One headline reads “Dementia’s first signs appear long before old age, study finds.” (Bloomberg) Alternatively, another headline reads that “Cognitive decline can start at age 45.” (Medscape). These differing interpretations are the leads for two “alerts” I follow to try to keep up with current topics related to memory and aging. In both cases, the actual data are the same and come from a recent article published in The British Medical Journal. The headlines are based on a large, prospectively designed longitudinal study of more than 7,000 volunteers aged 45-70. Each participant (ranging in age from 45 – 70) underwent cognitive assessment three times during ten years. Overall scores on tests of memory and reasoning declined during the ten years. Only scores on tests of vocabulary remained stable. On face value these findings appear to be worrisome. However, on closer […]
As discussed the past two weeks, depression is frequent in both community dwelling elders and those with dementia. No matter what the source of depression, the most effective treatment for depression is to get activated even though you don’t want to. This is true for the young as well as the elderly and for caregivers as well as care receivers. We have often discussed the benefits of exercise for cognitive skills but there is also considerable evidence suggesting that exercise improves mood. For example, active people are less depressed on average than inactive people. Furthermore, people who exercise regularly and stop tend to show a decline in mood when compared to those who start or maintain exercise. A recent study randomly assigned depressed adults to an exercise group, a medication group, or a placebo group. Both exercise and medications improved […]
As discussed last week, depression is frequent in both community dwelling elders (by most standards those over 55) and those with dementia. Depression is more likely in dementias due to either vascular disease (strokes) or Lewy body disease than in Alzheimer’s disease (maybe there’s a benefit to short term memory loss). In short, depression is a common but not inevitable outcome for all of us as we age. What are the best treatments for depression? How well do different treatments work for those who are demented as well as for those who are not? Medications in the class called selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Prozac, Zoloft, Celexa, and Paxil are the most common medical treatment for depression. However, they are not a panacea – especially in the elderly and those who are demented. A large portion of […]
Behavioral problems like aggression, agitation, and hallucinations are often treated with medications called “antipsychotics” or “neuroleptics.” Newer medications in this class include Risperdal, Zyprexa, Geodon, Seroquel, and Abilify. Older medications, including Thorazine, Haldol, and Melleril, are not widely used today. The benefits of these medications are modest at best. However, the list of adverse effects continues to grow. A recent study adds to the concerns with use of these medications to treat behavioral problems associated with dementia. Antipsychotic medications caused significant decline in remaining cognitive skills. There was a significant drop in neuropsychological test scores when compared to placebo after 12 weeks of treatment. It is unclear from the results whether the decline is permanent and would be reversed by cessation of the drugs. This adds another element to the growing concern over the use of antipsychotic medications to manage […]
Pat Summitt is a legendary coach and achiever. She has won more major college basketball games than any other coach in the history of the game. She announced yesterday that she has had memory problems, at least over the past year. Furthermore, she announced that she has a family history of dementia. Her story will hopefully encourage others to seek early assessment and treatment for memory issues. However, the condition she described is not a dementia. Dementia means cognitive impairment that compromises the ability to work and live independently. Ms. Summitt would not be able to continue to coach if she were already demented. Her condition would be more appropriately referred to as a confusional state or forgetfulness. She is still in control of her future and can plan to compensate for memory changes and continue to work. She has […]
Depression has been associated with dementia. For example, the Framingham study followed 949 men and women (average age was 79) for 17 years. There was a 50% increased risk of developing a dementia in those reporting symptoms of depression during the study. Similar findings are evident from the Baltimore Longitudinal study of aging. Depression robs motivation and enjoyment, drives poor self-esteem, adds to the discomfort of pain, and produces social isolation. Depression also distorts memory. In very severe depressions, one is so focused on inner feelings of despair that there are few memory resources left to process information from their surroundings. As if this weren’t enough, people who develop a depression in later life are more at risk of experiencing cognitive decline. There are four explanations for the association of depression and cognitive decline. First, depression is a symptom of […]
One of the most frequent questions I am asked is “What is the difference between Alzheimer’s disease and dementia?” Dementia is a general term that is often misunderstood. Dementia refers to mental deterioration to the point that one can no longer do higher level mental tasks like balancing a checkbook, using a computer, or preparing a meal. In more severe forms of dementia, one may no longer be able to tend to personal needs such as bathing, toileting, or dressing. In other words, dementia refers to mental decline where one can no longer function independently (i.e., needs at least some level of external care). Dementia refers to the severity of the mental deterioration. Dementia is caused by a loss of skills that used to work well (e.g., finding your way around, paying bills, dressing). There are many possible causes of […]
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 […]
Lewy Body Disease is the second most common cause of progressive dementia after Alzheimer’s disease affecting over 1 million in the U.S. Dr. Frederich discovered aggregates of proteins in the brain stem that deplete a neurotransmitter known as dopamine. This causes Parkinson’s symptoms and the abnormal proteins are known as Lewy Bodies. In some persons, Lewy bodies diffuse out of the core brain structures to other areas of the brain causing diffuse Lewy body disease. Lewy Body disease is a progressive brain disorder characterized by decline in short-term memory (not as prominent as in Alzheimer’s disease), visual hallucinations (but other types of hallucinations may occur), movement disorders (e.g., slowness of movement or speaking, shuffling feet, walking stiffly, falls, blank stare), delusions (false ideas about another person such as partner having an affair), sleep disorders (e.g., movement, gesturing, speaking during sleep […]
Delirium is a frequently encountered form of confusion that is very frightening to family and friends as well as to the delirious person. Delirium presents as a sudden and often severe confusion as a result of severe medical illness, medication, surgery, hospitalization, or drug or alcohol abuse. Delirium occurs in 10-20% of hospitalized adults, 30-40% of hospitalized elderly, and up to 80% of those in ICU. Delirium is especially prevalent in persons who are demented. Delirium and dementia are often confused. However, the differences are important to know. Dementia is an irreversible deterioration of mental skills and may be sudden in onset such as with stroke, head injury, or brain tumors. Dementia is more often a slow progressive decline over the course of months to years such as with Alzheimer’s disease. Delirium is sudden and reversible but may last for […]
