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Dementia and Alzheimer’s – What It Is, What We Can Do, What We Should Do
Posted By Horizon NJ Health on March 20, 2014
Tags: Dementia, Alzheimer’s
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Pius Chikezie, MD, MPH, FACP, Medical Director, Horizon NJ Health

Q. As my parents age, I worry about their health – their mental health. I see many older people around me who have become forgetful and, as they age, lose more and more ability to function. It really scares me that my mom and dad may, as they get into their 70s and beyond, lose their independence, their ability to take care of themselves. To be honest with you, I also worry about what may happen to me as I get older.
A. I understand your concerns. We all want the best for our parents as they get older. Dementia is a collective term used to describe the problems that people with various underlying brain disorders or damage can have with their memory, attention, language, thinking and problem-solving. Those who show two or more types of symptoms that affect daily function are said to have dementia. Dementia is also a serious public health problem – a recent study estimated that the economic cost of dementia in this country could double by 2040.
These types of disorders, known as cognitive disorders – what used to be known as senility - generally affect people more than 65 years of age. However, there have been many cases of people younger than 65 who have also shown signs of cognitive disorders. Those people are said to have early-onset dementia. There are many forms of dementia, but Alzheimer's disease is the best known and most common disorder under the umbrella of dementia, accounting for between 60 and 80 percent of all dementia cases. Other forms include Parkinson’s disease and vascular dementia.
An analysis of the most recent census estimates that 4.7 million people aged 65 years or older in the US were living with Alzheimer's disease in 2010. The Alzheimer's Association estimates that more than a tenth of people aged 65 years or more have Alzheimer's disease and that this proportion rises to about a third of people aged 85 and older.
Tragically, as the general health of people continues to improve, and as people live longer, more older people with healthy bodies still experience some decline in brain function as they age.
What causes dementia?
Alzheimer’s disease is caused by progressive brain cell death. It is thought to be caused by "plaques" between the dying cells in the brain and "tangles" within the cells. Doctors can detect these plaques by testing the patient’s brain cells for abnormalities in certain proteins in the brain. As in Alzheimer’s, all other forms of dementia are brought on by the death of brain cells. In vascular dementia, which is usually caused by stroke, brain cells die because of a lack of oxygen. Other forms of dementia may be caused by trauma to the brain that is brought on by accidents, sports injuries, or alcohol or drug abuse.
What are the signs of dementia?
According to the American Academy of Family Physicians, the following problems point to a possible diagnosis of dementia:
• Recent memory loss - a sign of this might be asking the same question repeatedly, forgetting about already asking it.
• Difficulty completing familiar tasks - for example, making a drink or cooking a meal, but forgetting and leaving it.
• Problems communicating - difficulty with language by forgetting simple words or using the wrong ones.
• Disorientation - with time and place, getting lost on a previously familiar street close to home, for example, and forgetting how they got there or would get home again.
• Poor judgment - the AAFP says: "Even a well person might get distracted and forget to watch a child for a little while. People with dementia, however, might forget all about the child and just leave the house for the day."
• Problems with abstract thinking - for example, dealing with money.
• Misplacing things - including putting them in the wrong places and forgetting about doing this.
• Mood changes - unlike those we all have, swinging quickly through a set of moods.
• Personality changes - becoming irritable, suspicious or fearful, for example.
• Loss of initiative - showing less interest in starting something or going somewhere.
There are many tests – cognitive and biological – that can be used to determine whether your loved one has dementia.
So how can we treat dementia? The bad news is that brain cell death cannot be reversed. We can only provide care and comfort for those who have the disorder. In the case of Alzheimer’s, there have been drugs that have been developed that can improve a patient’s quality of life.
And some forms of dementia can be treated by reversing the effects of underlying causes, including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.
To address your concern about your mental health as you get older, I can tell you that it is certainly true that people who are entering late middle age, say, those who are approaching 60, can do things to make themselves less likely to experience cognitive problems. I want to emphasize to you that dementia is not necessarily something you should expect to occur as you age.
You can take steps to try and avoid dementia. Don’t smoke. Don’t drink alcohol or use drugs. Stay physically active by exercising as much as possible. Eat a sensible diet and watch your weight to avoid obesity, or, if you are overweight, lose weight. Make sure you see your doctor frequently so you can properly treat or prevent chronic diseases and conditions, such as high blood pressure, high blood cholesterol, diabetes and depression. It is especially important to make sure your heart and cardiovascular system are healthy, as studies have shown that the risk of developing Alzheimer's disease or vascular dementia is higher among people who have diseases and conditions that damage heart health.
You need to keep your mind active as well. Stimulate your mind by participating in adult education. Play games and puzzles – many are available online – to keep your brain busy. Stay connected to your young family members, who help keep your mind young. Continue to be involved in your religion or faith.