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Mary Anders knew something was wrong when she and her husband, Al, moved to a new home. Al had a lifetime history of seizures and head injuries, but red flags started flying right away in the new house. The usually calm and carefree Al suddenly became easily confused and frustrated. Then, just as quickly, he'd "snap out of it." His disorientation advanced, however. One day, Al wandered away from home and was found miles off in freezing, 30-below weather. Mary made the tough decision: Al moved into a nursing home.
These days, Al, physically healthy at 67, remains in the nursing home he's lived in for the past 12 years and is getting the care he needs. But his case has never been definitively diagnosed. In fact, over the years, he has received multiple diagnoses: early-onset dementia, Alzheimer's disease, schizophrenia, traumatic brain injury and more.
"We can't solve the puzzle," Mary says. "Al's been unpredictable. Even now he has brief windows of clarity when he's completely himself. Usually, he doesn't know me. Then the phone rings and a nurse says, 'Al's on the phone and wants to talk to his wife.' It's devastating."
Al's story opens questions about what dementia is. According to Preston Peterson, MD, a geriatrician at the Legacy Clinic Northwest in Portland, Ore, "Dementia isn't one diagnosis, but a broad category of symptoms." And, he says, "Alzheimer's disease comprises between sixty to eighty percent of dementia diagnoses."
The Alzheimer's Association reports that more than 5 million Americans have Alzheimer's disease, a progressive and fatal disease that destroys brain cells, causes severe memory loss, and causes intellectual and behavioral disability.
Dementia, on the other hand, is a general term for serious, life-altering memory loss and other diminished intellectual abilities. The majority of cases falls under the title of Alzheimer's, but other types of dementia include:
- Mild cognitive impairment: This condition includes loss of memory, loss of language, or loss of another mental function--problems that are noticeable and show up on tests but don't interfere with daily life.
- Vascular dementia: This condition develops when impaired blood flow (like after a stroke) deprives brain cells of food and oxygen.
According to Dr. Peterson, it can be difficult to get an accurate diagnosis. , "Patients usually come in for short-term memory loss and speech disorders. We run tests--a neurological evaluation, blood tests, CT scan or MRI--for anything else that might cause symptoms, like alcohol or medications, vitamin deficiency, depression, anxiety, infection, or thyroid disorder. Alzheimer's is diagnosed when specific criteria are met and everything else is ruled out. The only absolute diagnosis comes with autopsy."
Everyone loses their keys or forgets a name occasionally, but there are 10 critical warning signs that warrant a closer look.
1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with regard to time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with speaking or writing words
7. Misplacing things and inability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality
If you have one or more of these symptoms, or you notice them in someone you know, it's important to see a gerontologist, neurologist, psychiatrist or psychologist with advanced training in senior health.
- Expect a complete medical exam, history and mental-status tests to determine if the patient:Is aware of symptoms
- Knows the date, time and location
- Can remember short lists of words, follow instructions and do simple
According to Dr. Peterson, the greatest risk factor is age. "Most patients are over sixty-five, but risks double about every five years. After eighty-five, dementia affects nearly fifty percent [of seniors]." While family history and genetics are uncontrollable risk factors, studies show some factors are controllable:
- There's a link between serious head injury and Alzheimer's. Use helmets and seat belts.
- Risks appear to be increased by heart disease, high blood pressure and cholesterol, stroke and diabetes. Dr. Peterson says, "People who exercise, eat a healthy diet, maintain healthy weight, [and] avoid tobacco and excess alcohol do better."
- Stay socially connected, and exercise both your body and mind.
There may be no cure, but there is hope. Dr. Peterson estimates that the average time from diagnosis to demise (usually from secondary illnesses like infection) is 10 years.
Medications can slow disease progression and give patients more functional years. The FDA has approved two types of drugs that affect chemical brain messengers important for learning and memory: Cholinesterase inhibitors (Aricept, Exelon and Razadyne) and Memantine (Namenda).
Scientists think vitamin E may help somewhat, and many studies are researching a wide range of non-drug, behavioral solutions for preventing and treating dementia symptoms. Antidepressants, antianxiety or other psychiatric medications make some patients more comfortable and less combative.
When these are no longer effective, many caretakers make the painful decision Mary made for Al: long-term residential care. "It's emotionally, financially and physically devastating," Mary says, "But at least I know he's safe." While Al's condition is unusual, Mary hopes to inspire people to do all they can to insure a healthy future and fund more research for better permanent solutions.
About the Author
Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other magazines.