Could a Diet Help Prevent Alzheimer's?

By Amanda Gardner, HealthDay News

Low-fat, low-glycemic eating plan improved 'biomarkers' of the disease, researchers say. 

 

MONDAY, June 13, 2011 (HealthDay News) — The low-fat, low-glycemic diet often promoted for general health and well-being may lower the risk of developing Alzheimer's disease if adopted early in life, researchers say. 

But starting such an eating plan after symptoms surface doesn't seem to help prevent deterioration of brain function, according to new research published online June 13 in Archives of Neurology. 

"This is not the first time this concept has emerged, that things you do in midlife or earlier on may have effects later on," said Dr. Marc L. Gordon, chief of neurology at Zucker Hillside Hospital and an Alzheimer's researcher at the Feinstein Institute for Medical Research in Manhasset, N.Y. 

"For example, we know that midlife obesity is associated epidemiologically with a higher risk of late-life dementia," he continued. "Whether that's causal or an effect of the disease is open to speculation, but it suggests that there may be periods of vulnerability that are different in different times in the life span." 

Although numerous studies have probed connections between lifestyle factors and cognitive ability, no solid proof yet exists that diet (or much else) can prevent Alzheimer's, the most common form of dementia among the elderly. 

A low-glycemic diet, which focuses on eating fruits and vegetables, whole grains and lean meats, avoids spikes in blood sugar and is said to promote feelings of fullness. 

A U.S. National Institutes of Health conference convened last spring concluded that, for now, older age is the leading known risk factor for Alzheimer's disease. A gene variation is also tied to increased risk for the brain disorder, the NIH review said. Experts at the conference stressed that the general public should still focus on avoiding behaviors already linked to other chronic diseases. 

This new study looked at the effect of different diets on biomarkers associated with Alzheimer's, such as blood sugar levels, cholesterol and blood lipid levels. The researchers also tested memory after participants followed the assigned diets. 

Twenty healthy adults and 29 with mild memory problems that could be predictive of Alzheimer's followed either a high-fat, high simple-carbohydrate diet ("HIGH" diet) or a diet lower in fat and simple carbohydrates ("LOW" diet). 

After four weeks, healthy participants on the LOW diet had changes in biomarkers, including insulin and lipid levels in the blood, which were moving away from those normally associated with dementia. 

In participants with mild cognitive impairment, this diet had the opposite effect. 

Commenting on the study, Dr. Suzanne de la Monte, professor of neurosurgery and pathology at Brown University and Rhode Island Hospital in Providence, said it remains to be seen if the changes noted in this study actually translate, over the longer term, into differences in risk for developing Alzheimer's disease. 

The bottom line, though, is the same as it's been for eons: A healthy diet lowers your risk of type 2 diabetes, heart disease, cancer and maybe even Alzheimer's. 

That means staying away as much as possible from processed foods, de la Monte advised. 

A second study, in the same issue of the journal, also looked at biomarkers and found that different levels were associated with different measures of cognitive function associated with Alzheimer's disease. 

This finding could help improve diagnosis of Alzheimer's, which now relies mostly on clinical observation.

Extra Pounds at Midlife May Boost Dementia Risk Later

By Kathleen Doheny, HealthDay

Being merely overweight in middle age raised risk by 70 percent compared to normal-weight peers, experts find.

 

TUESDAY, May 3 2011  (HealthDay News) — Being overweight during middle age may increase your risk of developing dementia later on, a new Swedish study suggests. 

Several studies have already linked obesity in middle age to dementia in later life, but it was unclear whether merely carrying some extra pounds in midlife was a risk factor. The new research suggests that even being overweight — defined as having a body mass index (BMI) of 25 to 30 — is linked with a higher risk of dementia. 

"Being overweight at midlife increased the risk of dementia in late life by more than 70 percent," said lead study author Dr. Weili Xu, a postdoctoral researcher at Karolinska Institute in Stockholm.

Being obese raised the risk even more, to nearly fourfold.

"Although the effect of midlife overweight on dementia is not as substantial as that of obesity, its impact on public health is significant," Xu said, noting that 1.6 billion adults worldwide are obese or overweight, including 50 percent of adults in the United States and Europe.

The study is published in the May 3 issue of Neurology.

In her study, Xu analyzed information from the Swedish Twin Registry. It included data on 8,534 twins aged 65 and older. Of those, 350 were diagnosed with dementia and 114 with possible dementia.

