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Dementia: Missing Pieces

November 3, 2013
By GLYNIS VALENTI - Staff Writer ( , Times Leader

The literal, Latin meaning of the word "dementia" is to "take away" or "reverse" the "mind." While Alzheimer's disease accounts for between 60 and 80 percent of dementia diagnoses, there are an estimated 50 kinds of dementia, with different causes and triggers, but all with nearly the same symptoms and manifestations.

Physically, what most people think of as dementia is a group of symptoms that indicates brain disease or damage and is not, as commonly believed, a normal part of aging. There are 100 billion neurons in a healthy brain that connect with each other via synapses, which are chemical pulses. These connections form the cellular foundation of memory, motor skills, emotions, communication and thought processes. With dementia, trauma or health conditions begin deteriorating these connections, sometimes as long as 20 years before the symptoms become evident.

This type of dementia is linked to abnormal protein activity inside and/or outside the neuron. Protein aggregates, or clumps, affect the quality of the connections and may block them completely. Depending on the area of the brain, the patient could lose short term memory, decision-making ability or muscle control. Dementia of this type may be slowed to a certain extent, but is not curable.

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Some dementia is treatable and even temporary, like that resulting from substance or alcohol abuse, tumors, fluid on the brain or vitamin deficiencies.

In patients suffering from dementia with Lewy bodies (DLB,) protein activity in the cortex creates early symptoms such as sleep disturbances, hallucinations and muscle rigidity and progresses to Alzheimer-like symptoms. Dementia from frontaltemporal lobar degeneration (FTLD) is concentrated in the front and side of the brain and affects behavior and language skills. Dementia is also a result of Parkinson's disease and begins with proteins accumulating deep in the center of the brain.

Alzheimer's disease is characterized by beta-amyloid (protein) plaques and tau (another protein) tangles forming outside and inside the neurons, respectively. These not only inhibit the synapses - communication connections - but destroy the nerve cells. The "forgetfulness" in the beginning stages of Alzheimer's progresses into memory loss, depression, confusion and inability to swallow or speak.

Another type of dementia, vascular dementia, is caused by blockages in brain blood vessels or microscopic bleeding after a head injury or stroke. Symptoms depend on where the injury is located, but impaired judgment is one of the early indications of this type of dementia. There is often also evidence of Alzheimer's or DLB present with vascular dementia.

While many people begin experiencing what they call "senior moments" between age 50 and 60, this is not necessarily the precursor to dementia or Alzheimer's. Some age-related memory loss is normal: forgetting an appointment, blanking out on someone's name, misplacing the car keys or eyeglasses. Signs of a more serious problem might include trying to remember a close family member's name, not recognizing the car keys or continually paying some bills twice and others not at all.

Officially, the "Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition" published by the American Psychiatric Association lists the criteria for diagnosing dementia as a decline in memory plus one or more of the following: "ability to speak coherently or understand spoken or written language," "ability to recognize or identify objects, assuming intact sensory function," "ability to perform motor activities, assuming intact motor abilities and sensory function, and comprehension of the required task" and "ability to think abstractly, make sound judgments and plan and carry out complex tasks." In addition, the indicated decline must be to a degree that interferes with normal daily life.

While, as mentioned, there is no cure for Alzheimer's disease (or similar brain diseases), there are ways to prevent it, reduce the risk of developing it or slow its progress - in a word, exercise, both physical and mental.

Physical exercise sends oxygen and blood to the brain. That promotes growth of the neurons and makes it easier for them to connect. Even older seniors can benefit from activities like washing the dishes and sweeping the floor according to a study from Rush University Medical Center. Seniors who walk as little as 45 minutes three times per week can noticeably improve their mental and physical health while decreasing the effects or risk of Alzheimer's. Even chores like gardening, raking leaves or cooking get the body moving and blood flowing.

Middle age isn't too early to eliminate or reduce the chance of developing the disease later. More research from Cooper Institute in Dallas indicates that health during middle age can influence the risk of brain disease in seniors. Not exercising regularly and carrying extra weight around the abdomen seem to increase that risk significantly.

In fact, following healthy heart practices at any age improve the brain's health, too. Part of this may be the vascular aspects of blood vessels, cholesterol and hypertension, but maintaining a heart-friendly lifestyle may eliminate the risk of Alzheimer's entirely in some people.

That includes diet, and experts are now recommending the Mediterranean diet over the low-fat, low-cholesterol programs prescribed after heart attacks and strokes. Diets high in fresh vegetables and fruits, fish and whole grains and that include monounsaturated fatty acids (like olive oil) and the heavy duty antioxidants of red wine (in moderation) are beneficial at any age. Recent research has also confirmed that olive oil helps clear abnormal proteins from the brain, greatly reducing the risk for Alzheimer's.

After exercise and dinner, sit down with a crossword puzzle, book or, best of all, a foreign language course. Mental activity gives the brain a workout that strengthens the synapses, enables better connections and improves memory. Seniors who play games, read, write or play an instrument can reduce their risk of Alzheimer's by as much as 75 percent. Learning a second language fluently cuts the onset of the disease by 50 percent according to a Canadian study.

Higher education and keeping the mind active throughout one's life actually reduces the problem protein levels in the brain. Even retiring at a later age will aid in keeping the brain active and healthier.

Data from the Alzheimer Association says an estimated five million Americans over 65 have Alzheimer's, and almost two-thirds of them are women. Because baby boomers are reaching retirement age, an estimated 40 percent increase in Alzheimer's patients is expected in the next 12 years. In Ohio, estimated cases in 2025 are projected to rise 10 percent from 2010 and 25 percent from 2000. Currently, one in three seniors dies from some form of dementia.

What if a loved one develops Alzheimer's or dementia? Because dementia can cause people to become confused, frustrated or depressed and impair motor skills and speech, experts recommend patience and respect in spending time with them. Depending on the stage of dementia, offer them simple choices but let them make their decisions; don't criticize or be condescending; divide activities into smaller tasks to help them feel more accomplished and less overwhelmed; listen to and acknowledge what they are saying even if it doesn't make sense or isn't correct; offer support and try to understand being in their position. Have patience, above all, patience.



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