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Dementia
Dementia
What Does Aging Mean To You?
Aging can be a blessing or a curse. When you have good
health, active interests, a loving family and friends, and
financial security, aging is not "aging," but living. However,
when financial, social, and medical worries weigh you down,
aging is a frightening prospect. One of the biggest fears that
people have concerns cognitive abilities - that is, losing the
ability to remember, think, and reason. Losing these mental
facilities is known as dementia.
Dementia is the umbrella term for a number of specific
diseases. Dementia can be defined as a persistent decline in
intellectual function, and it involves memory, problem
solving, and learning. It is characterized by short-term
memory loss; the inability to complete everyday, simple tasks;
confusion; impaired judgment (such as walking into traffic);
getting lost in familiar places; and paranoia. Dementia can be
relatively minor, and is often just referred to as a "bit of
dementia," or it can be life debilitating and fatal, when it
occurs as Alzheimer's disease.
Can Dementia be Reversed?
The
majority of health practitioners say that dementia is
irreversible-that nothing can be done, although there
may be hope in slowing it down. There are a few doctors,
however, who do not buy this. Abram Hoffer, M.D., and
Morton Walker, M.D., have both expressed the belief that
senility, which encompasses dementia, can be prevented
and reversed.
Their field is orthomolecular medicine, which is
achieving or maintaining health by manipulating
substances that are normally found in the body. This
would include vitamins and minerals.
Hoffer and Walker have cited success in using this
type of therapy, using a number of nutrients, including
those listed in "Nutrition" and chelation
therapy. |
Multi-infarct dementiaDementia can be
caused by changes in the blood vessels in the brain. This is
known either as vascular dementia or multi-infarct dementia
(MID). An infarct is a mass of dead tissue; so, MID is caused
by events that result in areas of dead tissue in the brain.
MID is now thought to account for between 12 percent to 20
percent of all dementia in the elderly. An additional 16
percent to 20 percent of the elderly have both MID and
Alzheimer's.
These changes in the brain's blood vessels can result from
a blood clot in the brain or a burst blood vessel. A small
stroke or minor blockage may result in small, and perhaps
unnoticed, changes - numbness in a hand, or a slight slurring
of speech. However, if a major vascular event takes place,
such as a stroke, symptoms are dramatic and could limit the
ability to talk and result in loss of short-term memory.
People with MID generally have a history of high blood
pressure, vascular disease, or previous strokes. Because the
actions - a blockage or stroke - often occur years apart, MID
is seen to occur as a series of "steps."
Alzheimer's disease
Alzheimer's is a type of dementia, which
selectively damages the brain. Alzheimer's was once considered
psychological, but we now know that it is a degenerative
disorder based on physiological changes in the brain. The two
characteristics of Alzheimer's are neurofibrillary tangles and
neuritic plaques.
In the case of neurofibrillary tangles, just imagine
washing long hair without a conditioner - you end up with a
tangled mess that you cannot get a comb through. In the case
of Alzheimer's, fibers in the brain's cells are tangled. And
as a comb does not flow smoothly through a tangle in the hair,
so information does not flow smoothly, or does not flow at
all, through neurofibrillary tangles. And because these
tangles surround the hippocampus, the brain's memory center,
new memories cannot be formed, and older memories are lost.
Neuritic plaques are a second characteristic of
Alzheimer's. A plaque is a buildup of abnormal brain cell
pieces. Picture a cluster of damaged plastic pieces melted
together. At the core of this buildup is amyloid, an abnormal
protein not usually found in the brain. Amyloid formation has
been linked to free radicals, which are renegade molecules
that behave like erratic bumper cars in our bodies. Free
radicals bounce against cells, damaging them, and are
implicated in disease and the aging process.
Mental Status
Questionnaire
Physicians use a Mental Status
Questionnaire (MSQ) to make a quick assessment as to
whether dementia is present:
- Where are we now?
- Where is this place located?
- What is today's date?
- What month is it?
- What year is it?
- How old are you?
- When is your birthday?
- What year were you born?
- Who is the president/prime minister of the
U.S./Canada?
- Who was president/prime minister before him/her?
9-10 answers correct: no confusion
6-8:
slight confusion
3-5: moderate confusion
0-2:
severe
confusion
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Causes
There are many theories on what causes
Alzheimer's, but no one knows for sure. Here are a few of the
theories:
A lack of brain neurotransmitters:
Alzheimer's
patients lack an enzyme needed to manufacture acetylcholine, a
neurotransmitter - a brain "messenger" - important in memory.
Not having enough acetylcholine may cause memory problems.
Viral or infectious agents:
Some researchers believe
that a "slow virus" causes Alzheimer's. These viruses can live
in a brain for some 20 years before causing a dementia.
Environmental toxins:
The brains of Alzheimer's
patients have aluminum levels up to 30 times higher than
other, age-matched people. However, it is not clear whether
the aluminum resulted in Alzheimer's, or whether Alzheimer's
resulted in aluminum buildup. Support of this theory is
partially based on the observation that the injection of
aluminum salts into animals leads to brain changes similar to
the tangles and plaques found in Alzheimer's.
Genetic defect:
Although difficult to confirm, there
is evidence that Alzheimer's has a genetic link. It may
cluster in families, and by some estimates 40 percent to 60
percent of U.S. cases are genetic.
Immunological defects:
Investigation of the neuritic
plaques gives rise to the possibility that the body has turned
against itself.
Lifestyle and nutrition:
Finally, there are
indications that diet may be involved. A recent study at Loma
Linda University found correlation between heavy meat eaters
and Alzheimer's (Neuroepidemiology, Vol. 11: 28-36).
People with Alzheimer's have low levels of vitamins B12, A,
and E, as well as lower levels of carotenoids and the mineral
zinc.
- If you forget where you put your glasses, you are
forgetful.
- If you forget you wear glasses, you may have
dementia.
- If you have some memory loss, but it does not
interfere with normal activities, you probably do not
have Alzheimer's.
- Also considered a dementia, or causes of dementia,
are nervous system diseases such as multiple
sclerosis, Parkinson's disease, Huntington's disease,
Pick's disease, and Creutzfeldt-Jakob disease.
- 1.3 to 1.8 million Americans over age 65 have
Alzheimer's.
- 250,000 Canadians have Alzheimer's.
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Negative synergy
It is becoming increasingly
apparent that we cannot pigeonhole dementia as having one
cause. The above theories are not as distinct and separate as
we might like them to be. What triggers Alzheimer's could be a
combination of all of these, or some sort of destructive
chain, where all, or different combinations of the above,
figure in.
Pseudodementias
Pseudodementias are not true dementias, but they should be mentioned,
simply because it is easy to mistake a pseudodementia for MID or
Alzheimer's. Oftentimes, the same manifestations of
forgetfulness, confusion, and memory loss are displayed. If
you suspect someone has a dementia, the first thing you should
look at are pseudodementias, as they can generally be treated.
Depression
When one is depressed, it may
result in confusion, forgetfulness, and slowness. Often,
loneliness and frustration are manifested in this way among
the elderly.
Drugs
The elderly are among the highest users
of prescription drugs and often take many at one time. Because
they cannot metabolize drugs as well as younger people, they
may be taking too much of a drug, and the side effects often
mimic the signs of dementia. This is a very common problem,
and a person's drug regimen should be one of the first things
checked.
Chemical imbalance
The brain has a great need for nutrients, and poor eating habits
and poor absorption can prevent the brain from getting
necessary nutrients. Because
many elderly people have little appetite or skimp on food,
this can be a problem. Often, mental problems due to a
nutrient deficiency manifest themselves before physical
problems. A deficiency in B vitamins, especially vitamins B1,
B3, and B12, or thyroid problems, may trigger dementia-like
symptoms.
Heart and lung problems
Because the brain
demands high quantities of blood and oxygen, insufficient
heart and lung action can also result in dementia-like
symptoms.
What can be done?
As noted, the first thing
to look at if you feel someone may have dementia are the
pseudodementias. After this, physicians have a number of
cognitive tests they administer, and, of course, brain scans.
The first, continual, and ultimately most difficult thing
to do is to keep the person functioning as she or he always
has. Insist on continuing the daily routine as long as
possible. Help when necessary, but encourage independent
living as long as possible. It has been proven that doing so
can slow the rapid decline that is often associated with
neglect, overprotection, and hospitalization. This can be, and
generally is, difficult, time-consuming, and emotionally
painful. It is usually helpful that the caregiver also accept
help and get involved with support groups.
Nutrition
Because one of the theories on
Alzheimer's centers on the absence of acetylcholine, giving
patients foods and supplements that result in more of this
neurotransmitter may help somewhat. One nutrient, choline, is
very important in the formation of acetylcholine. This is
found in legumes, organ and muscle meat, milk, and whole-grain
cereals. Choline supplements are also available. Another
supplement, phosphatidylcholine, helps raise levels of
choline. A similar sounding supplement, phosphatidylserine,
has also been used for Alzheimer's. Although both of these
exhibit promise, most experts say that it is "too early to
tell" how much good they do.
Ginkgo biloba is perhaps the supplement best known for
"brain health", and for good reason. It may help with MID due
to its antioxidant activity and because it increases blood
flow to the brain. There have been many studies performed on
ginkgo and cognition, and it is recommended by physicians in
Germany for the type of symptoms manifested in dementia. It
has also been studied for its effect on Alzheimer's, most
recently in the well-established Journal of the American
Medical Association (Vol. 278, No. 16. October 22/29, 1997).
In a one-year-long U.S. clinical trial, ginkgo did prove to
have at least a small effect on dementia. One-third of the
Alzheimer's patients taking ginkgo improved in memory tasks,
such as remembering dates. Half the group, although memory did
not improve, experienced no increased memory loss, and the
researchers noted that ginkgo may be the equivalent of a
six-month delay in Alzheimer's progression.
Vitamin E, already well-known for its cardiovascular
effects, also may be a dementia fighter. Last spring, the
New England Journal of Medicine (April 24, 1997)
published a report on Alzheimer's that said vitamin E (and
selegleine, a drug used for Parkinson's disease) "should be
considered for use in patients with moderate dementia." The
basis for vitamin E's benefits are probably due to its free
radical-fighting properties.
Chelating agents
The aluminum and toxic metal theory has spurred treatment with
chelation. Chelation is the term used when a substance
binds to another and removes it
from the body. In this case, a chelating agent that attracts
aluminum is given to the patient, and the aluminum is
eventually excreted. One study has shown that a chelating
agent slowed the rate of cognitive decline. (Neurology 46,
1996: 401-405)
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