Jon C. Thompson, Psy.D., HSPP, Clinical Services Manager of the Department of Neuropsychology at St. Vincent Neuroscience Institute
It is an unfortunate fact, but one that can not be ignored: most of us know someone whose life has been afflicted by dementia. It could be a grandparent, aunt, uncle, or a spouse. Dementia is devastating because it is so personal; it robs a person of the very essence of what makes them unique.
When the symptoms of dementia strike someone we love, it can make us feel powerless. Understanding this condition and the diseases that cause it can at least arm us with information to help us deal with the condition.
According to a Mayo Clinic blog written by Angela Lunde (click here), “The term dementia refers to a set of symptoms, not the disease itself. These symptoms might include language difficulty, loss of recent memory or poor judgment.” It follows then that the symptoms of dementia are actually caused by other diseases. Jon C. Thompson, Psy.D., HSPP, Clinical Services Manager of the Department of Neuropsychology at St. Vincent Neuroscience Institute, highlighted several of the more common causes of dementia, although many others exist.
- Alzheimer disease
- Vascular dementia
- Frontotemporal dementia
- Dementia secondary to Parkinson’s disease
- Dementia secondary to Huntington’s disease
- Dementia secondary to head trauma
Of those, the two most common causes of dementia are Alzheimer disease and vascular dementia; the general public is often the most familiar with Alzheimer’s disease because it accounts for over 50% of the cases of dementia. The symptoms, the treatment and the prognosis vary depending upon the underlying cause of dementia. Unfortunately, some estimates indicate that fewer than 50% of people with dementia will be officially diagnosed with a disease. Even after diagnosis, many people with dementia struggle to take their prescribed medications appropriately.
Regarding Alzheimer’s disease, doctors diagnose this condition based on symptoms, because a positive diagnosis can not be verified until the brain is examined after death. Dr. Thompson says that a brain of a patient with Alzheimer’s type dementia will exhibit characteristic physiological markers of the disease including the development of plaques and neurofibrillary tangles in the brain. These plaques and tangles cause pathological changes that prevent the neurons from communicating in the brain. In fact, the number and distribution of neurofibrillary tangles in the brain is directly related to the severity of the dementia.
Over the years, researchers have tried to pinpoint the causes of Alzheimer’s; for awhile studies seemed to point to links between aluminum and mercury toxicity and Alzheimer’s, but Dr. Thompson says that a strong link for that does not exist today. Rather, right now the best that research can do is to establish risk factors for Alzheimer’s.
According to epidemiological research, advanced age is the most consistently identified risk factor for developing Alzheimer’s type dementia. In fact, the risk for developing Alzheimer’s type dementia doubles every 5 years after the age of 65. In addition to age, several other risk factors have been identified. These risk factors include a family history of Alzheimer’s type dementia, low educational achievement, a history of head injury, and female gender.
Vascular dementias differ from Alzheimer’s type dementia in several ways. First, the risk factors of Vascular dementia are easily identifiable, and in some cases, controllable. Strokes, TIAs, hypertension, smoking, high cholesterol and diabetes can all contribute to vascular dementia due to the fact that these conditions can create lesions, or area of damage in the brain, that prevent the appropriate circulation of oxygen and glucose rich blood in the brain. As a result, neurons will not receive the nutrients and stimulation they require to survive. When this happens in the central nervous system, the damage is permanent because neurons in the central nervous system do not regenerate.
However, Dr. Thompson points out that this type of dementia may be more easily managed. “The hope or the expectation in vascular dementia is that if you manage your risk factors well and you are able to avoid additional cerebrovascular complications, you may be able to maintain your current level of functioning. In other words, your overall cognitive status may stabilize and there is a chance that you will not experience additional and significant cognitive decline in the future.
Overall Brain Health Important
An important question that many people wonder about is what, if any, prevention strategies we can implement in our lives to protect against dementia. While nothing is proven to prevent dementia, Dr. Thompson emphasizes the importance of overall brain health. “As we age,” he says, “the neurons in the brain require two different things to stay healthy and active, stimulation and the presence of neurotrophins. The more often neurons are stimulated, the more they release neurotransmitters and general neurotrophins, which are neurochemicals that help support the health and function of the neurons.”
Dr. Thompson explains that as people age, sometimes the tendency is for neuron stimulation to decrease because people may fall into behavioral patterns—in other words, they repeat the same routines, habits and patterns in their lives that they have cultivated over the years. It is important for people to challenge themselves with new and different mental activity. He points out that working a crossword puzzle can be an effective mental stimulation until it becomes routine for someone. Crossword puzzles tend to repeat the same questions. So, add some new mental challenges, such as learning a musical instrument, or studying a new subject. Becoming a life-long learner may go a long way to helping our brain health.
The second component Dr. Thompson recommends to keep our brains healthy is exercise. “There has been some research suggesting that when people engage in consistent physical activity, they actually perform better than matched controls on various aspects of memory and new learning,” he said.
In addition to maintaining brain health, Dr. Thompson suggests that those who have risk factors for developing Alzheimer’s should maintain a good relationship with their primary care physician and possibly a neurologist, especially if they are exhibiting symptoms of memory loss. While medication can not reverse the symptoms of Alzheimer’s, it can slow the progression of the disease. Therefore, it is important to meet with your primary care physician or neurologist as soon as there are signs of dementia in order to determine which types of medications may be best suited to treat your symptoms in the context of your specific medical history.
Dr. Thompson also mentioned that nutritional deficiencies (such as thiamin deficiency) can cause memory impairment. So a nutritional work-up may be an important early step in getting a correct diagnosis. Deficiencies can be corrected with the proper supplementation.
Finally, for families dealing with dementia, Dr. Thompson recommends becoming involved with local support and educational organizations such as the Alzheimer’s Association. This group can offer support and information for families. You may find their site here.
As in any challenging situation in life, you can help yourself by being informed, getting the proper medical care and surrounding yourself with supportive people.
For further information, check out the Nun Study, at this link. Dr. David Snowdon began the Nun Study in 1986 as a pilot study on aging and disability using data collected from the older School Sisters of Notre Dame living in Mankato, Minn. The goal of the Nun Study is to determine the causes and prevention of Alzheimer’s disease, other brain diseases, and the mental and physical disability associated with old age.
For more information on dementia, including symptoms, see this Mayo Clinic site.