|
I’m
surprised when some patients and caregivers confuse dementia and
Alzheimer’s as one and the same. Each time a family member is suffering
from memory loss, the conclusion is always Alzheimer’s. Is it reasonable
to label all dementias as Alzheimer’s?
As
a clinician, my answer to queries is that Alzheimer’s dementia is only
one type of dementia and that not all dementias are Alzheimer’s. Aside
from Alzheimer’s disease, other dementias exist such as Dementia with
lewy body, Vascular dementia, Parkinson’s disease with dementia, and
dementias due to various neurologic and medical conditions.
How will you know if a person is suffering from Alzheimer’s dementia? What is Alzheimer’s dementia?
Alzheimer’s
dementia is a neurologic disorder characterized by a progressive and
irreversible cognitive decline associated with impairment in
functioning. The cognitive deterioration consists of memory impairment.
Initially there is recent memory impairment but as the disease
progresses, even the long term memory is affected.
In
addition to memory impairment, a patient with dementia has impairment
in one of four cognitive areas: aphasia, apraxia, agnosia, and
impairment in executive functioning. Aphasia is a problem in language
characterized by inability to express oneself, repeat words or phrases,
or understand what is being said. Apraxia is inability to adequately
perform a usual motor activity such as combing the hair or brushing the
teeth despite no paralysis or musculoskeletal abnormality.
Agnosia
is inability to recognize objects or things despite intact sensory
functions. For instance, a demented patient cannot recognize a key or a
pen placed in his or her hands without looking at it.
Impairment
in executive functioning is characterized by difficulty in abstract
reasoning and in organizing things, schedule, and activities. Patients
with this problem give concrete meaning to proverbs. For example, when a
patient is asked what “don’t cry over spilled milk” means, the patient
responds, “It’s easy. Just wipe it!” Moreover, knowing the specific
similarities and differences of certain things (e.g. apple versus
orange) is a struggle for some patients.
What are the possible causes of Alzheimer’s?
The
cause of Alzheimer is still unknown. However, several risk factors have
been identified. One major risk factor is age. The risk of developing
dementia increases as our age advances. Older individuals therefore are
more at risk. Having said this, Alzheimer’s can also happen to young
individuals.
Other important
risk factors include the presence of apolipoprotein E4 allele, the
predominance of plaques and tangles in the brain, and the brain’s
impaired cholinergic system.
Is there any successful treatment for Alzheimer’s?
Alzheimer’s
disease is irreversible so current medications are only geared to slow
down the deterioration. These acetylcholisterase inhibitors, namely
galantamine, rivastigmine, and donepezil, are aimed at improving the
cholinergic functioning in the brain by inhibiting the cholinesterase
enzyme. Although initially indicated for mild to moderate dementia, some
recent evidence shows that some of these drugs may also benefit
patients with moderate to severe dementia. Further studies are warranted
to determine its efficacy in this group.
Copyright © 2004. All rights reserved.
Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist,
Reader’s Preference Choice Award 2002), speaker, workshop leader, and
psychiatrist. Dr. Rayel pioneers the CARE Approach as first aid for
mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.
mike@drrayel.com
|
