Annals of Long Term Care

Q. What is dementia?
A. Dementia is a condition of declining mental abilities, especially memory. The person will find it hard to do things he or she used to be able to do easily. Some examples are trouble balancing a checkbook, driving a car safety, or planning a meal. He or she will often have problems finding the right words and may become confused when given too many things to do at once. The personality of a dementia sufferer may also change. He or she may become aggressive, paranoid, withdrawn or depressed.

Q. Isn’t dementia just old age or senility?
A. Aging along does not stop us from taking care of ourselves. As we get older, it may take longer to remember names or to find the right word to say. Mild changes in thinking and remembering information (also known as mild cognitive impairment) may happen as we age, delaying or making though processes more difficult.

The loss of memory and other mental problems caused by dementia are bad enough to keep us from doing things we use to do easily. Researchers are trying to understand if dementia is an abnormal extension-a more sever form-of the mild, expected memory changes experienced by older adults, or it is entirely different situation. While dementia is more common in old age, it is not “normal.” Changes in memory should be evaluated.

Q. What causes dementia?
A. Alzheimer’s Disease is the most common type of dementia. But, there are many other causes of dementia. They include strokes, low vitamin B12 levels, thyroid conditions, depression, AIDS, and other infections. In addition, medications and some illnesses can cause confusion (delirium) in older people. This may look like dementia because it also affects memory.

Q. What is Alzheimer’s Disease?
A. Certain cells in the brain stop working and eventually die. These cells produce important chemicals [acetylcholine and others] needed for memory, language and other thinking functions. As the chemicals decrease, so do the person’s abilities to remember and think clearly. Alzheimer’s disease usually sneaks up on the person and family. It gets worse slowly and silently over several years, before the changes are noticed. Over time (usually 5-8 years), it advances to a point where the person can no longer handle simple tasks like eating or bathing.

Q. How do you get Alzheimer’s Disease?
A. We know that as we get older we have a greater change of getting Alzheimer’s disease. At the age of 65+, about 1 in 15 people has the disease. By the age of 85 and older, between 1/3 and ½ of the population has this disease. We also know that some families pass along genes that increase the risk for developing the disease. There are also factors in our environment that seem to trigger the onset of the disease. But those triggers are not yet known.

Q. Is there any point to seeing my doctor?
A. There are important reasons to get an evaluation. First there are now treatments available for Alzheimer’s disease. They can improve the symptoms and slow the progress of the disease. Second, there are other causes of dementia and confusion. Sometimes the person may return to normal once his or her medications are changed or medical illness is treated, Third, the doctor’s office should be able to assist you in finding community resources for information, support groups and help at home.

Q. What can we expect from the doctor?
A. Your doctor should take your concerns seriously. He or she should provide a careful medical examination and medication review. There should be tests of memory, blood work, and sometimes a scan of the brain. Referral for detailed mental testing may be made. If the diagnosis is clear, the doctor should provide care throughout the illness.

Q. What treatments are there for Alzheimer’s Disease?
A. Medicines approved for treating Alzheimer’s disease are donepezil [Aricept], galantamine [Reminyl] and rivastigmine [Exelon].