Thirty years earlier, the participants had provided what then must have seemed like mundane data: their height and weight.

That data would prove invaluable as Xu grouped them according to their BMIs, from underweight to obese (having a BMI higher than 30). Nearly 30 percent, she found, were either overweight or obese during midlife.

Further analysis showed that being overweight or obese in midlife independently increased the risk of later dementia, including Alzheimer's and vascular dementia.

About 26 percent of participants without dementia had been overweight at midlife, compared to 36 percent of those with possible dementia and 39 percent with diagnosed dementia.

And although 2.7 percent of seniors without dementia had been obese at midlife, 6.9 percent of those with dementia had been obese, as well as 5.3 percent of those with possible dementia.

When Xu analyzed twin pairs in which one had dementia in later life and one did not, she found the link to weight no longer significant, suggesting early environment and genetics also play roles in dementia.

Why the weight-dementia link? Several mechanisms could explain it, Xu said. A higher BMI is linked with diabetes and vascular disease, which is in turn related to the risk of dementia. Higher weight at midlife may reflect a long period of exposure to higher inflammation throughout the body, which has been linked with lower cognitive function.

Xu and her colleagues noted several study limitations, including the notion that BMI may not be the perfect measure of body fat composition.

They also noted that in terms of lowering dementia risk, it's never too late to start reducing body fat.

The study has a number of strengths, including the large number of people studied, according to Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center and professor of psychiatry and behavioral science at Albert Einstein College of Medicine in the Bronx.

Although the study finds a link between being overweight in midlife and dementia risk, it does not prove cause-and-effect, he said. Still, there is evidence that fatty tissue secretes inflammatory cytokines and other chemicals. These may have a direct effect on the brain, he said, inflicting damage to the neurons.

Dr. Gisele Wolf-Klein, director of geriatric education at the North Shore-Long Island Jewish Health System in Hyde Park, N.Y., said the study "is of great relevance in view of the growing epidemic of obesity in both the United States and Europe."

Language Fluency May Ward Off Dementia

By Michael Smith, North American Correspodent, MedPage Today

The ability to learn and speak two languages in addition to one's native tongue appears to keep the brain in shape, protecting it from dementia.

 

Wed. Feb. 23, 2011 — Speak English? Parlez français? Habla espanol?

Those who can say yes, oui, or si to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Dr. Magali Perquin, of the Public Research Center for Health in Luxembourg, and colleagues. 

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Moreover, the effect appears to add up — more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

“It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study,” Perquin said in a statement.

The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called “cognitive reserve” — developed by intellectual activities — protects against dementia.

Indeed, a similar study from a Canadian group, presented at the annual meeting of the American Association for the Advancement of Science this month, showed that having two languages rather than one appeared to delay the onset of dementia.

The “use it or lose it model of cognitive function” has been gaining popularity for several years, according to Richard Lipton, MD, of Albert Einstein College of Medicine in New York City. With colleagues, Lipton showed in 2003 that such activities as chess, bridge and doing crossword puzzles appeared to protect against Alzheimer’s disease.

In that context, Perquin’s findings “are not surprising to me,” Lipton told MedPage Today.

But he cautioned that there are at least two other possible explanations for such data, including his own findings.

On one hand, he said, it’s possible that the intellectual activities themselves are not protective, but that being the sort of person who does crossword puzzles or learns several languages is the key factor.

On the other hand, he said, it may be that the causality is reversed — that incipient cognitive impairment impairs the ability to perform such activities.

But the study is “fascinating,” he added, and “as an optimist, I would like to believe it is completely true.” 

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The so-called MémoVie study in Luxembourg is a longitudinal analysis of cognition and its risk factors in the elderly and one of the aspects of the study is the effect of multilingualism.

Luxembourg, a small country in the heart of western Europe, has three official languages and a large number of people who speak several tongues.

For the analysis, participants in the MémoVie study were classified as having normal cognition, some cognitive impairment, or frank dementia, with the latter being excluded.

All told, 44 participants had cognitive impairment and the remaining 186 were cognitively normal, the researchers reported.

Participants had spoken — or currently spoke — two through seven languages; those with only two languages were considered the reference group for a multivariate analysis that adjusted for age and years of education, Perquin and colleagues reported.

Analysis showed that, compared with bilinguals:

• Participants who had spoken three languages were four times more likely to be protected against cognitive impairment.
• Those with four or more languages were even better off — they were six times less likely to develop dementia than those who mastered only their native tongue.

