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Clues to dementia can be an inability to use the phonebook, a paranoid tendency that family members are spreading lies, opening cereal boxes from the bottom or bringing a reference manual to the neighborhood book club.
If there are no sudden or big unexplained personality changes, we often think, “That’s just what happens to the elderly," but could it be something more?
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Dementia the Creeper
People frequently accommodate their family members to avoid misunderstanding and confrontations. For example, a daughter might have to repeat and explain things multiple times to her father. The father responds with muddled words.
Sometimes the person with creeping dementia will explain their strange behaviors with small but plausible reasons: the print was too small, “I simply forgot," or protests that it did not actually happen that way. Denial of cognitive loss—knowledge through reasoning, intuition or perception—is quite common among people who have dementia, or in patients with Alzheimer’s.
Author Janet Yagoda Shagam writes in her book, An Unintended Journey, Dementia is a disease that “robs people of their education, their careers, and of their personal history."
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Alzheimer’s or Dementia?
What is the difference? Alzheimer’s is actually a form of dementia. In fact, there are several types of dementia, each with its own unique conditions.
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The second most common age-related dementia, Vascular accounts for 12 to 20 percent of all dementias and is abrupt, most often occurring when a heart attack or stroke reduces blood flow to the brain. If the person has had mini strokes, often called TIAs, small areas of brain damage can eventually cause noticeable symptoms such as slowed thinking and forgetfulness, mood changes, hallucinations, confusion and a lack of social skills. Physically and behaviorally, it can manifest with dizziness, tremors, shuffling walk, loss of bladder control, slurred speech, getting lost in familiar places and laughing or crying at inappropriate times. It may also mean difficulty in following instructions or performing familiar tasks.
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Frontotemporal Lobe Dementia
A German neurologist, Arnold Pick, described an 1892 case involving an elderly patient where there was progressive loss of speech and dementia. After her death, the autopsy showed that certain parts of the brain had shriveled. The areas of decay were located on the front of each side of the brain, just above the ear. These areas give us the ability to recognize faces and transfer short-term memories into long-term memory banks.
Behaviors associated with this form of dementia include neglect of personal hygiene, inappropriate behavior or social indifference, deteriorating language, an occasional increase in artistic and musical expression, loss of the meaning of words and word-finding difficulty.
A person with this form of dementia may no longer seem like the person you knew. A friendly, polite person becomes sexually aggressive or says unacceptable things. The cause is unknown but physicians generally believe that genetics may have something to do with this development in about half of the cases.
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Dementia with Lewy Bodies
Named after Doctor Frederich Lewy in 1912, this dementia is described as including hallucinations and delusions; alterations in sleep, heart rate and digestion; and a precipitous decline in the patient’s cognition and behavior. Certain other types of physical conditions such as shaking, rigidity and balance difficulties can occur.
An examination of the brain after death shows brain deposits comprised of several proteins—that sometimes can only be seen with microscope—making it difficult to diagnose. There are no predictable stages and dementia with Lewy bodies is a rapidly progressing disease. Death occurs within five to seven years of diagnosis.
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The most common type of dementia, researchers estimate it affects as many as five million people living in the United States. Statistics claim that one out of every 20 men and women between the ages of 65 and 74 has Alzheimer’s disease.
The cause is not known, but deposit and accumulation of fibrous protein that form beta-amyloid plaque, (a sticky substance that prevents cell synapses from firing), disrupts brain architecture, alters how the brain uses energy and promotes cell death. The result is a slow and progressive decline in memory, thinking and reasoning. Eventually people lose the ability to swallow and breathe in a coordinated fashion. Pneumonia can cause death as food is aspirated—inhaled—into the lungs.
It is difficult to differentiate the signs and symptoms of this mental thief from normal aging, but eventually Alzheimer’s victims begin to have a hard time living alone as symptoms occur more frequently.
Signs of Alzheimer Disease
- Memory loss, such as forgetting important dates or events
- Asking the same information multiple times
- Difficulty in following directions—for example, the inability to follow a recipe or do simple math
- Hard to complete familiar tasks such as driving to a relative’s house or remembering the rules of a familiar game
- Confusion with time or place, for example, losing track of time, dates or seasons, forgetting where they are or how they got there
- Trouble understanding visual images such as, judging distance or recognizing self in mirror
- New problems with words and conversation including inappropriate comments and using made-up words
- Misplacing things and putting things in odd places, like an iron in the refrigerator and often accusing others of theft
- Increase in poor judgment where they might give large amounts of money away or share bank numbers with phone solicitors
- Poor hygiene and personal grooming
- Withdrawal from family, work and friends, such as a loss of interest in social activities or hobbies, forgetting how to knit or use tools
- Changes in mood or personality, for instance, belligerence, depression, exaggeration of former personality traits
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A November 2014 multi-institutional study has outlined and established criteria for a new neurological disease closely resembling Alzheimer’s disease called primary age-related tauopathy (PART). Similar to Alzheimer’s disease, patients with PART develop cognitive impairment, but they lack amyloid plaques. Because this new knowledge is available, awareness of this neurological disorder can help doctors diagnose and develop treatments that are more effective.
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Care and Prognosis
According to a study published in the medical journal Neurology, the majority of people with dementia have never seen a doctor about their memory and thinking problems. While there is no cure, they can receive care earlier.
Janet Yagoda Shagam says that managing behavior is can help. She says an Alzheimer’s Association survey shows that caregivers are often more interested in medication to improve behavior and daily living skills than ones used to improve mental thinking. Improved cognition may mean the patient does not understand why they cannot live alone, drive or do their own banking.
Identifying the type of neurological disorder in the early stages of disease is critical if managing and combating this illness before irreparable brain damage has occurred.
- Shagam, Janet Yagoda. An Unintended Journey: A Caregiver’s Guide to Dementia. New York: Prometheus Books, 2013. Book.
- 20 Questions, 100 Answers, 6 perspectives. Cokato, MN:BIP Brilliant Image Productions LLC, 2012. DVD.
- UCSF Medical Center: Lewy Body Dementia
- Alzheimer's Association: 2012 Facts and Figures
- Alzheimer's Association: Know the Ten Signs (pdf)