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As we age, certain physical problems seem to arise and our thoughts no longer worry about the Cubs, but turn to the larger questions such as, “Am I ok?” We all understand cancers and heart attacks, but when we read about mental diseases, we are less aware. That is, unless someone close to us has experienced some mental health problem. The two words that worry us most are dementia and Alzheimer’s disease. In my case, my mother was diagnosed with the latter a year or so before she died.
But what are the differences between these two diseases that we hear and read so much about? Well, there isn’t a difference. Dementia is the overall category for brain cell damage, and Alzheimer’s is one of the dementia possibilities, accounting for 60 to 80 percent of dementia cases. The second largest category is vascular dementia, which is caused by decreased blood flow to the brain.
If dementia covers a decline in mental functions, not all mental changes are an indicator of trouble ahead. Typical mild forgetfulness is not necessarily a part of the disease. Trouble remembering the names of acquaintance or the name of that shop you went to when you were visiting New York is often a harmless aging change. Think of it as my computer is full, so some facts are deleted to make room for the new ones.
The earliest stages of dementia, known as mild cognitive impairment (MCI) are cases of forgetfulness beyond what is expected from aging. With MCI, in early stages, the person may well still be driving her car, paying her bills or doing similar tasks. They just may take more time than before. Alzheimer’s disease is a specific brain disease that progressively and irreversibly destroys memory and thinking skills.
How does a doctor determine whether a patient has a particular brain disease? Confirmation can be absolutely determined by a brain autopsy after death. The changes in the brain structure are readily apparent. But that seems a bit tough for a conclusion. Thus, it is determined by the doctor talking to the patient and talking to close family members about recent changes in behavior and ability. The doctor can administer a mental status exam or a neuropsychological evaluation. Often this doctor is a psychiatrist, neurologist or a geriatric physician.
The family may relate a growing irritability, anxiety or even depression in the patient. Simple things are more indicative than names and places forgetfulness. The inability to make calculations as simple as figuring out a tip for the waitress may indicate a more serious concern.
A common mental test is called the Hopkins Verbal Learning Test. This often involves having a medical assistant read a dozen words to the patient, then waiting a short time, and then having the patient recall as many of the 12 as he or she can. I have taken that test and scored well above the need for concern. Later, however, the doctor explained to me that a higher IQ can affect the results. Hmm. Another test is merely having the patient draw lines connecting a series of numbers or letters that are quite complicated in their sequence.
So, what are the differences between dementia and Alzheimer’s after all this? Alzheimer’s disease first affects the part of the brain associated with learning, not just memory. Early symptoms could include changes in short term memory, logical thinking and the loss of reasoning skills. As the disease progresses, symptoms become more severe and include confusion and substantial changes in cognitive ability. The smarter the patient, the harder it may be to recognize whether he or she has such a disabling disease. Some victims will make numerous notes to help remind him or her of those areas that they’re forgetting. My mother had “cheat sheets’ all over her home and in her car. It wasn’t until she set off to drive to her daughter’s home for dinner and totally lost her way that we knew there was a serious problem. Fortunately, she found her way back home and called my sister. Serious medical evaluation followed. As we sat with her, the psychologist looked at me and my sister and blatantly said, ”She has Alzheimer’s.” My mother turned to me and drew her finger across her throat. It was so my mother. She clearly understood the diagnosis.
What is some good news? Medicine is desperately trying to find a cure as more than 6 million Americans are estimated to be living with dementia. Amazingly, the percentage of affected people is falling. Reasons attributed to this good fact are linked to a rise in our education levels, less smoking and more early treatment for cardiovascular diseases and hearing loss.
Unfortunately, there has also been a rise in obesity, diabetes and a more sedentary lifestyle. All three are known to heavily attribute to the chance of getting these diseases. The best ways to avoid this age-related disease are to engage in physical activity, monitor your weight, cholesterol, and blood pressure, stop smoking and get those 7 or 8 hours of sleep. Also, most important is to stay socially active when one loses a spouse. Loneliness is another contributing factor. And my favorite? Start doing activities that challenge your brain, be it board games, puzzles, card games or my favorite, Sudoku. They say that crossword puzzles merely recall old memory, but each Sudoku puzzle is a new test challenging the short-term memory.
Finally, we can all hope for that magic medicine, but over a hundred drugs have already failed in testing. So, we must stay with those personal care items for now.