Posts Tagged ‘Dementias’

A new approach to Dementia

Tuesday, May 28th, 2013

When I think about our future I don't worry much about strokes, heart attacks, broken hips or even cancer. I've done all that I can, or more precisely all that I care to at the moment, to prevent those things from happening. I weigh 148.4 pounds this morning, way done from my high school weight of 172, eat lots of fruits and vegetables, and exercise very vigorously six days a week. My wife works out  as much as I do, although at a lesser pace. Now that we have a new dog, we're getting much more weight-bearing exercise, walking 40 to 80 minutes a day.

The most frightening word in my dictionary

The most frightening word in my dictionary

What I do worry about is dementia, for either of us. We have a long-term-care policy, but when we got it we limited the number of years covered. My choice would be not to live a long demented life. If I have Alzheimer Disease and get pneumonia, don't even think of giving me antibiotics.

A 2007 article in the journal Neuroepidemiology, with the lead author being, B L Plassman, reported on the "Prevalence of Dementia in the United States:  The Aging, Demographics and Memory Study." Eleven years ago there were an estimated 3.4 million people in the U.S. who were 71 and older (I'm 72) felt to have dementia. That was 13.9% of that population group. Most had Alzheimer Disease (9.7% of the 71+ year-olds or 2.4 million).

Age is a significant factor here as 5.0% of people in the 71-79 year-old group had a dementia diagnosis and 37.4% of those over 90.

At my age the Social Security database says I can expect to live 12.44 more years on average and my wife, about to be 73, can expect to live 13.91 more years. And those are the averages; my bet is as active and slender as we are and especially with my family history, one or both of us may well make it past 90.

The Cleveland Clinic online discussion of the problem, titled "Types of Dementia," mentions neurological diseases, vascular disorders (multiple small strokes can lead to one form), infections (e.g., HIV), chronic drug use, depression and accumulation of fluid within the brain (AKA hydrocephalus). Roughly 20% of all cases of dementia may have a treatable cause.

They estimate that 5-8% of those over age 65 have one or another form of dementia and that number doubles every five years above that age range. Some would estimate as many as 50% of those 85 and up have some form of the disorder, way over the percentage in that 2007 article.

Their approach is to group the problem into Alzheimer Dementia (50-70% of all dementia) and non-Alzheimer Dementia. And they are careful to distinguish between treatable and curable forms of dementia. Most forms are treatable; few are curable at present.

We've been through dementia scenarios on both sides of my family. My mother's last four years (from age 86 to 90) were spent in large part with Dad, who was quite competent mentally. He had resuscitated her from a cardiac arrest when she was 74 and she had twelve good years subsequently. But I have a photo of the two of them taken at their 65th wedding anniversary and Mom looks rather vague and unfocused. She wasn't violent or difficult in her last years, but would sit for hours reading...with the book held upside down.

Lynnette's mother, who lived until she was 86, had outbursts of anger over minor things that she was previously have been unfazed by; she would swear at someone in the nursing home over trivial affronts.  Her short-term memory was gone and after Lynnette and her sister got their Mom into the long-term care facility, she'd call my wife and say,"If you don't get me out of here immediately, I'll never speak to you again!"

A half hour later she'd have completely forgotten the episode.

We have and will have growing numbers of our elderly parents, grandparents, friends and our own selves with these issues. How best to take care of them?

Air Force Village II, where our surrogate parents live (they were patients of mine, ran our wedding in 1988 and decided we'd be another set of their adult children), has an Alzheimer and other forms of Dementia Research Unit called Freedom House in cooperation with the University of Texas Health Science Center in San Antonio. It's been in operation for fifteen years and is state of the art.

Comforting surroundings and attentive caretakers can help

Comforting surroundings and attentive caretakers can help

When I last visited that domicile for patient with one or another cause of dementing disease, I was greatly impressed by the caring staff and their innovative approach to its occupants.

A May 20, 2013 article in The New Yorker is titled "The Sense of An Ending." Staff reporter Julia Mead wrote about new ways to care for people with dementia. She notes that most care facilities operate with the "medical model," aiming to postpone dying through progressively escalating interventions.

Other places, including the one she featured, have adopted a more holistic approach, relying less on psychotropic medication, those commonly used by psychiatrists to alter chemical levels in the brain which impact mood and behavior.

