Dementia: When to worry

Have you ever gone to the pantry to get something then can't remember why you went there?  Can't remember where you put your phone or keys?  Have trouble remembering someone's name?  Are you worried about your memory?  Then join the crowd and perhaps worry less.  The type of memory problems described above are entirely consistent with normal brain function in someone over 55 (or younger) and are in no way indicative of dementia.  Many people consult doctors about their poor memory and are concerned they may be in the early stages of dementia.  If YOU ALONE are concerned about your memory, there is most likely less concern about dementia than if close family members are concerned.

True dementia does involve short term memory loss with retention of long term memories, but it's more than just that.  In general it can be said that dementia involves memory impairment PLUS some inability to function independently in one's daily routine, social activities, or relationships.  These independent functions might include:

• Impairment of complex tasks such as balancing a checkbook
• Impairment of reasoning such as difficulty dealing with new and unfamiliar situations
• Impaired spatial functions (Dementia testing often will involve asking the subject to draw a clock face with a given time on it, or copy a pattern on paper)
• Impaired language such as using the wrong words to describe things

Of those who have  dementia, about 70% have Alzheimer's disease, 10-20% have Vascular (stroke related) dementia and 10-15% have Lewy body dementia (an accelerated form of Alzheimer's).  Other diseases such as Parkinson's or brain tumors can also result in related dementias.

Dementia-like symptoms that can appear to be similar in behavior (but are not) can include age related mild cognitive impairment (MCI), delirium or depression.  Those with simple age related cognitive impairment may have some memory difficulty and they may think a little more slowly, but the ability to function with day to day activities remains intact.  Patients with delirium have a sudden onset of new mentation symptoms and this is usually reversible. On the contrary, the onset of dementia is gradual and will worsen with time.   Depression can also mimic dementia-like symptoms.  Depressed individuals may perform poorly on standardized dementia tests due to lack of motivation and/or poor effort.  Medications can also create brain function changes that simulate dementia; alcohol, antihistamines, psychiatric medications, sedatives and others can impair memory and cognitive function.

Getting evaluated for dementia first involves talking to your primary care physician about your symptoms.  Then a brief brain function screening test can be administered.  If the screening test score results in a cause for concern, then blood testing for reversible causes like vitamin B12 deficiency or thyroid deficiency can be performed.  The value of brain imaging in diagnosing early dementia is controversial since the most common causes of Alzheimer's disease and Lewy Body disease will show no abnormality on imaging tests.  Neuropsychological testing is frequently valuable in anyone who is having a new brain function problem.  This testing involves several standardized cognitive skills tests administered by a neuropsychologist. 

At best, medication treatment for dementia can provide a modest improvement in symptoms and can slow down the rate at which dementia progresses.  Dementia is frequently accompanied by depression so antidepressant medication can be beneficial as well as other stimulating activities such as Physical, Occupational and Recreational therapies aimed at cognitive rehabilitation, exercise and mental stimulation. 

The benefits of social support for all individuals, families and caregivers affected by dementia related disease cannot be emphasized enough.  The prognosis from early symptoms to morbidity may last as long as ten years or more.  Joining support groups, dividing up caregiving duties and finding proper medical care or placement is imperative for the well-being of the affected individual as well as their loved ones.

Staying at home with support, placement in Skilled Nursing, Dementia Care Units or Board and Care facilities are all choices families may make for their loved ones.  Please visit the Villa Care Homes website to see how small board and care facilities can manage residents with dementia with a regimented daily program and high level of care/supervision. www.VillaCareHomes.com

STROKE WARNING SIGNS

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die.
The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.
It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours. The warning signs of stroke include:

• sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body)
• sudden confusion, trouble speaking, or trouble understanding speech
• sudden vision loss (often in one eye only) or double vision
• sudden trouble walking, dizziness, loss of balance or coordination, or falls
• sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately. Stroke is a medical emergency.

Osteoporosis Part III: Precautions and Treatment

PREVENTION: Elderly people with osteoporosis should take every precaution to avoid accidental falls.  This disease is responsible for many of the hip, wrist, and spinal fractures that occur in elderly women.  If glasses are necessary for general vision, they should always be worn.  A cane or walker should be used if you do not feel steady on your feet, or if one has been recommended.  Shoes and slippers should have skid-resistant soles.  Additionally, handrails in bathrooms and sturdy banister rails along all stairs inside and outside should be installed for safety.

TREATMENT: Treatment of osteoporosis is geared toward halting, or at least slowing down the progress of the disease.  This may involve increased calcium intake, estrogen replacement therapy (provided there are no contraindications), physical therapy and weight-bearing exercise. 

At least six glasses of milk or equivalent servings of other high-calcium foods such as cheese or yogurt and a small supplement of vitamin D may be prescribed to be taken daily.  Oral calcium supplements may also be prescribed.  For postmenopausal women with osteoporosis, estrogen-replacement therapy has been shown to be the most effective way of slowing down bone loss.  Today, many doctors prescribe a combination of estrogen with a synthetic progesterone to simulate the hormonal environment existing before menopause.  As with any medication, there may be certain side effects from such a regimen; report any you notice to your physician.

Exercise is very important, especially the kind of exercise that allows your body weight to bear down on your skeletal frame.  Those who are bedridden, confined to a wheelchair, or with limited ability to move, physical therapy should be received on a regular basis.  While swimming and bicycling are great cardio-workouts, simple walking or light jogging is better for those with osteoporosis.  Walking is one of the best exercises for those who do not want to take part in active sports or who cannot do so because of their general health.

SUMMARY: Bone loss to some degree is inevitable as we grow older; however, with osteoporosis, the process is much more pronounced.  Bones are weaker and thinner (especially those of the sping), and fractures can occur more easily.  New treatments are being developed that may increase bone formation and thereby reverse osteoporosis.  Meanwhile, however, the object of treatment is to stop or slow down the process of the disease.  Current treatment involves an increased intake of calcium, estrogen replacement therapy, physical therapy and weight bearing exercise.  Preventative therapy for premenopausal women consists of a diet high in calcium and vitamin D and regular exercise.