Perquin noted that more research is needed to confirm the findings and to see if protection is limited to thinking skills related to language “or if it also extends beyond that and benefits other areas of cognition.”

Common Causes of Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Alzheimer's disease is the best-known cause of dementia — but there are a slew of other causes, too. Do you know what they are?

 

Dementia is really a big umbrella term that covers a number of different conditions that cause dementia symptoms. Of these, Alzheimer’s disease is the most common and perhaps best known — but it’s not the only one.

“There are many different types of dementia,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa. “The most common types of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, and Parkinson’s disease. All types of dementia are characterized by abnormal neurodegeneration, that is, brain cells dying off in high numbers daily. In most cases, this leads to cognitive and behavioral deficits or, in Parkinson’s disease, to deficits in motor skills.”

One of the ways in which types of dementia are categorized is by where the damage to these cells is occurring in the brain.

Broadly speaking, types of dementia are grouped as cortical or subcortical. Cortical refers to dementias that originate in damage to the cortex — the outer, gray, wrinkled layer layer of brain tissue with which people may be most familiar. Subcortical dementia has its roots in structures below the cortex, inside the brain. The dementia symptoms vary based on whether the dementia is cortical or subcortical. Despite this distinction, dementias of all kinds often involve multiple parts of the brain, and there is ongoing debate as to whether this is a meaningful way to categorize dementia symptoms.

 

Cortical Dementia 

 

Cortical dementia is likely to result in dementia symptoms such as loss of memory, loss of the ability to recognize people, and difficulty recalling the right words for things or concepts. Cortical dementias include:

• Alzheimer’s disease. Alzheimer’s disease causes a loss of memory and ability to think clearly. It is a progressive disease, eventually leading to a loss of ability to complete tasks of daily living.
• Creutzfeldt-Jakob disease. Also sometimes called mad cow disease, Creutzfeldt-Jacob occurs when naturally occuring brain proteins called prions start to change shape. This leads to cognitive impairments such as loss of memory, changes in thought processes, and changes in behavior.
• Frontotemporal dementia. This type of dementia results from degeneration of cells in the frontal lobe; it's characterized by behavioral and language deficits at a relatively young age — as young as 40.
• Wernicke-Korsakoff syndrome. This type of dementia is due to a deficiency in thiamine (vitamin B1) but is also often related to a history of heavy alcohol consumption or to having AIDS, or acquired immunodeficiency syndrome. Memory is affected, and people with this dementia often tell untrue stories that they fully believe to be true. Physically, this dementia can interfere with a person’s ability to move smoothly.

 

Subcortical Dementia

 

Dementia symptoms associated with subcortical dementias include loss of motor skills and the ability to learn processes, resulting in a general sense of slowing down. These types of dementia include:

• Huntington’s disease. A rare, inherited cause of dementia, Huntington’s disease leads to problems with motion such as twitches and lack of balance or coordination and may also lead to changes in mood, personality, and behavior.
• Parkinson’s disease. Parkinson’s disease is characterized by the gradual loss of motor skills, or shakiness and tremors while in motion. People with Parkinson’s disease may eventually experience other dementia symptoms, such as loss of memory.
• Vascular dementia. Vascular dementia occurs as the result of loss of oxygenated blood to parts of the brain. This can be the result of a single stroke or many small strokes, in which case it is called multi-infarct dementia. Evidence shows that subcortical vascular dementia also has effects in the cortex, leading to cortical dementia symptoms.

Some types of dementia appear to affect both cortical and subcortical areas of the brain. Dementia with Lewy bodies falls in this group. This type of dementia occurs because clusters of a certain type of protein called alpha-synuclein form in the neurons in various areas of the brain, leading to impaired memory, motor skills, and mood. Dementia with Lewy bodies can resemble both Alzheimer’s disease and Parkinson’s disease — and Lewy bodies are often found in patients with other types of dementia.

These are only a few of the many possible causes of dementia — and it’s important to understand the cause of your dementia because it will affect treatment decisions.

8 Dementia Myths and the Truth Behind Them

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Maybe you've heard that drug abuse causes dementia, or that red wine will protect you from the disease. Here are the facts. 

 

Perhaps because Alzheimer’s disease and dementia are something of a mystery, there are a number of myths surrounding their causes. A few of these common myths hold some truth, but some are complete falsehoods that muddy the water about the roots of symptoms and how to prevent dementia.

