Becoming forgetful in old age is often the subject of many jokes, but dementia is no laughing matter. It is really a slow form of brain death that can shorten the length and quality of your life greatly. The good news is that the majority of dementia is totally avoidable. Let’s find out how.
What is Dementia?
Dementia is characterized by a group of symptoms that are caused by gradual death of brain cells. Dementia results in cognitive dysfunction that makes it difficult or impossible for its victims to function effectively at their daily activities of living. By definition, it must last for longer than six months, not have been present from birth, and not be associated with loss of or changes in consciousness.
Dementia is a progressive disease that is caused by the gradual, steadily increasing death of brain cells. Most types of dementia start slowly, and worsen over a period of years. While most people who suffer from dementia are elderly, it is a different issue than the mild deterioration of memory and cognitive functions that often accompanies old age. Dementia is caused by specific diseases that affect memory, reasoning, planning skills, and personality. The symptoms vary dependent on the type of dementia and the particular areas of the brain affected. Alzheimer’s disease (AD) is the most common variety of dementia, followed by vascular dementia.
It is difficult to put exact numbers on the incidence of dementia, but it is estimated that up to 20% of folks between the ages of 75 and 84 suffer from some form of dementia, and those figures increase to 30-47% for those 85 and over. It is known that 2-4 million Americans currently have AD, and these numbers are expected to increase to as many as 14 million as we enter the mid-twenty first century, a time when the aged population in the U.S. will rise dramatically. Most folks who experience dementia are retired from the work force, so the direct effect on the economy is minimized. However, the cost of care for those with dementia is quite considerable due to financial burdens for care givers, including adult daycare and necessary home alterations, as well as medical care and institutionalization in nursing homes and special dementia care units.
What Are the Symptoms of Dementia?
Specific signs of dementia will vary from individual to individual, based mostly on the part of the brain that is affected. Most dementia is the result of brain cell death within the cerebral cortex, an area of the brain responsible for emotions, thoughts, memories, and personality. We must be careful to differentiate between dementia and delirium, which is a condition that can appear similar to dementia. The difference is that delirium typically exhibits a quick onset, and may be intermittent. It is caused by trauma or the side effects from certain drugs or medications, and is associated with changes in the level of consciousness. However, to complicate diagnosis, dementia and delirium will often exist simultaneously. Depression, a common malady among the aged, is also often confused with dementia. All this being said, there are some general symptoms that are quite common amongst dementia patients. These include:
- Memory loss: Short-term memory loss is often the first indicator of dementia. This may begin with misplacing personal items, and progress to forgetting how to find your way home while out on a drive, and can even get to the point where patients are no longer able to recognize or identify family members.
- Diminished problem-solving skills: Dementia victims often find it increasingly difficult to draw logical conclusions from gathered facts, or to organize their thinking and plan a project or do anything that involves multitasking. This can be especially troublesome for patients at work.
- Poor relational skills: As the illness causing the dementia progresses, victims may begin to behave inappropriately, and act overly aggressive, suspicious, friendly, or flamboyant.
- Poor personal hygiene: Normally tidy people may begin to neglect cleanliness and personal grooming.
- Speech and communication difficulties: Dementia patients will sometimes lose the ability to effectively communicate with others. This can take the form of inability to express their own thoughts, or to understand those of others. Some folks will speak in sentences that are improper and seem like nonsense, while others may speak grammatically very well, but their speech will not fit in with the current line of discussion.
- Disorientation: Dementia eventually affects a person’s ability to correctly determine the time of day, season, or their location, even if it is one they are very familiar with. They begin to lose perspective and suffer from confusion as to the realities of every day life.
- Restlessness and wandering: This can become a real problem for both the patient and caregivers. Dementia patients often have a very short attention span, and may start a project, such as cooking something on the stove, and shortly walk away and forget about it. Wandering away from the safety of their home is also a big issue. Many dementia units must have secured areas both inside and outside to prevent patients from meandering off.
- Personality changes: In the advanced stages of dementia, folks will often exhibit changes in moods such as depression, anxiety, paranoia, and even hallucinations in some cases. Psychosis can also occur. Some dementia patients begin to have difficulty distinguishing between their dreams and the real world, and may begin to act out on certain aspects of their dreams as if they were reality.
- Insomnia: This and other sleep disturbances are very commonly associated with dementia. Some will wander at night, when their disorientation is often greater than during the day.
