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Many
older people worry about
becoming more forgetful.
They think forgetfulness is
the first sign of
Alzheimer’s disease. In
the past, memory loss and
confusion were considered a
normal part of aging.
However, scientists now know
that most people remain both
alert and able as they age,
although it may take them
longer to remember things.
A
lot of people experience
memory lapses. Some memory
problems are serious, and
others are not. People who
have serious changes in
their memory, personality,
and behavior may suffer from
a form of brain disease
called dementia. Dementia
seriously affects a
person’s ability to carry
out daily activities.
Alzheimer’s disease is one
of many types of dementia.
The
term dementia describes a
group of symptoms that are
caused by changes in brain
function. Dementia symptoms
may include asking the same
questions repeatedly;
becoming lost in familiar
places; being unable to
follow directions; getting
disoriented about time,
people, and places; and
neglecting personal safety,
hygiene, and nutrition.
People with dementia lose
their abilities at different
rates. Dementia is caused by
many conditions. Some
conditions that cause
dementia can be reversed,
and others cannot. Further,
many different medical
conditions may cause
symptoms that seem like
Alzheimer’s disease, but
are not. Some of these
medical conditions may be
treatable. Reversible
conditions can be caused by
a high fever, dehydration,
vitamin deficiency and poor
nutrition, bad reactions to
medicines, problems with the
thyroid gland, or a minor
head injury. Medical
conditions like these can be
serious and should be
treated by a doctor as soon
as possible.
Sometimes
older people have emotional
problems that can be
mistaken for dementia.
Feeling sad, lonely,
worried, or bored may be
more common for older people
facing retirement or coping
with the death of a spouse,
relative, or friend.
Adapting to these changes
leaves some people feeling
confused or forgetful.
Emotional problems can be
eased by supportive friends
and family, or by
professional help from a
doctor or counselor.
The
two most common forms of
dementia in older people are
Alzheimer’s disease and
multi infarct dementia
(sometimes called vascular
dementia). These types of
dementia are irreversible,
which means they cannot be
cured. In Alzheimer’s
disease, nerve cell changes
in certain parts of the
brain result in the death of
a large number of cells.
Symptoms of Alzheimer’s
disease begin slowly and
become steadily worse. As
the disease progresses,
symptoms range from mild
forgetfulness to serious
impairments in thinking,
judgment, and the ability to
perform daily activities.
Eventually, patients may
need total care.
In
multi infarct dementia, a
series of strokes or changes
in the brain’s blood
supply may result in the
death of brain tissue. The
location in the brain where
the strokes occur and the
severity of the strokes
determine the seriousness of
the problem and the symptoms
that arise. Symptoms usually
begin abruptly and progress
in a step-wise fashion with
repeated strokes. At this
time, there is no way to
reverse damage that has
already been caused by a
stroke. However, treatment
to prevent further strokes
is very important.
Diagnosis
People
who are worried about memory
problems should see their
doctor. If the doctor
believes that the problem is
serious, then a thorough
physical, neurological, and
psychiatric evaluation may
be recommended. A complete
medical examination for
memory loss may include
gathering information about
the person’s medical
history, including use of
prescription and over the
counter medicines, diet,
past medical problems, and
general health. Because a
correct diagnosis depends on
recalling these details
accurately, the doctor also
may ask a family member for
information about the
person.
Tests
of blood and urine may be
done to help the doctor find
any problems. There are also
tests of mental abilities
(tests of memory, problem
solving, counting, and
language). A brain CT scan
may assist the doctor in
ruling out a curable
disorder. A scan also may
show signs of normal age
related changes in the
brain. It may be necessary
to have another scan at a
later date to see if there
have been further changes in
the brain.
Alzheimer’s
disease and multi infarct
dementia can exist together,
making it hard for the
doctor to diagnose either
one specifically. Scientists
once thought that multi
infarct dementia and other
types of vascular dementia
caused most cases of
irreversible mental
impairment. They now believe
that most older people with
irreversible dementia have
Alzheimer’s disease.
Treatment
Even
if the doctor diagnoses an
irreversible form of
dementia, much still can be
done to treat the patient
and help the family cope. A
person with dementia should
be under a doctor’s care,
and may see a neurologist,
psychiatrist, family doctor,
internist, or geriatrician.
The doctor can treat the
patient’s physical and
behavioral problems and
answer the many questions
that the person or family
may have.
