Mild memory loss always presents diagnostic and treatment dilemmas. The actual prevalence of Alzheimer’s disease (a major cause of memory loss) changes with age so that it is 1.4% during the late 60s, 2.8% during the early 70s, 5.6% during the late 70s, 11.1% during the early 80s, and jumps to as high as 50% after 85. It is safe to conclude that age trumps all other risk factors if we live past 85. There are many putative risk factors that may cause memory loss and may also slightly raise the risk of developing Alzheimer’s disease: cardiovascular disease, cerebrovascular disease, high cholesterol, peripheral artery disease, elevated homocysteine, low folate, diabetes, smoking, midlife obesity, short men, adult onset depression, family history, and head injury. The greater the number of risk factors, the greater the risk. Head injury has received increased attention […]
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Sleep apnea is characterized by reductions or pauses (10 seconds or more) in breathing during sleep. Sleep apnea is more common in men than women before age 50 and the same after age 50. It is more common with obesity (maybe as high as 70%), heart disease (30-50%), and stroke (60%). Estimates suggest that only 10% of those with sleep apnea receive treatment. Untreated sleep apnea is associated with increased accidents at work and while driving. Sleep apnea induces daytime fatigue and sleepiness, headache upon awakening, and insomnia. It also affects mental functions including poor concentration, impaired attention, and poor memory. It contributes to irritability and anxiety. Those with sleep apnea may exibit loud snoring and abrupt awakenings with shortness of breath. If you have this constellation of symptoms, consult your doctor who may order a sleep study to definitively […]
Caregiving takes an enormous emotional and physical toll even when it is a labor of love and/or obligation. In the case of caring for someone with progressive memory loss, a spouse or child often has to parent their partner or parent. This sets up a natural and sad antagonism. The caregiver must set limits and enforce rules (nag and be bossy) and the care receiver isn’t aware that they need the guidance as they forget that they forget and resent and resist rather than appreciate the efforts on their behalf. Take for example the case of a caregiver (partner or child) who is caring for her very forgetful but very bright husband/father. He is so forgetful that he cannot monitor how much money he spends in any given month and is prone to overspend. His partner/daughter has to put him […]
I was giving a talk about assessing memory the other day and I was asked a question that I have been asked often – “When will there be a cure for Alzheimer’s disease?” It is a difficult question to answer. I don’t want to sound as if there is no hope but I also don’t want to give false hope. I would be very pleased to be wrong about my belief that there will not soon be a cure for Alzheimer’s disease, cancer, heart disease, etc. First, consider that Alzheimer’s disease is a complex and progressive degenerative disorder of the brain. It is not the only complex progressive brain disorder. Other progressive brain disorders include but are not limited to Parkinson’s disease, multiple sclerosis, Lewy body disease, Pick’s disease, Huntington’s chorea, and primary progressive aphasia. All are subtle in onset, […]
Many who later develop significant memory disorders and dementia start with mild changes that are difficult to distinguish from the normal changes of aging. Ronald Peterson at the Mayo Clinic described such cases as Mild Cognitive Impairment in about 2000. A number of factors may cause Mild Cognitive Impairment: Alzheimer’s disease, vascular disease (i.e., small strokes), Parkinson’s disease, Lewy Body disease, Primary Progressive aphasia…. The important word is mild. Persons with Mild Cognitive Impairment are not demented. They live independent lives. Many do not become demented. However, the risk of becoming demented is much greater for those with Mild Cognitive Impairment than those who never show these changes as they age. The new diagnostic criteria for Alzheimer’s disease include Mild Cognitive Impairment. Accordingly in Mild Cognitive Impairment: • The person or family members express concern about changes in memory or […]
As infants, we need assistance to survive. As we develop and master the world about us, we need less and less assistance. We become independent. Progressive dementia follows the course of development backwards. With dementias such as Alzheimer’s disease, there is a gradual loss of independence that requires outside assistance. The principle works according to the pattern of first in, last out. Last in, first out. Treating progressive dementias requires a forward looking plan that provides assistance where needed in a systematic fashion before dementia sets in. At first, we can provide our own assistance. Short-term memory makes new learning more and more difficult over time. We assist ourselves at first by fortifying our calendar and checking it often. We use post-it notes. There are a multitude of external memory supports. The more complex skills weaken first. We need to […]
There are many types of learning and memory. There is associative learning such as that involved in knowing that a red traffic light means stop and a green traffic light means go. There is nonassociative learning where learning and memory interact to allow us to “learn to learn.” The more crossword puzzles we do the better we become at crossword puzzles. There is perceptual learning. I often marvel at how well artists can learn to use space and design to create beautiful images. There is motor learning which allows us to be able to learn to swim or ride a bicycle. There are also many learning styles or types of intelligence. Some are best as visual learners. They need to see in pictures or images. They best learn and remember a new name by seeing it. Some are best as […]
There are currently two classes of medications that are FDA approved for treating Alzheimer’s disease. The cholinesterase inhibitors have been in use the longest. There are three drugs in this class Aricept (generic name is donepezil and it is now available in generic equivalent form), Exelon (generic name is rivastigmine and is available as either an oral tablet or as a patch), and Razadyne (generic name is galantamine). In general, despite conflicting opinions of efficacy and mechanism of action, drugs from this class tend to increase the level of acetylcholine in neurons and slow the rate of progression in many who can tolerate them. These medications are FDA approved for all stages of Alzheimer’s disease. There is no clear clinical benefit for one over another. The other medication is named Namenda (other brand names are Axura, Akatinol, Ebixa, or Memox […]
Alzheimer’s disease is being redefined to include three phases. An early phase where there are no obvious symptoms but changes are occurring in the brain. A middle phase where the problems are mild and the diagnosis would be called Mild Cognitive Impairment. A third phase where the changes are severe enough to be called dementia (i.e., independence is lost). The most sticking, and hopefully controversial, change is the addition of the early phase where there are changes in the brain but no symptoms of cognitive decline. This phase is defined by the use of biomarkers such as brain scans and tests of cerebral spinal fluid. The problems with this early phase include the fact that there are no standardized biological tests or results defining this phase. Second, 30% of people with amyloid plaques never develop clinical signs of Alzheimer’s disease. […]
We often focus on the cognitive changes such as memory that predict risk of decline and future dementia. But those who work or live with persons that ultimately obtain a diagnosis of Alzheimer’s disease know there is more to it than just memory. Equally as damaging are changes in what researchers at Rush University Medical Center are call “life space.” Life space is getting out and about. Those with restricted life space don’t venture far from home. One of the studies recently coming out of Rush’s longitudinal study of aging demonstrated a link between restricted life space and latter development of Mild Cognitive Impairment and Alzheimer’s disease. There were 1294 participants who had no mental decline at the beginning of the study. Participants were assessed after 4 to 8 years with detailed tests of cognitive functioning. Life space was defined […]
