Vail Daily health feature: Dealing with Alzheimer’s and other forms of dementia
Special to the Daily
For more information on dementia and, specifically, Alzheimer’s, including diagnosis, caregiver support, researcha and education, visit http://www.alz.org/co or call the help line at 800-272-3900.
Editor’s note: This article was originally published in Vail Health magazine.
the brain experiences age-related changes much like the body does, but there are many ways to increase mental acuity and awareness.
Two-thirds of people older than 50 fear getting Alzheimer’s disease, according to a study presented by local neurologist Dr. Marc Treihaft, and with good reason. Statistics show the lifetime risk of developing Alzheimer’s after age 65 is one out of six women and one out of 11 men. Though Alzheimer’s makes up 75 percent of dementia diagnoses, it is just one of many; others include dementia induced by head trauma, alcohol, vascular disease, Parkinson’s, Huntington’s, amyotrophic lateral sclerosis (ALS) and more.
The questions become: What is the difference between dementia and normal changes in memory as the brain ages, and what can people do to help prevent, or mitigate, dementia?
IS IT DEMENTIA?
Dementia acts as an umbrella for a number of neurocognitive disorders. Its hallmarks include the loss of ability to think clearly and the loss of memory, reasoning and decision-making — all of which affect daily functioning.
Dementia begins with minor cognitive problems, often in the form of slight work and social mistakes.
“(People) may go to the basement and forget why they’re there or pay bills twice,” Treihaft said. “These are normal phenomena, to some extent, but if it’s a consistent pattern that one picks up, that changes the game.”
As the brain ages, it’s normal to become mildly forgetful.
“Just because we forget things, it’s not necessarily pathological,” said local psychologist Henry Goetze, Ph.D. “Some things have no real importance; they are incidental things. As we get older, we start to pay attention to things we can’t remember. Don’t worry so much about that because there are normal brain changes that occur as we get older. Not all forgetfulness is Alzheimer’s.”
Alzheimer’s is characterized by pathological changes in the brain, namely amyloid plaques and neurofibrillary tangles.
“These are tangles of proteins that are confusing us,” Treihaft said.
This pathology doesn’t occur to such a damaging degree in the normal aging brain.
“Our brain mass reaches its peak in our 20s and starts to slide off after that,” Goetze said, adding that normal changes are subtle and progress slowly, so they are apparent only occasionally — most often when people are trying to learn or remember something new.
Normal changes include difficulty recalling words, challenges in learning new tasks or learning old tasks in new ways and slower response time. On the other hand, enduring abilities include semantic and procedural knowledge, motor memory, abstract reasoning, judgment, problem solving and long-term memory.
While forgetfulness, or mild cognitive impairment, is common, statistics show 70 percent of patients will progress to dementia, though the percentage is lessening with medical advances in treatment and patients’ proactive, healthy lifestyle changes, Treihaft said.
The time to be concerned is when cognitive impairment results in an impairment of functioning, or “not being able to do what you once were able to,” Goetze said. Those who have a family history of dementia have a higher risk of suffering from it themselves and should be tested.
A number of factors can masquerade as dementia, including sleep deprivation, responses to anesthesia or chemotherapy, depression, severe anxiety, chronic pain, vitamin B-12 deficiency, head injuries, some types of seizures, migraines, medications (from anti-anxiety to sleep aids, narcotics and antihistamines) and emotional trauma.
“When we are under enormous stress, our cognitive sharpness decreases,” Goetze said.
It’s important for people to see a doctor when they experience cognitive impairment because 20 percent of dementias are reversible. Causes include metabolic issues, such as low vitamin B-12, hypothyroid or alcohol consumption; infection, such as syphilis, Lyme’s Disease and HIV; structural problems, such as brain tumor or stroke; inflammation, such as vasculitis; and mental illness. For cognitive issues due to depression, “you treat the depression, and it’s gone,” he said.