What Are the Most Common Types of Dementia?
Alzheimer’s Disease (AD)
Alzheimer’s Disease is the most common condition that causes dementia, and accounts for an estimated 50-75% of all cases. In a nutshell, AD occurs because of the abnormal growth of two different structures within the brain: neurofibrillary tangles and senile plaques.
- Neurofibrillary tangles are masses of protein fibers that form inside brain cells or neurons. These growths are thought to interfere with normal function of the neurons, thereby causing brain dysfunction.
- Senile plaques involve the formation of “clumps” of certain parts of the neurons that enclose proteins known as beta-amyloid deposits. These too cause the brain to malfunction.
The greatest risk factor for AD and dementia in general is advanced age, but it is important to realize that AD and/or dementia are not an inevitable result of aging, but distinct diseases with specific causes. More study has been done on AD than any other form of dementia, and certain causes have been pinpointed:
- Family history: Risk is increased for AD/dementia if it runs in your family. One genetic factor in particular has been identified. We all produce a protein called polipoprotein E (ApoE), which is needed to properly carry cholesterol in the blood, but research indicates that about 15% of people inherit a gene that produces a form of ApoE that increases a person’s risk for AD/dementia. The precise reason why this form of ApoE leads to a greater likelihood of dementia is not well understood as of yet.
- Heavy metals: The ingestion of certain heavy metals such as aluminum and, to a lesser degree copper, have been linked to a greater incidence of AD. It is best to avoid excessive exposure to food cooked in aluminum cookware, beverages in aluminum cans, as well as certain over the counter products such as antiperspirants and antacids that contain aluminum. Some public water systems are also treated with a form of fluoride that can combine with aluminum and form aluminum fluoride, a substance that has been identified as a risk factor for AD in some studies.
- Obesity: Being overweight has innumerable negative consequences on our bodies, and increasing risk for dementia is one of them. One study of 1500 subjects indicated those that were significantly overweight in middle age had twice the risk for dementia as senior citizens. When combined with hypertension and high cholesterol, the risk increased to about six times the chance of otherwise healthy people. The connection between obesity and dementia is a strong one.
This type of dementia is the second most common, accounting for approximately 5-30% of all dementia cases. It is called vascular because the causes of this form of dementia are related to decreased blood flow to the vessels that feed the brain. Vascular dementia is most often the result of either a total or partial blockage of an artery in the brain. A complete blockage is called an infarction, commonly known as a stroke. Not all strokes lead to dementia, but approximately one-third of stroke victims will experience some degree of dementia within six months.
In the case of a partial blockage or narrowing of a blood vessel in the brain, the portion of the brain affected may experience neuron death due to a lack of nutrients and oxygen, leading to dementia symptoms.
A medical history of any type of vascular disease such as stroke, hypertension, or diabetes (high glucose levels can damage the circulatory system) increases a person’s risk for vascular dementia. Vascular dementia often occurs in conjunction with AD, and has many signs that are similar to AD. It usually, but not always, comes on much faster than AD. Vascular dementia can also be associated with conditions such as lupus, Lyme disease, Parkinson’s disease, head trauma, and prolonged drug and alcohol abuse, among others.
How Can Dementia be Prevented?
The body cannot replace brain cells. Once they die, there’s no coming back. So, in that sense, there is cure for dementia. However, the good news is that most cases of dementia, other than those caused by hereditary diseases beyond our control, can be prevented. Here’s how:
- Maintain a healthy weight: As discussed above, obesity is a huge factor in dementia. It greatly affects your overall health, and can contribute to many vascular diseases that increase risk for dementia. The best way to do this is eat well and get enough physical activity.
- Watch your blood pressure: Hypertension (high blood pressure) weakens your entire circulatory system, and this automatically puts you at greater risk for dementia.
- Avoid diabetes: Diabetes is a major public health problem in the United States and other Western countries mainly because of poor diet and unhealthy lifestyle choices. It also is one of the major contributors to increased risk for dementia.
- Avoid aluminum: It has been proven in studies time and time again that excess exposure to aluminum has a clear link to increased dementia. Think about what you are putting in or on your body.
As with so many other epidemic diseases in modern times, most cases of dementia are a direct by-product of the dietary and lifestyle choices we make throughout our lives. You do not have to be sick and worn out when you reach middle age and beyond. It is not inevitable. Just as sickness is a choice, so is wellness, in the vast majority of cases.