A woman named Tena Alonzo, featured in the New Yorker article, has spent twenty-eight years dealing with dementia patients and prefers to refer to them as "people who have trouble thinking." Alonzo is the co-director of PCAD, Palliative Care for Advanced Dementia, at a retirement community in Phoenix. Her work, done in concert with her physician co-director, emphasizes comfort for the afflicted individual; knowing their life story and incorporating it into the care plan, individualizing care to meet the needs of the person (not the staff), anticipating their needs versus waiting for behaviors to occur, and having her staff act as the voice of those with dementia.

Her retirement home has no fixed bedtimes, rising hours or even mealtimes; staff walk around with plates of small sandwiches and cookies and lemonade are offered on a movable snack cart. Dementia patients often lose weight as they become less likely to ask for food or drink.

In a 2010 publication, Alzheimer disease was the seventh leading cause of death in the United States with annual costs estimated at $172 billion and unpaid care being given by 10.9 million of us.

We have a friend who is working on a major project to treat Alzheimer disease, but until his work and that of many others comes to fruition, alternate concepts of how those afflicted can be cared for are desperately needed.

I'm glad to see some are trying innovative approaches.


Thanks for the Memory: part 2: Dementias

Tuesday, June 19th, 2012

It's on the tip of my tongue

In 1990 I needed neurosurgery. The mass which was removed turned out to be benign, but I had a major post-op bleed and was left with a considerable scar on my right frontal cortex. Up to that point I'd had, as I often said, "the fourth best memory in the family."

Afterwards my brain worked well enough. But I had considerable problems moving information from short-term to long-term memory. So when I bought the Harvard Medical School booklet mentioned in my last post, I was intrigued by the research that has been done on the subject and how it applied to me and to others, especially as we age.

Most of us worry about dementia; the Aging, Demographics and Memory Study figures, published in 2007 looking at people 71 or older, estimated there were 3.9 million people with dementia in the US in 2002. Of that group, 2.4 million had Alzheimer's disease. The crucial factor, I thought, was the prevalence, the total number living with a disease, went up with age from 5% of people in the 71 to 79 year old group to 37.4% in those 90 and above. And there are lots more of us living to that age than before.

It's become clear that having a stroke, what used to be termed a "cerebrovascular accident" (CVA), is another major route for developing dementia. A 2010 study in the journal Stroke describes dementia associated with "first-ever stroke" in a French city of 150,000 inhabitants over a 24-year period. Out of nearly 4,000 patents suffering a CVA, 20.4% had dementia. Risk factors for the outcome included age, diabetes, prior heart attack, and atrial fibrillation (an irregular heart rhythm associated with a risk of emboli, blood clots that can be dislodged, travel to the brain and clog an artery).

These figures clearly included those with new-onset dementia, but, because of the study's design, didn't exclude those who may have had the problem prior to their stroke. Nonetheless a history of stroke nearly doubles the prevalence of dementia in people over 65.

Another group with an increased incidence of neurocognitive (thinking/memory) issues includes the roughly 40 million infected with HIV. At least 30% of that group have associated brain function impairment ranging from minor or mild symptoms to full-fledged dementia. With the newer anti-retroviral drug treatments, the incidence (new cases) of HIV-associated dementia (HAD) has markedly decreased, although with people living longer with the virus, overall there are more HAD patients.

There is a roadblock between the circulation and the brain itself, the blood-brain barrier (BBB), which serves, in usual circumstances, to prevent microbes from invading the central nervous system. The human immunodeficiency virus can penetrate the BBB in several ways: one of which is by hitching a ride inside one kind of immune cells called monocytes. This is termed a "Trojan Horse" method.

Another disease, affecting 1.3 million Americans, is termed Lewy Body Dementia (LBD). It's closely associated with the dementia seen in Parkinson's disease. Both have deposits of an abnormal protein that causes difficulties in brain function. In LBD these proteins are found in several areas of the brain; with Parkinson's they are more localized.

Let's get the right pill to help, not hinder

So why is it important to know what kind of dementia a person has?

Some types respond poorly to medications that may help other forms, at least to a limited extent. And LBD patients may be helped by meds that offer less benefit to Alzheimer patients.

It's not always easy, but an experienced neurologist can often sort out which person has which disease.