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alzheimer_s_dementia

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Alzheimer's and Dementia

A collection of information. This is not definitive and detailed, consult elsewhere for this info; and this is not something you should rely upon for diagnosis or treatment.

Information here comes from Alzheimer's & Dementia for Dummies (much material is taken from and verbatim from this book) available on Amazon, Lexington Cary Memorial Library, and likely elsewhere; and from a Mayo Clinic website.
Mayo Clinic also has information about Treatments, what's on the horizon
See bibliography below for more info.

What dementia is

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is a general category of medical conditions that affect normal brain functioning.
The World Health Organization (WHO) defines dementia as [A] syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e., the ability to process thought) beyone what might be expected from normal aging. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.

Some terms used

  • Syndrome: symptoms that together are characteristic of a particular medical condition. (People with the condition have most of these symptoms but don't show all of them to receive the diagnosis.)
  • Chronic and progressive: the condition is ongoing long term [chronic] and gets steadily worse with time [progressive].
  • Consciousness: in relation to dementia, people with dementia are awake and mentally aware of their surroundings, although what's going on around them is confusing to them.

What dementia is not

The most common misconceptions about dementia

  • All old people get dementia. Nope, it's not part of growing old. 1 in 9 older than 65 and 1 in 3 older than 85 suffer from it.
  • Dementia is same as Alzheimer's disease. Nope, Alzheimer's is one of a number of brain diseases that lead to dementia.
  • Memory loss equals dementia. Nope, while dementia does affect memory, a diagnosis of dementia requires that a person show many other more complex symptoms.
  • Everyone with dementia becomes aggressive. Nope, although some with dementia can become agitated, aggression isn't always a part of dementia, and it's usually triggered by the way someone is treated or communicated with.
  • A diagnosis of dementia means a person's life is over. Nope, many medical, social, and psychological treatments and strategies are available.
  • Everyone with dementia ends up in a nursing home. Nope, although 1/3 of people with dementia require more intensive care, many people can get enough help and support to stay in their own homes.
  • My relative has dementia, so I'm going to get it too. Nope, while some forms of dementia have a genetic component and may run in families, this is the minority, it doesn't follow that you'll get it. And it's not something you can “catch”.

What Alzheimer's disease [AD] is

Alzheimer's is a form of dementia; those with AD have dementia, but not all those with dementia have AD. The Alzheimer's Association defines Alzheimer's disease as “an irreversible, progressive brain disease that slowly destroys memory and thinking skills, eventually even the ability to carry out the simplest tasks.” AD is a fatal disease, ending inevitably in death.

Anormal deposits of specific proteins in the brain disrupt normal brain function; as these deposits spread, brain tissue starts dying leading to further cognitive impairment. The brain shrinkage can be seen in CT and MRI scans.

What AD is not

  • Curable
  • Contagious
  • A natural part of the aging process
  • Something you get from using deodorant or cooking in aluminum pans
  • Inevitable if you live long enough

Less than 5% of all cases of AD run in families.
A blood test can tell you whether you have a certain form of cholesterol-carrying protein associated with a higher incidence of AD but more than half with the risk factor never get AD. Because of the low correlation between the protein in the blood and getting AD, it's best not to take the blood test or have genetic testing to spare you from unnecessary worry.

Age and Dementia

A clear correlation between increasing age and chances of developing dementia.

AgeNumber diagnosed dementia
<651 in 1,500
65-701 in 100
71-791 in 20
80-891 in 4
90+1 in 3

Four types of dementia

[1] Alzheimer's disease

Most common form of dementia, in USA, 62-80% of cases.
Is 5th leading cause of death in Americans >65

[2] Vascular dementia

Second most common, in USA, 10% of cases.
Previously known as multi-infarct or post-stroke dementia, resulting from stroke.
Similar symptoms to AD but depend on parts of the brain affected by stroke.

[3] Lewy body disease

Rare, <4% of cases.
Lewy bodies are protein deposits that damage brain cells, these also found in those with Parkinson's disease, thus an overlap in symptoms between these two conditions.
Symptoms similar to AD, but sufferers also develop muscle stiffness, tremors, and shakiness in their limbs, and slower movement. Also frequent visual hallucinations, seeing animals or people that aren't there.

[4] Frontotemporal dementia

Least common of these, affects about 50,000 in US and is <2% of dementia cases. This type is most likely of these 4 types to be diagnosed in those under 65.
Shares many features of AD but also has symptoms: strange or sexually disinhibited behavior, lack of empathy, poor personal hygiene, apathy and loss of motivation, increased appetite for sweet or fatty foods, and repetitive and compulsive speech and actions.

Mild cognitive impairment: Dementia lite?

Like dementia, mild cognitive impairment [MCI] can affect a variety of normal thought processes including memory, planning, and judgement, but it doesn't impact mood or a person' ability to perform day-to-day functions. While it can be a sign of future dementia (most likely AD), 60% of those developing mild cognitive impairment don't get any worse and some get better.

