Aging and Wellness

Dr. Asfaw's Medical Newsletter on aging and wellness
Dementia: Another Fact of Life

Most people associate forgetfulness with aging. Although the faculty of memory generally declines with age, dementia is a more insidious form which affects one's quality of life. Dementia is the name for a group of symptoms which affect the functions of the brain: memory, reasoning and judgment. They are most common in the elderly.

Symptoms

So what signs should one look for to differentiate between minor memory loss and the onset of the more insidious dementia? A higher frequency and severity of the following symptoms should cause alarm:

  • Difficulties recalling recent events, finding the right words to label thought patterns or name objects, or recognizing previously familiar people and places.
  • Difficulties in planning and carrying out routine tasks like following recipes, writing letters or giving instructions to others.
  • Noticeable shift in behavior and personality, perhaps a sense of hopelessness, depression, irritability, or even the inability to groom oneself.

Despite worries about interruptions dementia may cause to one's own or a family member's livelihood, knowledge about it can brings some relief. It helps to know a little about the different dementias, how they emerge, are treated, and may be prevented.

Dementia is not a disease itself. It is a group of symptoms that may accompany diseases or conditions.

Kinds of dementia

Dementia can be classified under two broad categories the cortical dementias and the sub cortical dementias based on which part of the brain is affected.

Cortical dementias arise from a disorder affecting the cerebral cortex, the outer layers of the brain that play a critical role in cognitive processes such as memory and language. These dementias include Alzheimer's disease, which is really one of two other degenerative diseases: Lewy body disease and Pick's disease, and Creutzfeldt-Jakob disease, which is a quickly progressing and fatal disease that is characterized by dementia and myoclonus muscle twitching and spasm. Patients with these afflictions usually show severe memory impairment and aphasia, the inability to recall words and understand common language.

Sub cortical dementias result from dysfunction in the parts of the brain that are beneath the cortex. Usually, the memory loss and language difficulties are late events in these dementias. Rather, People with sub cortical dementias, such as Huntington's disease and AIDS dementia complex. Tend to show changes in their personality and attention span, and their thinking slows down.

Then, there are cases, such as with multi-infarct dementia, where both parts of the brain tend to be affected. Sometimes Alzheimer's type dementia and vascular dementia may coexist.

The most common cause of dementia is Alzheimer's disease which constitutes 50 percent to 70 percent of all dementia.

Causes of Dementia

There are many causes of dementia.  The cause of Alzheimer's type dementia, which is a non-reversible dementia, is not known.

Other types of dementias are caused by vascular (blood flow related) disorders such as multi-infarct disease; infections such as HIV dementia complex and Creutzfeldt-Jakob disease; inherited disorders such as Huntington's disease; vitamins deficiency; and chronic drug use.

Diagnosing Dementia

During an evaluation of the patient for possible dementia, various examinations are conducted including a mental status test gathered a standardized questionnaire which evaluates orientation, attention, calculation, memory, language and visio-spatial ability – one example in this arsenal of test is a clock drawing test. The doctor also takes a detailed medical history of the patient and requests a variety of blood and urine tests. The doctor may also request a psychiatric assessment. A neuroimaging study may also be conducted through the use of CT scan or MRI of the brain.

Treatment of Dementia

Dementia is irreversible when caused by disease or injury, but may be reversible when caused by drugs, alcohol, or hormonal deficiencies. There has nonetheless been major pharmaco-therapeutic progress in treating dementia. Most commonly used drugs include donepezil (Aricept), Galantamine (reminyl), Rivastigmine (Exelon), and Memantine (Namenda), Aricept, the oldest and most prescribed medication, acts by inhibiting the enzyme that destroys excessive acetyl choline – a neurotransmitter – in the brain and which maintains its appropriate level. The doctor usually uses judgment to select the proper drug and follows the patient's progress through regular follow-ups to assess and evaluate its benefits.

Prevention of Dementia

There is no known way to prevent Alzheimer's disease although several of the drugs used to treat dementia may reduce its risk or slow its progression.

The risk of developing vascular related dementia, also known as multi-infaret dementia, may be reduced by reducing the risk of stroke. The risk of stroke can be reduced by monitoring high blood pressure, abstaining from smoking, reducing risk to heart disease, being aware of one's family's history of stroke and managing diabetes.

Studies have also shown that frequency of participation in leisure activities – reading, playing board games, dancing, playing musical instruments – were associated with a reduced risk of dementia. Among patients already affected, those treated with Vitamin E showed slight delay in the progression of dementia.

Ask Dr. Asfaw

Following are answers to questions I commonly get from my patients. I will use this column to give patients ideas about certain conditions they may be experiencing or are concerned about so they are more informed about their well-being. However, as this column gives only brief answers, in no way should the information be construed as medical advice to be taken in lieu of an actual physician's guidance and care.

Why do I feel dizzy all the time?

Dizziness is a common complaint among those over 65. In order to find out why you get dizzy, you need a full medical evaluation by your doctor. Dizziness is not the illness itself but a symptom, and is treatable when the underlying problem has been identified. Dizziness is associated with central nervous system disorders, vestibular diseases (affecting center of the inner ear which facilitates balance), inner ear disorders, changing blood pressure, psychological causes, cervical illnesses, and cardiac, metabolic and respiratory diseases. Also some medications may cause dizziness in some patients.

What level should my cholesterol be? Shall I be concerned about it?

It is important to know one's cholesterol level, because high cholesterol is associated with coronary artery disease, cardiac arrest (heart attack), and strokes. Therefore if you have high cholesterol, greater than 240 mg/dl, you should consult with your physician. Initial management of high cholesterol involves dietary control, and frequent follow-ups. If your cholesterol does not decrease after three months of dietary control, then cholesterol lowering medication is prescribed. To obtain the appropriate medication, you will need to consult your physician.

I get heartburn every evening. What is the reason? What should I do to control it?

If you get a heart burn, the most likely cause is acid reflux disease. It can be confused with heart problem since the pain is experienced in the chest area. If you have acid reflux disease, you should avoid eating prior to going to bed. If this does not help, acid lowering medication may be prescribed by your physician and some others may be obtained over the counter. If you are overweight, losing weight can alleviate your heartburn problem.

I have fallen down three times and am always afraid of falling. What could be happening to me?

It is important to identify the reason for the fall. A fall can be associated with poor vision, muscle weakness, low blood pressure, or more serious issues such as cardiac arrhythmia and other cardiac problems. There may also be external environmental factors. Once the reason for your falls is identified, the appropriate treatment can be carried out. When the problem is due to muscle weakness, physical therapy is very beneficial.