By
Roy M. Arnold MD
As the population ages, the number of persons living with dementia is increasing. This column will discuss the most common causes of dementia, how they are manifested and how they may be delayed or prevented. First, what is dementia? Dementia is the acquired and persistent manifestation of brain function affecting recent memory, decision-making, and expressive speech sufficient to impair daily functioning. It may initially express itself as misplacing things, forgetting conversations or repeating questions. Speech may be impaired by not being able to find the right words for an action or object. Decision-making impairment may be manifested by forgetting to pay bills or disorganization.
The most common cause of dementia is Alzheimer’s disease which is characterized by accumulation of amyloid plaques and a tangling of nerve fibers in the brain. It accounts for 60-80% of all dementia and is the fifth most common cause of death in the US. The second most common cause of dementia is Vascular Dementia which accounts for 10-20% of cases. It is caused by recurrent tiny vascular occlusions throughout the brain causing mini-strokes. When the damage becomes widespread, dementia can result. The remaining 10-20% of cases are caused by a variety of conditions such as Lewy body disease, frontotemporal dementia, alcoholism, Creutzfeldt-Jacob disease and normal pressure hydrocephalus. Rarely infections or nutritional deficiencies may cause dementia. Fewer than 2% of cases of dementia are due to a correctable cause such as infection, normal pressure hydrocephalus, nutritional deficiency or depression.
Dementia is rare prior to age 50, occurs in about 2% of those aged 60-69, but increases to 20-25% in those aged 80-89. The sex distribution is equal in males and females, however in absolute numbers more women are afflicted because women tend to live longer.
Dementia is usually diagnosed by clinical examination and by history. Special testing such as neuropsychologic testing or brain imaging is often performed. Unfortunately, treatment for Alzheimer’s disease and other forms of dementia is limited. Only 2 categories of drugs have been studied in treating Alzheimer’s dementia. First are cholinesterase inhibitors such as Aricept, Exelon and Razadyne. Multiple studies have shown that these drugs can delay the progression of mild cognitive impairment 12-24 months. In the long run however they do not have an effect on overall cognitive decline, disability or death. The second class is NMDA inhibitors of which only one, Namenda is approved in the US. This drug works through a different neural pathway and can improve short term memory function, and decision-making temporarily. It’s effects are not long-lasting and are similar to the cholinesterase inhibitors. Neither of these categories of drugs have been thoroughly studied in other types of dementia, although they are commonly used off-label for those disorders. Several studies have shown promising results using anti-oxidants such as Vitamin E and beta-carotene. More studies need to be done before any firm conclusions can be drawn about the efficacy or lack thereof.
How can persons lessen their chances of developing dementia? First and foremost, the healthier one is entering the seventh decade of life (60+) the less likely one is to develop dementia. Physical conditioning through exercise has a protective effect against dementia that lasts as long as the physical conditioning continues. Being at or near Ideal Body Weight also has a protective effect.
Intellectual activities and cognitive training can stimulate brain function and delay the onset or progression of dementia. Reading educational books, magazines or online publications, brain games, learning a new skill like another language, a new pastime like knitting, cooking or gardening can improve cognitive function later in life.
Social activities like volunteer work, civic or social clubs, or even political activities can lessen cognitive decline.
Healthy diet is important in maintaining overall health, as well as building cognitive functioning. A diet rich in fruits and vegetables, high in protein and with limited amounts of animal fat and alcohol can delay the progression from normal intellectual functioning to cognitive impairment. This effect may be related to the higher antioxidant content of such a diet.
In summary, get fit, stay fit, eat healthy, interact socially, and stimulate your intellect. Even if mild cognitive impairment already exists, these steps have been shown to substantially delay progression. Those of you with loved ones who are experiencing early signs of cognitive impairment, should encourage them to engage in some of these activities after consulting with their healthcare providers.
The Alzheimer’s Association (www.alz.org) has a wealth of information on their website and a local chapter. They can be found on the web at www.alz.org/kyin
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