For
some people in the early and
middle stages of
Alzheimer’s disease, the
drugs tacrine (Cognex),
donepezil (Aricept),
rivastigmine (Exelon), and
galantamine (Razadyne,
formerly known as Reminyl)
are prescribed to possibly
delay the worsening of some
of the disease’s symptoms.
Another drug, memantine (Namenda),
has been approved for
treatment of moderate to
severe AD. Doctors believe
it is very important for
people with multi infarct
dementia to try to prevent
further strokes by
controlling high blood
pressure, monitoring and
treating high blood
cholesterol and diabetes,
and not smoking.
Many
people with dementia need no
medication for behavioral
problems. But for some
people, doctors may
prescribe medications to
reduce agitation, anxiety,
depression, or sleeping
problems. These troublesome
behaviors are common in
people with dementia.
Careful use of doctor
prescribed drugs may make
some people with dementia
more comfortable and make
caring for them easier.
A
healthy diet is important.
Although no special diets or
nutritional supplements have
been found to prevent or
reverse Alzheimer’s
disease or multi infarct
dementia, a balanced diet
helps maintain overall good
health. In cases of multi
infarct dementia, improving
the diet may play a role in
preventing more strokes.
Family
members and friends can
assist people with dementia
in continuing their daily
routines, physical
activities, and social
contacts. People with
dementia should be kept
up-to-date about the details
of their lives, such as the
time of day, where they
live, and what is happening
at home or in the world.
Memory aids may help in the
day to day living of
patients in the earlier
stages of dementia. Some
families find that a big
calendar, a list of daily
plans, notes about simple
safety measures, and written
directions describing how to
use common household items
are very useful aids.
Advice
for Today
Scientists
are working to develop new
drugs that someday may slow,
reverse, or prevent the
damage caused by
Alzheimer’s disease and
multi infarct dementia. In
the meantime, people who
have no dementia symptoms
can try to keep their memory
sharp.
Some
suggestions include
developing interests or
hobbies and staying involved
in activities that stimulate
both the mind and body.
Giving careful attention to
physical fitness and
exercise also may go a long
way toward keeping a healthy
state of mind. Limiting the
use of alcoholic beverages
is important, because heavy
drinking over time can cause
permanent brain damage.
Many
people find it useful to
plan tasks; make “things
to do” lists; and use
notes, calendars, and other
memory aids. They also may
remember things better by
mentally connecting them to
other meaningful things,
such as a familiar name,
song, or lines from a poem.
Stress,
anxiety, or depression can
make a person more
forgetful. Forgetfulness
caused by these emotions
usually is temporary and
goes away when the feelings
fade. However, if these
feelings last for a long
period of time, getting help
from a professional is
important. Treatment may
include counseling or
medication, or a combination
of both.
Some
physical and mental changes
occur with age in healthy
people. However, much pain
and suffering can be avoided
if older people, their
families, and their doctors
recognize dementia as a
disease, not part of normal
aging.
For
More Information
The
Alzheimer’s Disease
Education and Referral (ADEAR)
Center is a service of the
National Institute on Aging,
part of the Federal
Government’s National
Institutes of Health. The
Center provides information
to health professionals,
patients and their families,
and the public. Contact:
ADEAR Center
P.O. Box 8250
Silver Spring, MD 20907 8250
1-800-438-4380
www.alzheimers.org
The
Alzheimer’s Association is
a nonprofit organization
supporting AD research and
offering information and
support services to people
with AD and their families.
Contact:
Alzheimer’s
Association
225 N. Michigan Avenue,
Suite 1700
Chicago, IL 60601-7633
1-800-272-3900
www.alz.org
Information
about community resources is
available from State and
Area Agencies on Aging.
Contact:
Eldercare Locator
1-800-677-1116
www.eldercare.gov
For
more information on health
and aging, contact:
National Institute
on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY
toll-free)
www.nia.nih.gov
To
order publications (in
English or Spanish) online,
visit: www.niapublications.org.
Visit
NIHSeniorHealth.gov (www.NIHseniorhealth.gov),
a senior-friendly website
from the National Institute
on Aging and the National
Library of Medicine. This
simple-to-use website
features popular health
topics for older adults. It
has large type and a
‘talking’ function that
reads the text out loud.
National
Institute on Aging
U.S. Department of Health
and Human Services
Public Health Service
National Institutes of
Health
August 2005 |