Need help separating good dementia information from bad? We’ve gone to an expert to get the facts.

Myth No. 1: Dementia is caused by exposure to aluminum.

Cooking in aluminum pots and drinking from aluminum cans came under suspicion as a cause of dementia a number of years ago, when this myth first spread. But there is no truth to the fear, says Paul B. Rosenberg, MD, assistant professor of psychiatry and behavioral sciences in the division of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine in Baltimore.

“This was an inference from a type of dementia caused many years ago by aluminum that made its way into dialysis patients, but aluminum has nothing to do with dementia as we diagnose it now,” explains Dr. Rosenberg.

Myth No. 2: Dementia is caused by early drug abuse.

Rosenberg says this is an area that has not been thoroughly explored, but currently there are no data to support a connection between drug abuse and Alzheimer's or dementia. Drug abuse isn’t a healthy choice for many other reasons, however.

Myth No. 3: There is nothing you can do about dementia once you have it.

While dementia is by definition a progressive disease, there are steps you can take to slow its progress and find ways to compensate for your lost cognitive abilities in the early stages. Work with your doctor to find medications that might help address symptoms of dementia, and try to stay as physically, mentally, and socially active as possible.

Myth No. 4: Concussions in youth and middle age cause dementia.

News about the increased rates of early dementia in former football players has stimulated this myth, but the jury is still out, says Rosenberg. “There is a suspicion that concussions in young or middle age increase risk for dementia in old age, and we are trying to study this now.”

Myth No. 5: Red wine protects you from dementia.

“There is a little evidence that low-level social drinking — one drink or less per night — may be protective, but that finding is quite controversial,” says Rosenberg. The controversy arises because heavy drinkers tend to die young, skewing the data. Meanwhile, people interested in the protective benefits of resveratrol, a chemical found in red wine, should take heed: “You probably have to drink 20 bottles per night to get a good dose,” says Rosenberg.

Myth No. 6: If someone in your family has dementia or Alzheimer’s disease, you will have it too.

Not so, say the experts. Some forms of dementia do have a genetic component, especially if a close relative such as a parent or sibling has the disease — but as with many inherited diseases, you have some control over how inherited risk plays out in your own life. “Our evidence is that good heart health — exercise, controlling blood pressure and cholesterol — will help prevent dementia,” says Rosenberg.

Myth No. 7: Alzheimer’s disease and dementia are the same thing.

Alzheimer’s disease is the most common form of dementia, but there are other types of dementia characterized by different symptoms.

Myth No. 8: Gingko biloba can prevent memory loss.

For a while, researchers were looking at the herbal supplement gingko biloba as a way to slow or prevent memory loss — but studies have shown no effect on memory. “Gingko was a nice idea, but it didn’t work at all,” says Rosenberg.

These are just some of the myths that surround the subject of dementia. But remember, it's always advisable to get dementia information from reliable sources, such as your doctor, instead of relying on rumors about causes or ways to prevent dementia.

Normal Memory Loss or Dementia?

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH 

Lost your keys? Don't stress — a memory glitch here and there often accompanies aging. Lost your way home? This could be signaling something more serious.

 

Is it just age-related memory loss — or the early signs of Alzheimer’s disease? Sooner or later, you will ask this about yourself, your spouse, or someone else in your family. But the question of whether you are noticing dementia signs is not an easy one to answer.

A certain degree of forgetfulness may accompany aging. Normal memory loss most often means that you have a harder time recalling new pieces of information, such as the name of a person you met for the first time last week.

“Typical signs [of dementia] are extreme forgetfulness, not just forgetting the keys here and there. Rather, forgetting where one is, whether or not one just ate, forgetting to put shoes on before going outside, and that sort of thing,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa.

So if you go for your daily walk and experience a little confusion about how to get home, should you worry? Many experts, like Andel, think it’s a good idea to err on the side of caution and get in touch with your doctor if you have moments of forgetfulness that worry you.

“The difference can be very subtle, and any suspicion should be consulted and/or confirmed by a professional, such as those working at memory clinics of Alzheimer’s disease centers,” he says. The advantage to working with an expert, such as a neurologist, is that an expert can give you memory tests that help determine whether your experience with memory loss is normal or not.

