is really a name for a varying set of symptoms, rather than a specific disease.  These symptoms can range from mild to severe, and can include memory loss, confusion, problems with judgment, planning and concentration, as well as personality and mood changes.

Saying someone has dementia is like saying someone has a fever; it does not tell you why someone has it.  The causes of dementia can include illness, infections, injuries, diabetes and lead poisoning, as well as nutritional, hormonal, vitamin or body chemistry imbalances.  It can also be caused by aluminum toxicity from aluminum ingestion and reaction to medicines.

Some of these causes are reversible, and in some cases the progress of the condition can be slowed down by medical treatment.  Therefore, the most important first step to understanding what form of dementia you or a loved one may have, and what can be done about it, is to get an accurate diagnosis.  This involves speaking openly and honestly with your doctor, and having a thorough medical exam, including a neuropsychological evaluation.  

Dementia is not the same thing as Alzheimer's disease.  Alzheimer's disease is simply one of the illnesses that can cause dementia.  Unlike some forms of dementia, Alzheimer's effects are permanent and we do not yet know its causes, its cure, or its prevention.  As the disease progresses from early, to mid, to late stage, it affects the body as well as the mind, making it difficult for people with it to talk, walk, swallow, control their bowels, etc. 

Alzheimer's can strike younger people, but the chance of getting it increases with age and the risk appears to be higher for women and some people with less formal education. Researchers are also studying the role genetics may play in developing the disease.  Although Alzheimer's is currently incurable, medications are now available that can control and reduce its symptoms and slow its progression. 

 

Ask Your Doctor

Provided by William Hall, MD
Director of the Center for Healthy Aging
University of Rochester

This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.

  1. I seem to have some problems remembering things, like the names of acquaintances.  Could this be Alzheimer's disease?
  2. There seems to be a strong history of Alzheimer's in my immediate family. Is it heritable, and should I get tested?
  3. Is the brain scan a reliable early test for Alzheimer's?
  4. Are there any foods or supplements that might help prevent Alzheimer's?
  5.  What is the usual lifespan of someone with Alzheimer's disease?
  6. When are drugs indicated in Alzheimer's disease?
  7. Where can I learn more about Alzheimer's?
  8. Are there other diseases that can mimic Alzheimer's
  9. When and how do I approach the decision to take away access to driving an automobile?
  10. When is the right time for institutionalization?
  11. Is it ever ethical to withhold artificial feeding in terminal stages of Alzheimer's?

Quick Facts

Dementia is not an inevitable part of the aging process.  Mild memory loss and some slowing down of mental processes often do accompany advanced aging, but they are not symptoms of true dementia.

Dementia is really a name for a set of symptoms, rather than a specific disease.  Dementia can actually take several forms and has several different causes.  Some forms of dementia are temporary, some of its causes are reversible, and in some cases the progress of the condition can be slowed down by medical treatment.  A thorough medical (physical and mental) examination is the important first step in diagnosing and treating dementia.

Dementia is not the same thing as Alzheimer's disease. Alzheimer's disease is a specific illness that causes dementia. Its effects are permanent and its cause and cure are as yet unknown. However, some new drugs have successfully slowed the progression of the disease in a significant number of people.

The prevalence of dementia - and Alzheimer's disease - does increase with age.  Here are some statistics from Dementia.com.

Percentages of people who have some form of dementia (but only about half of them have Alzheimer's disease):

  • Less than 2 % of people age 65-69
  • About 5 % of people age 75-79
  • About 20 % of people age 85-89
  • About 33% (one third) of people over 90

It is estimated that about 4.5 million Americans have Alzheimer's disease.  This includes:

  • About 5 % of people over 65
  • About 20 % of people over 80
  • About 30 % of people over 90

Key Point 1

Memory loss and confusion are not a "natural part" of getting older. 

Aging is often accompanied by some mild loss of memory for words and names, some slowing down of mental processes, and some trouble focusing attention. But true dementia - an obvious decline in mental ability, including confusion, more than mild memory loss, and personality change - is not an inevitable part of aging.  For example, occasionally forgetting where you put the keys is not a sign of dementia; putting the keys in the refrigerator may be. 

Here are some other important early signs of dementia:

  • Forgetfulness that affects work: while nearly everyone occasionally forgets names or appointments, if this happens frequently and is accompanied by confusion, it might signal a weakening of the memory.
  • Problems with normal tasks, such as cooking, cleaning, dressing: it is common to forget the pot on the stove; it is less common to forget that you've cooked at all.
  • Problems with words: again, it is common to have trouble finding the "right word", it is less common to forget simple words and use inappropriate fillers that make a sentence sound garbled.
  • Problems with space and time, that is, knowing where you are and what time it is: we all get disoriented occasionally, but consistently getting lost in your own house is a good reason to seek medical help.
  • Problems with judgment: you may normally disagree with your loved ones about what is "appropriate dress" for a specific event, but wearing a bathrobe to go shopping or three sweaters on a hot summer day is another warning sign of dementia.
  • Problems with abstract thinking: many of us have trouble balancing our checkbooks, but people with dementia often can't recognize numbers or do simple arithmetic.
  • Mood swings and changes in behavior: we all get mood swings, but for people with dementia they can be very sudden and seemingly inexplicable.
  • Personality changes: personalities do change with advancing age, but for people with dementia these changes may be more sudden and much stronger; for example, a generally friendly, outgoing person may become cold, angry, jealous or quiet.
  • Loss of initiative: while no one stays motivated constantly, people with dementia may lose all interest in their work, hobbies, friends, etc. without developing any new interests.

