One illness that is becoming more common because of our older population is not often talked about. That illness is dementia. The term dementia encompasses a group of illnesses in which an individual's mental abilities deteriorate or are lost. This loss can be gradual as in Alzheimer's disease or sudden as in infarct dementia (the form of dementia that results from strokes). Because there are some forms of dementia that can be treated very effectively, it is important to do a medical investigation, including blood tests and brain scans, to see whether a treatable form of the disease is the cause of the dementia.
The most common kind of dementia is Alzheimer's disease, named after its discoverer. Alzheimer's affects one percent of the population above age 65, two percent over age 70, with the rate doubling each additional five years, but it can strike as early as the mid forties. The disease starts rather slowly and affects recent memory first. In the early stages of Alzheimer's all tests including brain scans are normal. Many people who experience memory problems wonder if they have the beginning of Alzheimer's disease. As a rule of thumb if a person knows he or she is having memory trouble, then they probably do not have Alzheimer's disease. Usually people with Alzheimer's disease aren't aware they are having memory problems. Some people with Alzheimer's have hallucinations. One of the more common forms of hallucination is seeing little people in their homes or back yards. Some people become very agitated and belligerent in the later stages and are unable to care for themselves.
The diagnosis of Alzheimer's disease is made by knowing the history of the person's symptoms and doing medical tests to rule out other causes of dementia. The diagnosis can only be confirmed at death when a biopsy of the brain is done. However, psychological testing can be very helpful in the diagnosis. Psychological testing is very similar to IQ testing and thus one can measure a person's present level of intellectual ability and compare that with what would be expected from the person previous level of functioning in life.
The cause of Alzheimer's is not known, but there appears to be a genetic factor. A person is much more likely to get the illness if they have a parent with the illness. Another clue is that people with trisomy 21, which is a genetic disease, almost always develop Alzheimer's after age 40. Treatment of Alzheimer's disease is just in its infancy. Three medicines now available have been shown to slow the progress of the illness.
Giving one large group of people with the illness the medicine, and comparing it to another group who did not receive the medicine have proved their effectiveness. For this reason it is hard to know if the medicine is having an impact on an individual, since how fast the disease would have progressed without the medicine is not known. If a person is hallucinatory or agitated, there are other medications that can control those symptoms.
The most definitive treatment is placing a person in supervised care where someone is with them to be sure their needs are met and that they stay safe.
The second most common form of dementia is infarct dementia caused by having continual small strokes. Sometimes it is hard to separate infarct dementia from Alzheimer's disease, but the onset of infarct dementia is more abrupt, and the effects of strokes can often be seen on the brain scans. Controlling high blood pressure and giving blood thinners such as aspirin can slow down this illness. The progression of this dementia isn't nearly as regular or predictable as with Alzheimer's, and many times Alzheimer's disease and infarct dementia occur together.
There are many other causes of dementia. Alcoholism is one of the most common and this dementia can be very severe. Low thyroid, vitamin B12 and folic acid deficiency, viral infections, and AIDS are just a few examples of other common causes.
If you have a friend or relative who is showing signs of memory impairment and is beginning to show evidence of deteriorating function, then have them evaluated by a physician as soon as possible. The sooner the disease is diagnosed the more likely it can be slowed or reversed.
Iowa Psychiatric Society
515-633-0341
Email: iowapsych@qwestoffice.net