 

Dementia Signs that Indicate a Problem

Consider these red flags of memory loss and cognitive problems:

• Does it interfere with daily life? Everyone forgets a name, only to remember later — but if you’re consistently forgetting appointments, can’t remember how to cook foods you’ve always been able to cook, or people tell you you’ve asked them for the same information multiple times, those are more serious signs.
• Do you have trouble thinking things through? We’ve all made a mess of our accounting once or twice, but if you just can’t figure out how to balance your checkbook or plan the kind of trip you used to enjoy, it may be time to seek help. In fact, a recent study suggests that problems remembering how to handle money foreshadows an Alzheimer’s diagnosis by up to a year.
• Are you having trouble retracing your steps? Everyone misplaces their keys, but most people usually can go back over their steps to find them again. Dementia signs include an inability to retrace your steps to find lost items.
• Are you at a loss for words? We all know about the tip-of-the-tongue phenomenon, when a word you want is just out of reach. But frequently being unable to come up with the word or phrase you want can be a sign of Alzheimer’s disease.
• Do you lose your sense of place and time? Forgetting where you are, how you got there, the order of events, or even what day it is — these are all more than just “normal” signs of memory loss.

 

Other Causes of Forgetfulness

It’s natural to worry about dementia and Alzheimer’s disease as causes of your more-than-normal forgetfulness, but you should know there are some other possible causes, including:

• Alcoholism
• Dehydration
• Depression
• Head injury
• Medication side effects
• Protein deficiency
• Stroke(s)
• Vitamin B12 deficiency

When you talk to your doctor about your concerns about memory loss and the risk of Alzheimer’s disease, she should also ask questions that will help her find out whether there may be other causes of your problems.

“True dementia cannot be reversed whereas cognitive impairment due to other causes can be reversed" in many circumstances, says Andel.

So if you’re worried, talk to your doctor. At best, you will be reassured that your occasional forgetfulness is normal for your age — and at worse, you will be able to start early with dementia treatment and management strategies.

The Enigma of Early-Onset Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH

The risk of being diagnosed with dementia increases with age — but for a small group of people, dementia symptoms start appearing as young as 35. 

 

Dementia is usually thought of as a health concern of the elderly — but for a few patients, a dementia diagnosis comes earlier. This loss of memory and cognitive abilities at a younger age is called early-onset dementia. Diagnosis of early dementia is a challenge, and dementia treatment is complicated by the demands of younger families and jobs.

“The majority of cases of dementia in the United States are in people over 65, and 50 percent are in people over 85 years old but … we’ve seen patients who have the disease at 35,” says Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago.

As many as 6 percent of Alzheimer’s disease cases occur before age 65, usually in a person’s forties or fifties. Close to 60 percent of those cases are inherited — 13 percent appear in families in which three generations have developed Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia symptoms, but other causes of early-onset dementia include:

• Vascular dementia. Changes in blood flow to parts of the brain, often due to mini-strokes, can begin in mid-life.
• Frontotemporal dementia. A fatal disorder in which parts of the brain shrink.
• Parkinson’s disease. Motor skills — walking, balance, and the like — deteriorate because the brain stops producing dopamine.

The Complications That Come With Early Dementia

 

Early-onset dementia comes with complications that do not arise in later years, including:

• Difficult dementia diagnosis. Dementia is usually not a doctor’s first conclusion when a person starts to lose cognitive function in middle life — which means that it can take a while to arrive at a correct diagnosis. However, while the diagnostic process is taking place, dementia symptoms can wreak havoc on personal relationships and work obligations.
• Family. When people are diagnosed over age 65, they are usually finished with child-rearing responsibilities, but early-onset dementia can interrupt family life as adults in middle age may still be raising children, supporting young adults in college, and even caring for their own aging parents.
• Employment. Dementia treatment often focuses on helping patients stay as long as possible in the working world. Patients and families also have to work with employers to adjust workloads or tasks to suit abilities.
• Finances. The burden of early dementia combined with the possible loss of employment can cripple a family’s financial situation.
• Qualifying for services. Many services and funding programs are only available for people over age 65, which means patients with early onset dementia and their families have to work harder to get the support they need.

Handling an Early Dementia Diagnosis

 

“We have to take a slightly different approach to building the care plan,” says Dr. Shah. A care plan is a detailed approach to dementia treatment that creates a so-called web of services around the patient and his family. These services include a medical team, occupational therapists, support groups, and community services or agencies that can provide assistance.

Therapy may be necessary for the children and spouses of the dementia patient, who may experience significant anger, grief, and resentment over an early dementia diagnosis. The care plan has to be adjusted as the needs of the patient and family caregivers change.

