SUNY Downstate Health Sciences University
BRIDGE: The Brooklyn Initiative to Develop Geriatrics Education
What is Dementia?
Dementia, also called senility, is a group of disorders that affects the brain. The disorder impairs a person's way of thinking, remembering and reasoning skills that interfere with a person's normal day to day activities. Memory loss is a common symptom of dementia. Many diseases can cause dementia such as strokes and Alzheimer's disease, which is the most common of the disorder. Other causes of dementia are Vascular Dementia, Lewy Body Dementia, Frontotemporal Dementia, and dementias associated with Parkinson's Disease and Huntington's Disease.
After Alzheimer's disease, Vascular Dementia is the second most common of dementia. Vascular dementia is caused by decrease or interrupted blood flow to parts of the brain. Risk factors that can be controlled are the same as those for heart and blood vessel disease in other parts of the body. These include high blood pressure, smoking, high blood fats or lipids including cholesterol, elevated homocysteine, and little exercise and being overweight.
The onset of vascular dementia is sudden differing from the gradual symptoms of Alzheimer's disease. Reduced ability to think, remember and process information is usually sudden and often follows restricted blood flow. Most common cause of poor blood flow is a stroke. Often the progression of Vascular Dementia occurs in steps as the brain experiences further blockage over time. This pattern is described as multi-infarct dementia (this term is sometimes substituted for Vascular Dementia).
Lewy Body dementia is caused by progressive destruction of brain cells by protein deposits. Visual hallucinations is a hallmark symptom of the dementia, the person usually also has problems with concentration and other symptoms of dementia. About one third of individuals with Parkinson's disease develop dementia. Lewy bodies are often found in regions of the brain associated with Parkinson's disease. Lewy bodies are also present in some people with AD. Lewy bodies can sometimes be treated with cholinesterase inhibitors.
What used to be called Picks disease, Frontotemporal Dementia involves primarily the frontal and temporal lobes of the brain. FTD is very uncommon and usually begins with substantial personality and behavior changes that precede problems with memory and language. There are no treatments in common use.
What is Mild Cognitive Impairment
Mild Cognitive Impairment: Described as problems with memory like AD but symptoms not as severe. Persons with Mild Cognitive Impairment are able to carry normal activities. Signs of MCI include misplacing items often, forgetting important events or appointments, trouble coming up with desired words. With MCI individuals are more likely to develop AD.
What is Alzheimer's disease
Alzheimer's disease is a form of dementia; it is the most common among older people.
It is an irreversible progressive brain disease that slowly destroys memory and thinking skills. Memory is the first to be targeted by the disease; plaques and tangles forming on the brain is considered the main sign of the disease.
The disease was discovered by Alois Alzheimer in 1906, he noticed a change in brain tissue in a woman patient of his who died of an unusual mental illness.
These plaques and tangles as they form on the brain, they attack healthy nerve cells affecting their communication with each other resulting in their death. As the nerve cells die, brain tissue begins to shrink.
Increase in age and family history is a risk factor for the disease, as person's age to 60 and above they are more at risk of getting the disease. If person has a family history of Alzheimer's then they are more likely to get the disease once they reach a certain age.
The Diagnosis & Treatment of Alzheimer's Disease
Alzheimer's is difficult to diagnose, not one doctor specializes in the diagnosis and treatment of the disease. It's best with a team of professionals including neurologists, neuropsychologists, psychologist, psychiatrists, geriatricians, and others. A total diagnostic workup includes medical history, imaging procedures, and neuropsychological testing, as well as other procedures depending on the individual's presentation When a neuropsychologist or other professional in the field of psychology or psychiatry sees a person exhibiting symptoms of Alzheimer's, a set of criteria is often used to help make an accurate diagnosis. The DSM-IV outlines a detailed set of criteria for the diagnosis of Alzheimer's.
First multiple cognitive deficits must be present, one of which must be memory impairment. In addition, one or more of the following must be displayed:
Aphasia – a deterioration of language abilities, which can manifest in several ways.
Apraxia – difficulty executing motor activities, even though movement, senses, and the ability to understand what is being asked are still intact.
Agnosia – an impaired ability to recognize or identify objects, even though sensory abilities are intact.
Problems with executive functioning such as planning tasks, organizing projects, or carrying out goals in the proper sequence.
In order to meet the criteria for AD, the deficits must affect one's ability to hold a job, fulfill domestic responsibilities and/or maintain social relationships. The deficits must also represent a significant decline from the person's previous level of functioning.
What are the Stages of Alzheimer's Disease?
Stage 1: No impairment: Classified as normal brain activity. Unimpaired individuals have no memory problems.
Stage 2: Very Mild Cognitive Impairment: This is classified as normal aging or early signs of Alzheimer's disease. Many individuals may feel as if they have memory loss or lapses. They may lose their keys or forget familiar names.
Stage 3: Mild Cognitive Decline: Decreased ability in remembering people's names, reading a passage and retaining little detail; decline in ability to plan or organize.
Stage 4: Moderate Cognitive Decline: Reduced memory of personal history, the affected individual may seem subdued or withdrawn, especially in socially and mentally challenging situations.
Stage 5: Moderately Severe Cognitive Decline (Mid stage Alzheimer's disease): In this stage major gaps in memory and deficits in cognitive function emerge. The individual requires help with dressing appropriately for the season, they become confused about their whereabouts, time of the day, day of the week, or season.
Stage 6: Severe Cognitive Decline: Memory difficulties continue to worsen. Significant personality changes emerge, recall their own personal history imperfectly but generally can recall their own name. Occasionally individuals with AD forget the names of their spouses or caregivers but are able to distinguish between a familiar and unfamiliar face, and tendency to wander and get lost among other things.
Stage 7: Very Severe Cognitive Decline: This is the final stage when many of the individuals lose their ability to communicate, respond to their environment, and ultimately their ability to control movement. Frequently individuals lose their capacity for recognizable speech although words or phrases may occasionally be uttered.
Individuals lose their ability to walk, stand, or sit without assistance. Reflexes become abnormal and muscles get rigid. Swallowing is impaired.
6-Item Memory Disorder Screening
Do you or your family member have:
- Problems repeating or asking the same thing over and over?
- Problems remembering appointments, family occasions, holidays?
- Problems with writing checks, paying bills, balancing the checkbook?
- Difficulty shopping independently (e.g., for clothing or groceries)?
- Difficulties taking medications according to instructions?
- Problems getting lost while walking or driving in familiar places?
A positive response to 2 or more items suggests need for a more detailed evaluation.