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.
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 diseaseAlzheimer'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.
CausesThere 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.
Negative synergyIt 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.
PseudodementiasPseudodementias 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.
DepressionWhen one is depressed, it may result in confusion, forgetfulness, and slowness. Often, loneliness and frustration are manifested in this way among the elderly.
DrugsThe 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 imbalanceThe 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 problemsBecause 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.
NutritionBecause 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 agentsThe 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)
© 1998 - 2004 by AIM International.
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