Dementia

Contrary to popular belief, memory loss is not a “normal” part of aging but it is a frequent one.  Dementia is not synonymous with Alzheimer’s disease.  There are many different causes of dementia and Alzheimer’s disease is just one of them.

The main categories of dementia are:

    •    Neurodegenerative (or a progressive deterioration of the nervous system).  Alzheimer’s is the most common.
    •    Vascular or “hardening of the arteries”.  By having multiple small vessels close off , small areas of the brain tissue are lost.  As the amount of tissue loss increases, there is an associated loss of memory and gait imbalance.
    •    Infectious processes such as Prion disease (for example, Mad Cow Disease) or lyme disease can cause memory loss.
    •    Nutritional deficiencies such as lack of Vitamin B12 or hormonal abnormalities such as low thyroid function can present as memory loss.
    •    Depression may present as memory loss with what is called a “Pseudodementia of Depression”.  

The treatment of memory loss is quite variable and is individualized according to the cause.  Over the last two decades there have been new treatments introduced which while they do not offer a cure for all types of memory loss, are likely to slow down the process.

It is very important that patients who suspect that they are experiencing memory loss be evaluated.  There are signs on the neurologic physical examination and on cognitive tests offered in the office that can help determine who should undergo further evaluation.  Some types of memory loss can be cured and others slowed down.

It is also very important that the family and caregivers of patients with dementia acknowledge the burden they bear.  There is support to be found and helpful tips to be given that can improve the quality of life for everyone in the home.

Alzheimer’s Disease

This disorder is most commonly diagnosed in patients over 65 years of age though early-onset AD can occur much earlier.  Recent memory is affected more than remote memory.  In addition to memory loss, there can be confusion, aggression, loss of language skills and paranoia. In recent years a new diagnostic category has been coined as Mild Cognitive Impairment.  Patients with MCI show evidence for a degree of  memory loss which does not meet the criteria for AD.  50 percent of patients with MCI will go one to develop AD.  A portion of the remaining 50  percent without AD may have a reversible cause for their symptoms.

The cause is thought to be associated with plaques and tangles in the brain.  There is some genetic heritability which can be reflected in a bloodtest called the APO E genotype.  Not everyone who carries the high risk gene will develop the disorder and some with develop the disorder without a genetic predisposition. In fact, the vast majority of cases of Alzheimer’s disease are sporadic. A spinal fluid test is available which may confirm the diagnosis of AD.  SPECT scans and PET scans can also be helpful in making the diagnosis. Cognitive tests not only help to make the diagnosis, but also allow us to track the effectiveness of our treatment and guide us when to try another available medication.  Neurotrax is a computerized cognitive test available in our office.  Some patients may be referred to a Neuropsychologist for more detailed testing.

While risk factors for cardiovascular disease such as hypercholesterolemia, diabetes and smoking are associated with a higher risk of developing AD, treatments for these disorders have not been shown to prevent or reverse the disease.  For example, statin drugs which lower cholesterol levels have not proven useful in the treatment of AD.  There has been some suggestion that light to moderate use of red wine may be associated with a lower risk for developing AD.  Vitamin supplementation has not been helpful either.  On the other hand, long term use of NSAID’s (non-steroidal anti-inflammatory drugs) may be associated with  lower risk of developing AD, presumably through reduced inflammation related to amyloid plaques.  Ginkgo has not been scientifically proven to improve cognitive function.  Coffee drinkers may enjoy a lower risk of AD in later life.

There are a number of medications available to treat the cognitive function of AD patients.  These are either meds that reduce the rate of break down of Acetycholine, a chemical in the brain , or block the overstimulation of glutamate (another chemical in the brain) receptors.  The indications of these meds is to treat cognitive manifestations of AD but none have the indication for halting progression.

Studies have shown that mental stimulation will delay the clinical decline even with ongoing degeneration in the brain.  Accordingly, puzzles, computer games and interactive group activities are recommended along with physical exercise.


Diets for Alzheimer Patients

There is no dietary cure for Alzheimer’s Disease but certain diets may pose higher or lower risk for developing the disorder.  Some studies indicate that people who have a diet high in carbohydrates can have almost four times the risk of developing Mild Cognitive Impairment. Sugars also play a role in the development of MCI and diets with more proteins and fats may offer some protection against developing it.


Resources

Alzheimer’s Association
Alzheimer’s Foundation
Center for Healthy Aging (Greenwich Hospital)
Waveny Care Network (New Canaan)
 

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