Dementia reaches a mild or moderate level when short-term memory problems become consistent. People may forget conversations or movies they just watched, repeat questions, become lost easily and need assistance with personal hygiene.
Patients with late, or severe, stages of dementia usually need full assistance and eventually have difficulty sleeping and eating.
Lifestyle can go a long way in preventing dementia.
“General good health — healthy body weight — and proper diet are important,” Goetze said. “The enemy of memory is vascular disease, so avoid diets high in fat and cholesterol that block arteries and veins and inhibit blood flow and oxygen to the brain.”
Treating hypertension and diabetes sooner, rather than later, can make a difference between dementia and normal aging. Chronic sleep disturbances can also negatively affect memory. Goetze suggests refraining from alcohol, tobacco and marijuana, especially when young.
“Alcohol is a neurotoxin. It kills brain cells,” he said. “The more alcohol we drink, the more brain cells we kill off and the higher chances of memory impairment.
“Young men and woman should refrain from both alcohol and marijuana abuse. Both of these substances negatively affect the developing brain and interfere with memory.”
New research also shows that closed-head injuries and repetitive concussions can cause dementia. Closed-head injuries are a type of traumatic brain injury in which the skull and dura mater remain intact. Auto accidents, sports accidents and falls contribute to most closed-head injuries.
“Sports such as soccer, football and boxing have been implicated in longer-term memory and motor problems,” he said. “Protect your head.”
And, as it turns out, helmets may not protect brains well enough, so it’s up to sports participants to play it safe.
“Helmets don’t do enough because of the head bouncing in and out of the head plate,” Treihaft said.
Interacting socially and practicing cognitive skills keeps the brain active, though the jury’s still out as to whether they actually help prevent dementia. Still, Treihaft said it might protect you a little bit from the decline, and Goetze and local psychologist Geoge McNeill, Psy.D., both support the “use it or lose it” theory.
“Stay mentally active,” Goetze said. “Learn new things. Make new neural connections. Stimulate your mind with new learning. Maintain social contacts. Social interaction helps to keep one’s memory sharp.”
DEALING WITH DEMENTIA
Alzheimer’s is currently incurable, and medications such as Donepezil, Memantine and Rivastigmine have minimal effects, Treihaft said. But, there’s hope. Treihaft said we’re sitting on the cusp of a medication breakthrough; he expects effective medications to emerge within a couple of years.
For now, cognitive therapy and medication, including antidepressants, are the best options. In addition, caregivers must attend to their own mental health.
“Most of my time in the office is spent with the caregiver — that’s who’s suffering,” Treihaft said.
Dementia, and specifically Alzheimer’s, has been called “the long goodbye.”
“It is a very painful and protracted process, which is as painful for loved ones as it is for the patient,” Goetze said.
The Alzheimer’s Association offers support on a local and national level and gives specific recommendations for early-, middle- and late-stage care. These tips can help loved ones understand the disease process, which can reduce frustration.
“Caregivers need to make sure to protect and care for themselves,” Goetze said. “All caregivers need opportunities to ‘recharge’ their batteries with respite care and self-nurturance.”
For both caregivers and people who are simply experiencing the effects of the aging brain, or those with early stages of dementia, McNeill recommends a practice called A New Process Goal.
With it, he teaches people to notice reactions to events, like not being able to recall a word quickly, and simply observe it, rather than hooking in emotionally and becoming upset. His approach is one of acceptance, of “openly embracing one’s experiences, both good and bad, without attempting to change them … (and) acting in service of who you want to be, not in the service of getting your reaction to go away.”
This type of emotional flexibility allows for change to occur without pulling a person into a negative reactionary behavior; instead, a person remains clear about what he or she values and chooses to act upon those things.
Whether an individual’s aging brain subtly changes within the normal realm of cognitive functioning or begins to deteriorate more quickly through dementia, McNeill’s approach can soften the blow, so to speak.
“We don’t have a choice about our aging brain,” he said, “but we do have a choice about what we do with it.”