The abnormally aging brain

In a person with MCI (Mild Cognitive Impairment), it's not uncommon to notice the following

  • Forgetfulness
  • Difficulty following conversations
  • Declining ability to make sensibe decisions
  • Getting lost easily
  • Poor concentration and attention span

Global Deterioration Scale (GDS)

Developed by Dr. Barry Reisberg in 1982, shows generally follow this progression of those with MCI that progress to dementia.

Stage 1No problems identified
Stage 2Patient recognizes that he/she has a problem, perhaps remembering names, but he/she scores normally on diagnostic tests
Stage 3Subtle problems carrying out thought processes start to affect work and social activities. Tests may begin to pick up problems – this is MCI (Mild Cognitive Impairment)
Stage 4Clear-cut difficulties develop in terms of memory and carrying out tasks such as dealing with finances or traveling. Denial is common; early dementia has set in.
Stage 5The person needs some assistance but is capable o washing, dressing, eating, going to the bathroom, and choosing appropriate clothes. Forgetfulness (names, places) is becoming more severe.
Stage 6The person is largely unaware of anything that's happening to him/her in the recent past. He/she needs help with most of the basic activities of daily living and may need to be in a nursing home. Incontinence is common.
Stage 7By this stage the person is experiencing severe dementia. He/she's completely dependent on others for everything, often including mobility. Verbal communication skills are extremely restricted.

Taking steps to avoid MCI

No specific treatment exists.
It might help to address risk factors for poor circulation by: control blood pressure, eat low-carb and high-fiber diet, quit smoking, limited alcohol, and getting regular exercise.
Evidence suggests that keeping the brain mentally active can help: word and number puzzles, reading, maintaining stimulating hobbies, social activities.
Consider reading Staying Sharp for Dummies which discusses this evidence in detail.

Identifying Early Warning Signs

Top ten most important early symptoms to look out for. It's more than just being forgetful; to be diagnosed, someone must show at least 2 if not more of these 10, which can be subtle to start with.

  1. Memory problems that affect daily life (important dates and events, route taken on well-traveled journeys, where you've left important paperwork, names and faces of friends, neighbors, and work colleagues)
  2. Difficulty with planning and problem solving (become confused using debit/credit card, lose track of what their bank or credit card statement shows, have difficulty paying bills or paying taxes, become confused while trying to put gas in the car)
  3. Problems finding the right word (finding right word becomes elusive, substituting something similar eg football becomes kick ball, wristwatch becomes hand clock; difficulty following thread of conversations)
  4. Confusion about time and place
  5. Poor judgement (spending money on things not needed, using inappropriate dress like wear coat to beach or shopping in rain wearing just t-shirt and sandals)
  6. Visuospatial difficulties (clumsiness, loss of ability to judge widths and distances resulting in falls and breaks, auto accidents)
  7. Misplacing things (losing ability to retrace steps to find things)
  8. Changes in mood (rapid switching between extremes of sadness, fear, anger)
  9. Loss of initiative
  10. Personality change (eg reserved person becomes flirty and uninhibited; extrovert may become withdrawn and reclusive. Common changes include becoming: confused, suspicious, withdrawn, angry, sexually uninhibited)

Mayo Clinic - Symptoms List

This information extracted from Mayo Clinic website on 1/29/2023; consult their site for the most recent information.

Memory

People with Alzheimer's may:

  • Repeat statements and questions over and over
  • Forget conversations, appointments or events, and not remember them later
  • Routinely misplace possessions, often putting them in illogical locations
  • Get lost in familiar places
  • Eventually forget the names of family members and everyday objects
  • Have trouble finding the right words to identify objects, express thoughts or take part in conversations

Thinking and Reasoning

Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts such as numbers.

Multitasking is especially difficult, and it may be challenging to manage finances, balance checkbooks and pay bills on time. Eventually, a person with Alzheimer's may be unable to recognize and deal with numbers.

Making judgments and decisions

Alzheimer's causes a decline in the ability to make reasonable decisions and judgments in everyday situations. For example, a person may make poor or uncharacteristic choices in social interactions or wear clothes that are inappropriate for the weather. It may be more difficult to respond effectively to everyday problems, such as food burning on the stove or unexpected driving situations.

Planning and performing familiar tasks

Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's often forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior

Brain changes that occur in Alzheimer's disease can affect moods and behaviors. Problems may include the following:

  • Depression
  • Apathy
  • Social withdrawal
  • Mood swings
  • Distrust in others
  • Irritability and aggressiveness
  • Changes in sleeping habits
  • Wandering
  • Loss of inhibitions
  • Delusions, such as believing something has been stolen

Bibliography

Books referenced herein and other useful materials. Available on Amazon, but also in libraries and other bookstores.

alzheimer_s_dementia.txt · Last modified: 2023.01.29 16:38 by Steve Isenberg