Some forms of dementia are temporary; others, such as that caused by Alzheimer's disease, are not.  Alzheimer's is a progressive disease that goes through three general stages called early, mid and late stage, or mild, moderate and severe.  In early-stage Alzheimer's, mood swings and the weakening of mental abilities begin to be noticeable.  People may begin to have trouble with driving, paying bills, and other tasks of daily life.

As the disease progresses, people with Alzheimer's have difficulty with simpler tasks, such as using appliances, using the telephone, and dressing. By the mid-stage, major changes in behavior develop, and people may begin to forget where they are. In the late-stage, physical problems dominate; people have trouble walking, talking, swallowing, controlling their bowels and other body functions. Eventually, the disease is fatal.

Alzheimer's, however, can take very different courses. We do not know how long it will take an individual to go through each stage; wide variations are possible. And new drugs have proven very effective in slowing the progress of the disease.

    

Key Point 2

The progression of dementia may be slowed down by intervention, so getting an early and accurate diagnosis is very important.

Because dementia can take so many forms and has so many causes, the most important first step to understanding what form of dementia you or a loved one may have, and what can be done about it, is to get an accurate diagnosis.  If you notice changes in a loved one's or your own mental abilities, you should seek medical advice.  Speak openly and honestly with your doctor and explain what changes you have noticed.  You or your loved one should also have a thorough medical examination, including a general physical and neurological exam and a neuropsychological evaluation.  A neuropsychological evaluation consists of a number of written and/or oral tests that measure a person's mental functioning.  The results are compared with the normal range of scores and help in the diagnosis of dementia, and its differentiation from depression and other causes of cognitive impairment.

When you have an accurate diagnosis, you can begin to take the appropriate steps to deal with the condition.  These may include medications (discussed below), lifestyle changes, and planning how to handle needs such as safety, transportation, nutrition, social stimulation, physical stimulation, and legal and financial affairs.  You may also want to plan to get extra help (privately or through social service and government agencies, at home or in skilled care facilities) for you or your loved one as the condition progresses.

A class of drugs known as acetylcholinesterase inhibitors, sometimes called cholinesterase inhibitors, has successfully slowed the progression of Alzheimer's disease in a significant number of cases.  They work by preventing the breakdown of acetylcholine, a chemical in the brain that helps memory and other thinking skills. Donepezil is the generic name of a commonly prescribed cholinesterase inhibitor (in the show it is referred to by a brand name, Aricept). Two other generic cholinesterase inhibitors are galantamine and rivastigmine.

A newer drug that has also proven effective, and is also mentioned in the show, is memantine.  Recently, a multi-center study was directed by University of Rochester Medical Center faculty.  The study was led by Dr. Pierre Tariot, who appears on this episode of Second Opinion. It concluded that memantine, when taken with donepezil, helped moderate-to-severe Alzheimer's patients maintain or in some cases improve their memory and other mental activities and their ability to do the tasks of daily life.  Memantine is one of a new class of drugs for treating Alzheimer's and the first approved by the FDA for advanced Alzheimer's patients.

Of course other factors, such as care and personal environment, are also important for people with Alzheimer's disease and their caregivers. Physical, emotional, and mental activities, such as music therapy and brain exercise (doing crossword puzzles), have shown to be helpful.

    

Key Point 3

Some of the causes of dementia, such as reactions to drugs, alcohol and medicines, hormone and vitamin imbalances, and depression, are reversible.  By making changes in your environment and lifestyle, you may be able to slow the progress and even reverse the effects of dementia.

Some important changes to consider are:

  • Check your house for lead paint and take steps to remove or contain it as soon as possible.
  • Get regular physical exercise.
  • Stop smoking.
  • Stop drinking alcohol.
  • Keep your blood pressure under control.
  • Keep your cholesterol under control.
  • Eat a heart-healthy diet; it is also good for your brain.
    • Fruits and vegetables
    • More fish, less meat
    • "Good" oils, such as olive oil
    • Antioxidants - nutrients and other substances that protect cells in the body from the damage caused by "oxygen free radicals" (molecules that seek to become oxidized, a process that harms body tissues and has been linked to many diseases, including stroke, heart disease, and cancer); antioxidants are found naturally in food but are also available as dietary supplements.  Important antioxidants include:
      • Vitamins A, C, E and beta-carotene (found in carrots)
      • Lycopene  (found in tomatoes)
      • Flavonoids  (found in ginkgo biloba, black cherries, blackberries, bilberries and blueberries)
      • Quericetin - a specialized flavonoid
      • Coenzyme Q10 - a vitamin-like substance
    • Some research shows that older people, especially heavy drinkers and smokers, as well as those who are eating less, taking aspirin frequently, or who have impaired immune systems, may benefit from taking antioxidant supplements daily.
    • Folates - foods rich in folic acid, such as:
      • Green vegetables
      • Strawberries, oranges, raspberries
      • Tomatoes
      • Nuts and seeds
    • Phytoestrogens-plant, estrogen-like substances and natural estrogens have not been shown to be beneficial

Following these guidelines, taking good care of yourself and having regular medical check-ups can strongly help prevent the onset of dementia, slow its progress, and reverse its effects.

Medline Plus

Medline Description: 

Conduct an off-site search for Dementia information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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