Dementia Part II - Alzheimer's

Last week, we talked about dementia in a general sense. Today, we will focus on the most common cause of dementia, which is Alzheimer's disease. About 5.8 million people in the US age 65 and older are living with this progressively worsening dementia.

What causes Alzheimer's disease?

Scientific researchers believe that for most people, Alzheimer's disease is caused by a combination of factors, including genetic, environmental, and lifestyle factors, which affect the brain over time.

Although we don't know all of the possible causes of Alzheimer's disease, we do know that there are some specific genetic mutations which can increase the risk for Alzheimer's disease.

How does Alzheimer's disease cause dementia?

People with Alzheimer's disease have 2 types of abnormal deposits in their brains, plaques and tangles. Plaques are made up of clumps of a protein called beta-amyloid.

Tangles consist of fibers of a protein called tau protein. Tau proteins are important for normal function of nerve cells including helping facilitate transport of nutrients. But for a reason that we don't yet understand, in Alzheimer's disease, the tau proteins change shape and become grouped together into multiple tangled structures.

These deposits of plaques and tangles damage nerve cells and the connections between them, eventually causing nerve cells to die.

What are the symptoms of Alzheimer's disease?

Like the symptoms of dementia in general, which we discussed last week, symptoms of Alzheimer's disease include:

• Memory loss
• Difficulty with thinking and reasoning
• Trouble making decisions or reasonable judgments in everyday situations
• Difficulty with tasks requiring planning, such as cooking or playing a game
• Difficulty performing familiar tasks, eventually even basic tasks such as getting dressed
• Changes in personality or behavior

What skills might be preserved for longer periods?

Some skills can remain intact for much longer because they are controlled by parts of the brain that are affected later in the course of the disease. These can include:

• Reading or listening to books,
• Telling stories or reminiscing about remote events,
• Singing and dancing,
• Drawing or doing arts and crafts activities

How is Alzheimer's disease diagnosed?

There are several things that doctors use to make a diagnosis of Alzheimer's disease.

• History of typical symptoms,
• Physical exam including a detailed neurological exam,
• Tests to assess memory and thinking skills,
• Imaging of the brain – such as MRI, CT scan, PET scans,

How is Alzheimer's disease treated?

There are several drugs that may be used to treat the symptoms of Alzheimer's disease which may slow the declining function for some patients or help to improve behavioral symptoms.

About a year ago, the FDA approved a new drug, which is supposed to target and remove amyloid plaques from the brain. The research shows promise but the approval was given on the condition that further studies be conducted to confirm the benefit of the drug.

What are some important things to know when caring for a person with Alzheimer's disease?

Besides drugs, an important part of caring for a patient with Alzheimer's disease includes making sure they are in a safe and supportive environment. Here are some things you can do:

• Keep medications in a secure location and use a checklist to make sure they are taken.
• Always keep important valuables, such as keys, phone, purse, etc. in the same place.
• Set up automatic payments or automatic deposits for financial transactions.
• Have the person with Alzheimer's always carry a cell phone, with important phone numbers programmed in and with location tracking enabled.
• Make sure they always wear a medical alert bracelet and carry identification with them.
• Consider an alarm system on windows and doors.
• Maintain routines with the same things done at the same time every day and appointments on the same day of the week.
• Use a posted schedule or calendar where they can check off daily tasks as they are done.
• Get rid of clutter and throw rugs to avoid tripping. Install handrails and grab bars where needed.
• Make sure they wear shoes with good traction that fit well and are not too heavy.
• Keep family photographs around the house and consider labeling them with names if needed.
• Reduce the number of mirrors in the house. Images in mirrors may be confusing or even frightening to a person with Alzheimer's.
  

Next week, we will wrap up our series with information about risk factors for dementia and how you might decrease your risk of developing dementia.

If you have any questions about dementia, please log into your account and send
us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Dementia

June is Alzheimer's and Brain Awareness Month. I thought we could start our series on this subject this week by talking about dementia in general. Next week we will talk more about the most common type of dementia, which is Alzheimer's disease.

What is dementia?

Dementia refers to a group of symptoms related to a decline in memory, thinking, and social abilities. The term dementia applies when these symptoms are severe enough to interfere with your daily life. It is not simply memory loss, although that can be one of the early signs of dementia. Dementia does not refer to a specific disease. There are several diseases that can cause dementia.

What are the symptoms of dementia?

Symptoms can be broken down into 2 categories.

Cognitive changes, those related to the mental processes of perception, memory, judgement, and reasoning can include:

• Memory loss – Usually noticed by others
• Difficulty with problem solving
• Difficulty with visual or spatial abilities – Such as getting lost in familiar areas
• Difficulty finding words or other communication problems
• Trouble handling complex tasks or following multi-step directions
• Decreased organizational skills or trouble planning things
• Confusion and/or disorientation
• Trouble with coordination or movement of the body

Psychological changes, those relating to emotions, awareness, feeling, or motivation can include:

• Personality changes
• Depression or anxiety
• Paranoia
• Agitation
• Hallucinations
• Inappropriate behavior

What is the difference between dementia and delirium?

Dementia is a chronic process that usually comes on gradually and is progressive. Delirium is a state much like dementia, with confusion, memory loss, personality changes, etc., which develops over a shorter period of time, often caused by an acute illness or infection, as a side effect of a medication, or even as a result of severe sleep deprivation. Delirium is reversible if the underlying cause is treated appropriately.

What are the different causes of dementia?

Diseases that cause a primary progressive dementia include:

• Alzheimer's disease – The most common cause of progressive dementia. We'll talk more about it next week.
• Vascular dementia – Caused by damage to blood vessels that supply your brain. This may be due to multiple strokes causing damage to the brain or from chronically low blood perfusion to the brain causing the brain to shrink.
• Lewy body dementia – Caused by clumps of protein, called Lewy bodies, that are deposited in the brain. It causes a dementia that has features of both Alzheimer's and Parkinson's disease.
• Frontotemporal dementia – Caused by nerve degeneration in the frontal and temporal parts of the brain. It often causes more personality and behavior changes early on.
• Mixed dementia – Some people have a combination of more than one of these diseases.

Diseases that may cause dementia as a secondary feature of the underlying disease include:

• Huntington's disease
• Traumatic brain injury – Especially multiple small traumatic injuries like concussions.
• Parkinson's disease
• Creutzfeldt-Jakob disease – A rare brain disease caused by infectious proteins deposited in the brain.

As we continue the series, we will discuss Alzheimer's disease in more depth, as well as talking more about the risk factors for dementia and how you might be able to decrease your risk of developing dementia.

If you have any questions about Dementia, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor