HealthLine: What Did You Just Say?

It is not uncommon, especially at my tender age, to walk into a room and forget what I was going to do in there. Huh, admit it, this does sound familiar?  Dementia is defined as the loss of brain function which affects memory, thinking, language, judgment and behavior.  It is far more common in the geriatric
population, but may occur before the age of 65.

Mild Cognitive Impairment (MCI) is the stage in between the period of normal forgetfulness and the actual development of dementia.  The early symptoms of dementia may consist of language problems such as word finding for certain objects or difficulty multi tasking which may progress to a more moderate dementia with challenges with reading or writing or forgetting details about current events or major milestones in one’s life.  By the severe dementia stage, patients can no longer understand language, recognize family members or perform such basic skills as eating, dressing and bathing.

Most types of dementia can be categorized as either irreversible or reversible.  The irreversible causes of dementia consist primarily of Alzheimer’s disease, Lewy Body disease and vascular dementia.  Alzheimer’s disease and Lewy Body disease are
caused by microscopic changes in the brain and abnormal protein deposition in
the brain respectively.  Vascular dementia is a product of multiple, small strokes over time.

Reversible dementia may be stopped if the origin of the dementia can be found and treated before the condition progresses. This most commonly occurs in case of brain tumors, changes in blood sugar, sodium and calcium levels, Vitamin B12 deficiency, Normal Pressure Hydrocephalus reduced with a cranial shunt, certain medications and chronic alcohol use.

Up until 1907 “senility” was felt to be caused by either syphilis or hardening of the arteries of the brain.  Research went on to show that specific microscopic changes in the brain correlated to the development of dementia.  In 1976, neurologist Robert Katzmann suggested a link between what was traditionally known as “senile
dementia” and Alzheimer’s Disease.  He was the first scientist to open the view that dementia is not a normal part of aging, and therefore patients who develop dementia after age 65 carry the diagnosis of “senile dementia of the Alzheimer’s type” (SDAT) and “Alzheimer’s disease” describes those patients with dementia prior to age 65.

In 2005 it was estimated a worldwide prevalence of dementia of 24.3 million with 4.6 million new cases each year.  Dementia doubles every 20 years and will reach 81.1 million by 2040. Less than 10% of cases of dementia are actually reversible.

The diagnosis of dementia can be made by history, physical examination and a Mini Mental Status Exam (MMSE) or Folstein test.  This is a 30 point
questionnaire given to the patient that evaluates cognitive ability and
usually takes 10 minutes to complete.  It measures various functions including arithmetic, memory and orientation.

Although there are no medications to treat the underlying pathophysiology of the disease, there are medications to treat the behavior and cognitive symptoms of dementia.  Acetylcholinesterase inhibitors, such as Aricept, Razadyne and Exelon, act to raise the amount of the neurotransmitter acetylcholine, which is deficient in dementia patients.  NMDA receptor blockers or Memantine agents, most commonly Namenda, reduce glutamate believed to over stimulate and damage neurons in the brain.

Though treatments are limited, the key to dementia currently is to prevent it from ever occurring.  There is some evidence that moderate alcohol consumption and a Mediterranean diet may reduce the risk of developing dementia, along with frequent mental exercise, as simple as reading the newspaper daily or working crossword puzzles.  One Canadian study did show that a lifetime of bilingualism reduces the onset of dementia by four years in patients who were monolingual.

Next time you are in the kitchen and cannot remember why you are there, pour a glass of wine and sit down and eat a plate of pasta.  It will come back to you.

Dr. Ballard is a Board Certified Internist and Geriatrician with a special interest in Women’s Health.  She practices in Enumclaw, 360-825-1389.  Dr. Ballard’s comments are informational only and not to be construed as medical advice. 
Consult your personal physician for any medical issues.