Dementia is a chronic disease that causes a decline in one’s memory and ability to function over time.
Dementia is not a normal part of aging—it is not inevitable. It is more than mere forgetfulness. Dementia is a collection of diseases that share four characteristics:
• They are not acute
• They affect memory
• They cause a decline in one’s ability to function
• They cause cells in the brain to die, shrinking the size of the brain over time
There are four types of dementia, each with distinct triggers and symptoms.
• Alzheimer’s: The most prevalent type, Alzheimer’s accounts for 60 percent of newly diagnosed dementias today. Difficulty with short-term memory, procedures, and naming are typical symptoms.
• Vascular: Vascular dementia occurs when blood vessels above the neck that carry oxygen to the brain are blocked, causing brain tissue to die. Difficulty concentrating, finding words, or completing complex tasks are initial red flags
• Lewy-Body: This type of dementia progresses much faster than Alzheimer’s. Early signs mimic Parkinson’s Disease—stiffness in the extremities, difficulty with gait and balance, and problems with cognition.
• Fronto-Temporal: The least common type of dementia, fronto-temporal affects parts of the brain that control behavior, personality, and the ability to complete complex tasks. Early symptoms include abnormal social behavior, aggression, and grandiosity.
People with dementia typically exhibit two early warning signs: difficulty with short-term memory and difficulty with naming. These symptoms are red flags signaling the beginning stages of dementia.
• Memory loss is less about memories disappearing and more about an inability to effectively create new memories for recent events. People with this type of “working” memory loss ask the same question repeatedly.
• Naming difficulty is an inability to retrieve words stored in the recesses of the mind. In normal aging, cues will help one recall a forgotten word quickly, or the person will remember it on his own. For someone with dementia, cuing isn’t effective, and the word doesn’t come to her mind later.
Progressive brain cell death due to Alzheimer’s disease is the most common cause of dementia. Other causes include:
• Brain tumor
• Traumatic head injury
Most dementias are not curable. For the less than five percent of dementias that accompany other well-known diseases such as Huntington’s Disease, Down Syndrome, and Syphilis, a small number are potentially reversible including B12 deficiency, normal pressure hydrocephalus, and severe hypothyroidism.
If you suspect your loved one or you has dementia, a physician can perform a full assessment complete with several memory tests. The General Practitioner Assessment of Cognition (GPCOG) test asks a series of questions in two parts. It tests the patient and someone close to the patient to determine whether exhibited symptoms indicate dementia. Questions for the patient include:
• What is your age?
• What is the time, to the nearest hour?
• What is the year?
• What is your date of birth?
The mini-mental state examination (MMSE) is a cognitive test that is used to diagnose dementia caused by Alzheimer's disease. It measures orientation to time and place, word recall, language abilities, attention and calculation, and visuospatial skills. If either of these tests suggest memory loss, the physician will recommend routine blood tests and a CT brain scan to confirm the diagnosis.
Individuals living with dementia and their families can choose from a variety of care settings and services. When working with a physician to create a treatment plan, first consider the differences between skilled and unskilled care.
• Skilled care is short-term medical care that requires a licensed and trained professional—usually a nurse or therapist—who can monitor and assess the patient, educate the family, and document and communicate observations to the physician. Skilled care can be provided in almost any setting, requires the certification and oversight of a physician, and is typically paid for by Medicare or private health insurance.
• Unskilled care refers to the support family members give for daily living activities such as getting out of bed, ambulating, using the toilet, meal preparation and housework, and grooming. Unskilled care is a long-term need, does not require the oversight of a physician, and typically is paid for out of pocket. The amount of skilled and unskilled care a patient receives depends on the treatment setting.
• Home health describes skilled medical services reserved for homebound patients and focused on a specific medical problem. Home health professionals visit a patient once or twice a week, and a physician oversees the care.
• Home care is unskilled care provided to loved ones for support in daily living activities. Home care must be conducted on an ongoing basis.
• Nursing facilities provide a combination of skilled and unskilled care. Eighty percent of residents live there full-time; the other twenty percent attend part-time to receive skilled care only. Nursing facilities typically accept Medicare and private health insurance.
• Assisted living residences provide room, board, and recreation opportunities. Additional services such as primary and skilled care are not mandated, and the residence charges for extra services it chooses to provide. Many patients pay for partial or full assisted living costs out of pocket.
Certain risk factors that contribute to dementia can be controlled or treated, such as longstanding heavy alcohol use, high cholesterol, heart disease, and depression. Of all the strategies known to prevent or delay dementia, exercise may be the most impactful. There are many risk factors that influence both the odds of developing dementia and the age when dementia appears that consistent exercise can both lower and delay.
• Because nearly one-third of dementias have a vascular component, anything that improves the health of one’s arteries and veins throughout her lifetime will lead to less cell death in the brain, lower memory loss, and a decreased risk for dementia.
• Research suggests vigorous exercise leads to changes in brain chemistry and more and tighter connections between neurons, which may build one’s degree of resistance to dementia.
• Exercise also helps to improve mood, so depression is another risk factor for dementia that exercise can modify.