There may be a perception that early dementia progresses more rapidly than later onset dementia, but this is likely because everything related to dementia treatment, including entering a nursing home, is happening at an earlier age rather than happening more quickly or severely.

Early onset dementia places a significant burden on families — but with the dedicated help of their medical team, friends, family, and coworkers, patients may be able to maintain quality of life for many years.

The Seven Stages of Dementia

By Madeline Vann, MPH | Medically reviewed by Niya Jones, MD, MPH

From "no impairment" to "very severe," knowing the seven stages of dementia can help guide you as a caregiver. 

 

One of the main topics of discussion when someone is diagnosed with dementia is the “stage” of the disease — a marker of how far it has progressed.

Dementia symptoms can range from mild memory loss to more severe cognitive difficulties that make it hard to manage daily activities without help. These symptoms are broadly grouped into categories called stages that help guide doctors and families in their care of dementia patients.

“Usually we think of memory loss as a continuum,” explains Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago. “Dementia is defined as chronic memory loss, ultimately affecting quality of life.”

Dr. Shah points out that people with dementia progress along the memory loss continuum in their own individual way, and often there is no clear-cut moment when you know that your loved one has moved from one stage to another. Becoming familiar with the stages of dementia, however, is still useful for giving care. This can help guide:

• Expectations. You and your family members will have a general idea of what your loved one’s future may hold and you can make plans accordingly.
• Treatments. The medications available to help control dementia symptoms have been studied in clinical trials during different stages of dementia. Not all medications are necessarily appropriate for your family member, depending on their specific symptoms and stage of dementia.

The Stages of Dementia

The stages of dementia are as follows:

• No impairment. At this stage, there are no obvious signs of dementia and people are still able to function independently.
• Very mild. Dementia signs are barely noticeable and simply appear to be the kind of forgetfulness associated with aging — such as misplacing keys but finding them again after some searching.
• Mild. At this stage, patients are “usually able to do basic activities of daily living,” says Shah — which means they can perform their daily routines, such as getting up, going to the bathroom, getting dressed, and so on, without difficulty. Symptoms of dementia at this stage may include:
  • Some forgetfulness and memory loss
  • Repetition
  • Losing items without being able to retrace steps to find them
  • Slight trouble managing finances, such as balancing a checkbook
  • Confusion while driving
  • Trouble managing medications
  • Loss of concentration
• Moderate. At this stage patients have “trouble doing routine tasks that they always did, such as cooking, laundry, or using the phone,” explains Shah. Other dementia symptoms during this stage include:
  • Trouble holding urine (incontinence)
  • Increase in memory loss and forgetfulness
  • Inability to use or find the right words and phrases
  • Difficulty doing challenging mental math exercises, such as counting backwards from 100 by 7
  • Increase in social withdrawal
• Moderately severe. At this stage, dementia patients will need some assistance with their day-to-day activities. Symptoms of moderately-severe dementia include:
  • Increase in memory loss, including inability to remember home address, phone number, or other personal details
  • Confusion about location or chain of events
  • Trouble with less challenging mental math exercises
  • Needing help to select appropriate clothing for the climate, season, or occasion
• Severe. “Caregivers have to help a lot more with day-to-day activities” at this stage, says Shah. Dementia signs at the severe stage include:
  • Needing help to get dressed
  • Requiring help with toileting, such as wiping and flushing
  • Wandering and becoming lost if not supervised
  • Inability to recall the names of family members or caregivers, but still being able to recognize familiar faces
  • Sleep disturbances
  • Changes in personality or behavior, such as increased paranoia or even hallucinations
• Very severe. This is the final stage of the disease. Symptoms of dementia during this stage include:
  • Loss of language skills
  • Loss of awareness of surroundings
  • Requiring help to eat
  • Lack of control over urination
  • Loss of muscle control to smile, swallow, or even walk or sit without support

In order to determine your loved one’s stage of dementia, your doctor will ask a variety of questions of both the patient and the caregiver. These questions may include some mental tests. One frequently used screening tool is called the Mini-Mental State Examination, an 11-question exam that can help pinpoint cognitive decline on a scale of 0 to 30. In general, Shah says that a score between 14 and 26 points correlates to mild/moderate stage dementia and a score between 4 and 14 correlates with severe dementia.

It’s important to remember that the stages of dementia are somewhat fluid — use them to help plan for future changes and to work with your doctor to develop a solid treatment plan.

