Health Column: Understanding Alzheimer’s dementia
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
The announcement by the family of Bronco owner Pat Bowlen that he was suffering from Alzheimer’s dementia triggered sad memories of patients from the past: Minnie, the lovely first-grade teacher whose paranoia that her good and faithful husband of 60 years was having an affair; Bernie, a retired chemist who could spout complex formulae, but repeatedly got lost in the neighborhood where he had lived for 25 years; and my hero, Jess, a Palisade farmer who daily, without complaint, retrieved his wife’s shoes from the roof of their home where she had tossed them.
Today, let’s look at the increasing prevalence of dementia, its various forms, risk factors and how dementia is diagnosed.
Dementia is a broad term for a group of symptoms affecting thinking and social abilities severe enough to interfere with daily functioning. Common signs and symptoms of dementia include memory loss, difficulty communicating, difficulty with planning and organizing, getting lost, personality changes, inability to reason and agitation.
Alzheimer’s dementia (AD) is the most common cause of dementia. Named after a German neurologist, Alois Alzheimer, AD is a progressive disease characterized by the development of protein tangles and plaques in the brain that lead to brain cell death. Vascular dementia, the second most common form of dementia is usually caused by problems in the flow of blood to the brain. It ofttimes begins suddenly after a stroke and progresses in a step wise fashion. Fronto-temporal dementia is characterized by early changes in personality and behavior, rather than memory loss. There are other dementias associated with long-term heavy alcohol ingestion, Parkinson’s disease and HIV infections.
As we live longer, the incidence of dementia continues to grow. Among Americans aged 71 and older 14 percent of us have some type of dementia. Dementia prevalence increases with age, from 5 percent of those aged 71-79 years to over 40 percent of those aged 90 and older. We don’t know why.
The primary risk factor for AD is increasing age. Those who have a parent, brother, sister or child with AD are more likely to develop the disease than those who do not have an affected relative. Finally, scientists have discovered several genes that put us at risk. Those who inherit the APOE-e4 gene from one parent have an increased risk of AD and inheriting two copies of the gene magnifies that risk. However, many patients with two copies of the gene never develop the illness.
Diagnosing dementia early in the course of the illness may be difficult. There is frequently an overlap of normal short-term memory loss (“where did I park my truck?”) associated with aging and frank early dementia. There is no one test or scan to make the diagnosis, but the AD diagnosis is based on a physician carefully listening to the patient’s and family’s story. Commonly, the physician may order some laboratory tests and a CT scan of the head to exclude conditions that may mimic dementia.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at email@example.com.
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