Sunday, January 3, 2016

Apple #723: Dementia

I've been looking up all kinds of thing about dementia and Alzheimer's Disease because it seems more and more apparent that my family is looking down the long barrel of what is most likely Alzheimer's where my mom is concerned.  She hasn't been officially diagnosed as having that (it's unfortunately common for a doctor not to tell a patient when he or she may have Alzheimer's because it's an upsetting diagnosis), so I could be wrong (but I don't think I am), or maybe I'm speaking too soon.  But I don't think it's ever too soon to get information.

And I figured, as long as I'm looking up all this stuff, why not share some of what I'm learning with you.  Since we're all living longer, chances are better than good that most of our parents will experience some form of dementia at some point.  So while I'm one of the first among my friends to be facing this in my parents, I'm sure that many of my friends will soon be entering this territory too.

It's not really a fun place to be.

But information helps, as much as anything can.  It helps to understand what's going on and why, helps to know that the changes that are happening are not the result of some conscious decision but are rather the result of some uncontrollable change in brain biology.  So that's why I keep looking up stuff, and that's why I think it might be helpful for someone else to read what I'm learning.

One of my big questions is, what is dementia, exactly?  People keep throwing this word around and I'm having a hard time getting a fix on what the word actually means.  I get especially confused by how people use the word in relationship with Alzheimer's.

A good visual representation of dementia
(Image from the Royal College of Speech & Language Therapists, London)

Definition of Dementia

  • A lot of sources will say that the difference between dementia and Alzheimer's is that dementia is a generic term that refers to a set of symptoms, and Alzheimer's is a specific disease.  But then when they further describe dementia, they describe it as being characterized by symptoms, so I get confused.  
  • One site calls dementia a syndrome, and based on what I've read elsewhere, I think that's probably the best way to think of it.  So let's go with that, and I'll break it down further from there.
  • Dementia is
    • A generic term that may apply in several circumstances
    • A syndrome, or a combination of symptoms that together indicate dementia
    • A term used to describe a significant loss of cognitive function 
  • In order for the symptoms to add up to dementia, at least two of the following have to be present:
    • Memory loss
    • Difficulty finding the right words
    • Inability to focus or pay attention
    • Problems in logical reasoning
    • Problems with problem-solving, such as planning or organizing or carrying out complex tasks
    • Difficulty with physical coordination and motor functions
    • Disorientation issues, such as getting lost
    • Problems with visual perception
  • The symptoms need to be significant and lasting, as opposed to occasional or passing or temporary.
  • The symptoms do not resolve with changes in medication, or the cessation of an illness or an infection.

Another problem with trying to understand dementia is that everybody's list of symptoms is slightly different.  But the major elements are often the same, and they all indicate significant, noticeable cognitive impairment.
(Image from LifeStyle Options, Inc.)

  • Additional symptoms may include psychological changes, such as
    • Inappropriate behavior
    • Agitation
    • Paranoia
    • Hallucinations 
  • A lot of people equate dementia with aging, or they think it's just a normal part of aging.  This is partly because it has become so common.  About 1% of people aged 65 have some form of dementia.  In people age 80, it's around 11%.
  • That may not sound like much, but in 2012, about 41 million people in the US were 65 or older.  Applying those percentages of frequency of dementia within certain age groups, somewhere between 410,000 and 4 million people had dementia in 2012.

Somewhere between 1% and 10% of people over 65 have dementia.  Looks like there are about 30 people in this photo.  Taking this as a representative sample of the general population, 1 to 3 of the people in this photo would have dementia.
(Photo from the Town of Queensbury)

  • So, dementia is common, but that doesn't mean it's normal.  In fact, dementia is a sign that something is wrong. Pain is something else that's common, but just because lots of people have pain for any number of reasons, that doesn't mean nothing's wrong.  In fact, pain is the alarm bell that something is wrong.  Same is true of dementia.

Causes of Dementia

  • A lot of different types of illnesses or conditions can cause dementia.  These illnesses or conditions each have their own suite of cognitive symptoms.  There is a lot of overlap in the symptoms of each of the causes, but the causes are often distinguished from each other in terms of which symptom appears first, or which of the symptoms is most prevalent.
  • Things that can cause dementia:
    • Alzheimer's Disease -- the most common cause of dementia
    • Lewy Body Dementia  -- similar to Alz in terms of the protein bodies in the brain, but with this, short-term memory is OK, but you get hallucinations.
    • Parkinson's Disease --  primarily characterized by muscle rigidity and tremors, plus the dementia
    • Vascular Dementia -- in most cases, this means caused by a stroke.  This kind of dementia looks very similar to Alzheimer's, and some people may have both. Some symptoms that may be different than Alz include laughing or crying inappropriately, loss of bladder or bowel control, or hallucinations. Second-most common cause of dementia.
    • Other medical conditions such as alcoholism, thyroid disease, thiamine deficiency, electrolyte imbalance, or HIV infections
    • Drug interactions or toxicity
    • Brain injuries or illnesses other than stroke, including infections like meningitis or syphilis or fluid build-up in the brain, or brain tumors, or Pick's disease which is due to atrophy of the brain.
Of the possible causes of dementia, Alzheimer's is the most common
(Pie chart from Cargo Collective)

  • Isn't this fun? All the things that can go wrong with your brain?  Egad. 
  • The point is, if you think you are experiencing dementia, or if you think someone you know has dementia, it's important to get thee to the physic to get it diagnosed.  Dementia means there's a problem in the works someplace, and it's important to identify the cause of the problem.
  • In some cases, the cause of the problem is really depressing and not very treatable.  But in other cases, it is treatable and it's important to act sooner rather than later.  And for those conditions which aren't treatable, it's helpful to start making plans sooner rather than later, so nobody's scrambling later on.
  • Also, if you need to start looking for resources to help you help someone who has dementia, the Area Agencies on Aging is a good place to start.  This agency has offices located throughout the country, in accordance with a 1973 federal law that says we have to do more for our aging family members.  They are there to help people of all income levels find resources and support for the challenges we all face as we age.  They have to be there, and they have to help, so take them up on it.

WebMD, Dementia and lots of other related pages
Mayo Clinic, Dementia
Alzheimer', What Is Dementia? and lots of other related pages
Prevention Magazine, 55% of Doctors Keep a Patient's Alzheimer's Diagnosis Secret, April 1, 2015
Alzheimer's Disease International, The Prevalence of dementia worldwide
Ortman, Velkoff, and Hogan, US Census Bureau, An Aging Nation: The Older Population in the United States

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