Dementia is a major health problem among older adults that becomes increasingly common with advancing age. By age 85 it is estimated that approximately 50% will have dementia. People with dementia have a decline in memory as well as impairment in one of the following areas: language, perception, calculation, judgment, and problem solving skills. Due to this decline people with dementia will have problems socially, in their jobs, as well as problems with daily living such as cooking, driving, and financial management
Dementia isn’t a disease, it is a symptom caused by many different problems.
The 2 major causes of dementia are:
- Alzheimer’s Dementia – which is responsible for 60% of cases.
- Vascular Dementia – which is responsible for 20% of cases.
- Approximately 10-15 of dementia cases are due to other causes such as Parkinson’s disease or head trauma, and approximately 5% of dementia cases can be due to something reversible such as underactive thyroid.
In the brain of the person with Alzheimer’s Disease there is progressive death of the nerve tissue and replacement with abnormal neurofibrillary plaques and tangles. These plaques occur throughout the brain causing problems in all areas of function. It is unknown what starts this process or why it happens.
- Risk Factors: Age, Family History, APOE-E4 genetic marker
- Diagnosis: History of slow, progressive memory loss. Physical Exam, laboratory tests to check for thyroid condition, Anemia, kidney or liver disease. Neurological exam, CT or MRI of the head, and mental status testing. In Alzheimer’s there is no specific test, which gives you a diagnosis.
- Treatment: Currently there is no cure for Alzheimer’s disease. Medications called the cholinesterase inhibitors (Aricept, Exelon, Reminyl)delay the progression but do not cure the disease. There are clinical trials for a vaccine and neuroprotective medications underway.
- Prevention: Because the actual cause of Alzheimer’s disease in unknown there is no specific means of preventing this disease. There have been some studies, which show that non-steroidal drugs such as aspirin or ibuprofen, as well as anti-oxidants such as Vitamin E may help to prevent this disease.
In the brain of the person with vascular dementia there is a very different process. Vascular dementia refers to dementia that is the result of a brain attack (stroke). The stroke could have been due to a blood clot (embolic) or bleed (hemorrhagic). The dementia that results following the stroke is sudden unlike Alzheimer’s dementia. Often however people sustain multiple small strokes over time so the dementia is progressive and often hard to distinguish from Alzheimer’s dementia.
- Risk Factors: History of heart disease, diabetes, and high blood pressure.
- Diagnosis: History of abrupt loss of memory, Physical and neurological exam with symptoms such as abnormal reflex, weakness of a body part, loss of vision of one part of the eye, problems walking. Laboratory tests are ordered the same as for Alzheimer’s. A head CT or MRI will demonstrate evidence of prior stroke.
- Treatment and Prevention: Treatment is aimed at better blood pressure control to prevent new strokes. Sometimes blood thinners such as aspirin or Coumadin are also used to prevent new strokes. Physical, occupational and cognitive therapy are all important following a stroke to help improve areas damaged by the stroke.
The Alzheimer’s Foundation offers information on the disease as well as multiple resources for diagnosis and treatment. On Long Island the Alzheimer’s Foundation offers quarterly classes held at various locations as well as several day long “Coping and Caring” Conferences. In addition support groups are sponsored by the Alzheimer’s Foundation both for the caregiver and the patient.
Works cited: Geriatrics at your Fingertips. Reuben, et al. 2002.
Mayo Clinic Symposium on Geriatrics Part V. Fleming, et al., 2001.
For additional information, please call (631) 444-4000.