Dementia — Beyond Alzheimer's Disease

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH 

Alzheimer's disease is the most common cause of dementia, but it's not the only one. From Parkinson's disease to stroke, find out which other conditions are associated with dementia.

Alzheimer’s disease causes up to 75 percent of dementia cases — but even though the two conditions are often associated, dementia is not always related to Alzheimer’s disease.

“Dementia is just a fancy word for memory loss,” says Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago. “It doesn’t tell you what the cause is.” In addition to memory loss, dementia also causes difficulty with thinking, reasoning, and decision making.

A dementia diagnosis is based on the presence of certain symptoms, which are then categorized to determine the stage of dementia and the appropriate dementia treatment. There is no cure for dementia, which is by definition a fatal, progressive disease, meaning dementia symptoms will only get worse over time. Dementia treatment, however, can help slow the progression of symptoms in some cases.

 

Possible Causes of Dementia

If someone is diagnosed with dementia, the possible causes include:

• Alzheimer’s disease
• Creutzfeldt-Jakob disease, a rare brain disorder sometimes referred to as mad cow disease that kills most patients within a year
• Frontotemporal dementia, a condition in which parts of the brain shrink, affecting either behavior or speech
• Strokes, in which cause brain cells die because their oxygen supply has been cut off or from bleeding in the brain, sometimes resulting in a condition called vascular dementia
• Traumatic brain injury
• Lewy body dementia, a common type in which Lewy bodies, a type of protein, build up in the brain, causing cognitive and other types of problems
• Parkinson’s disease, which occurs when nerve cells in the brain lose the ability to make a chemical transmitter called dopamine, causing difficulties with movement, as well as dementia

The Worst Form of Dementia? Because Alzheimer’s disease is the most common cause and the most often studied, people may believe it to be the “worst” form of dementia.

“In general, for anybody with dementia, it’s just horrible — for the person and the caregivers,” says Dr. Shah. He explains that there has been limited research on which types of dementia consistently progress faster or more severely, so there is no objective standard of what might be the worst type of dementia. Whichever one you are dealing with is likely to feel like the worst.

 

How Dementia Is Treated

Even if Alzheimer’s disease is not the cause of the dementia, treatment is likely to be the same.

“We use the same treatment mechanisms for everybody,” says Shah. “Ten percent is medications; 90 percent is education and community support.”

The medications that are available to help control dementia symptoms have primarily been tested in Alzheimer’s disease patients and are generally approved for use in Alzheimer’s disease — which means that if they are used for a patient with vascular dementia or Parkinson’s disease, that is technically an “off-label” use.

This may not change the outcome of treatment, but Shah emphasizes that it is important for doctors, patients, and their families to be clear about off-label uses of dementia medications.

Most dementia treatment involves developing an individualized care plan, says Shah. That means creating a web of care with the patient in the middle, surrounded by family and caregivers, and building a network of support that involves the medical team, as well as community and social services.

However, if your form of dementia is caused by something other than Alzheimer’s, you may have additional treatments that are specific to your underlying condition.

Even if you do have Alzheimer’s, your doctor may want to prevent complicating factors that could add to your dementia, such as strokes, so you could also be started on treatments that are new to you, such as blood pressure and cholesterol medication.

 

Are All Dementias Made Equal?

Regardless of the cause of dementia, you can expect the disease to progress through the same stages, as defined by worsening symptoms, although at different speeds. If you are concerned that a diagnosis of Parkinson’s disease or frontotemporal dementia means you will one day have Alzheimer’s, know that one cause of dementia does not automatically become another type of dementia.

Understanding the differences among the different causes of dementia — and what they mean for dementia treatment and quality of life — is challenging. Research and consultation with your medical team are an important part of coming to grips with what this news means for your health and your family.

Is It Alzheimer's?

• By Katherine Lee

What distinguishes Alzheimer's from other types of dementia? Here's how experts make a diagnosis

Dementia is a general term that describes a significant loss of intellectual abilities, including memory, the ability to reason, and other cognitive and behavioral changes that can interfere with daily life. While a number of health conditions can lead to dementia and related brain deterioration, the most common cause is Alzheimer's disease, which according to one recent study sponsored by the National Institute on Aging, now accounts for as much as 70 percent of all cases of dementia in people 71 and older.
Alzheimer's disease strikes about 5 percent of all people between the ages of 65 and 74. Some forms of dementia can be treated, and some symptoms may even be reversed, especially if caught early. Most types of dementia, however, including Alzheimer's, become progressively worse and are, as of now, incurable.
 
