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 […]
The Alzheimer’s Association International Conference met in Paris in August, 2011. This is an annual meeting that brings out all of the latest research findings. The first results from the Dominant Inherited Alzheimer’s disease study indicated that that there are measurable changes in cognition, biochemistry, and imaging up to 20 years before symptoms appear. These results are based on studies of high risk individuals who are carriers of a mutant gene that induces early onset Alzheimer’s disease that may develop as early as the 30s and 40s. These findings again confirm that Alzheimer’s disease comes on over the course of decades and that treatment approaches must be proactive. If you wait for symptoms, you lose your advantage. New research suggests that traumatic brain injury doubles the risk of dementia. These findings are based on a retrospective study of older (55 […]
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 […]
The American Heart Association and the American Stroke Association have issued a 42 page statement regarding the vascular contributions to cognitive impairment and dementia that was published in the July issue of Stroke. Although Alzheimer’s disease has received the most attention vascular changes make significant contributions to cognitive decline and should be routinely addressed in clinical practice. The statement suggests a new term, “vascular cognitive impairment,” to incorporate the varied cognitive disorders associated with stroke ranging from mild cognitive disorders through dementia. Don’t be confused by the introduction of a new term as accumulating evidence indicates that vascular factors also play a role in neurodegenerative cognitive disorders such as Alzheimer’s disease that develops latter in life and the recommendations below apply to all of us. Two criteria are needed to diagnose vascular cognitive impairment: (1) neuropsychological evaluation to demonstrate cognitive […]
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 […]
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 […]
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 […]
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, […]
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 […]