Symptoms of Dementia
While dementia presents itself differently from individual to individual, common symptoms include:

• Memory loss that increases over time
• Language problems, such as difficulty finding words or understanding spoken or written communication
• Disorientation, eventually extending to familiar places
• Persistent confusion, including about the date or time of day
• Face-recognition issues, in time even with familiar people
• Lack of self-regard, including neglect of personal safety or hygiene
• Inability to do routine tasks, such as pay bills or shop for groceries
• Erratic behavioral and psychological changes, such as paranoia, hallucinations, depression, temper tantrums, or insomnia

Diagnosing Alzheimer's
Since the only way to definitively confirm the presence of Alzheimer's disease is by looking at changes in brain tissue, which can usually only be examined after death during an autopsy, any diagnosis of Alzheimer's is essentially an educated guess. But, despite the challenge of sorting out Alzheimer's from other causes of dementia, experts at the National Institute on Aging estimate that doctors at specialized centers can now diagnose Alzheimer's with 90 percent accuracy. Some diagnostic tools doctors use for Alzheimer's include:

• Patient evaluation, including an overview of their general health, previous medical conditions, and their ability to conduct daily activities
• Cognitive tests to measure memory, problem solving, and language skills
• Lab tests of blood, urine, and spinal fluid
• Brains scans

Other Forms of Dementia
While Alzheimer's disease is the most common form of dementia, affecting an estimated 4.5 million Americans, other diseases or traumas can also lead to neurological dysfunction. In some cases, different types of dementia can coexist in one patient. Some examples of non-Alzheimer's dementia include:
Vascular dementia. Caused by impaired blood flow to parts of the brain, this form of dementia can occur when narrowed blood vessels provide less oxygen than necessary to the brain tissue, after a major stroke, brain hemorrhage, or a period of catastrophically low blood pressure, or due to other artery-damaging conditions such as systemic lupus erythematosus or temporal arteritis. Onset of symptoms can be sudden (such as following a major stroke) or can progress gradually after a series of smaller strokes (called multi-infarct dementia).

Dementia with Lewy bodies (DLB). Patients with this type of dementia have abnormal clumps of protein in their brains. DLB symptoms include progressive cognitive decline with lethargy, visual hallucinations, and loss of movement and motor control. Lewy bodies have also been found in people with Parkinson's disease and Alzheimer's, suggesting a connection among the three conditions.
Frontotemporal dementia (including Pick's disease). This rare disorder is sometimes characterized by the shrinking of areas in the front and sides of the brain (which can be detected with a brain-imaging scan). Because these areas of the brain regulate social behavior and judgment, this type of dementia is often characterized by sudden personality changes and inappropriate behavior, as well as by problems with understanding and using language.
Huntington's disease. People with this fatal genetic disorder develop involuntary movements, such as twitches and spasms, difficulty with motor tasks, mood swings, intellectual impairment, personality changes, and eventually severe dementia.
Parkinson's disease. Early symptoms of Parkinson's include stiffness of the limbs, tremors, speech impairment, and difficulty with walking and muscle control. Dementia can often occur as a secondary symptom in the later stages of the disease.
Related reactions. Some other situations that can cause dementia-like symptoms include reactions to medications, thyroid problems, infections in the brain, alcoholism, HIV-related dementia, and even vitamin deficiencies.
The Future of Alzheimer's Diagnosis
Early and accurate diagnosis offers the best chance of treating Alzheimer's symptoms and helps to give patients and their families more time to evaluate and discuss their treatment and care options. For this reason, doctors are working on ways to improve early detection. Some of the latest efforts include:

• Memory tests. Researchers are working to improve standardized memory and recall tests to better track changes that might indicate early Alzheimer's and even predict which individuals are at higher risk of developing the disease in the future.
• Tissue comparisons. Studies are examining the relationship between early damage to brain tissue and later development of Alzheimer's.
• Blood tests. Researchers are looking for ways to identify changes in blood chemistry that could one day lead to blood tests or other simple tools to identify individuals at risk for Alzheimer's.
• Imaging scans. Doctors are looking at ways to use neuroimaging, such as positron emission tomography (PET) and magnetic resonance imaging (MRI), to one day help identify individuals who are in the early stages of the disease, even before they develop symptoms.