Health & Wellness Corner: Understanding Dementia
I recently experienced a most extraordinary presentation on Understanding Dementia by Dr. James Coggin, M.D, speaker for INR-Institute for Natural Recourses. The focus of this 8 hour seminar was on learning and understanding the variety of chronic-progressive-degenerative- neurological disorders that fall under the “umbrella term” we know as dementia. Here are some highlights from Dr. Coggin’s lecture.
Dementia is a progressive loss of cognitive function- often accompanied by disturbances of mood, behavior, and personality- that leads to significant impairment in the ability to perform normal activities of daily living (ADL’s). Dementia is not a specific disease (like Alzheimer’s); rather it is a term for a group of symptoms caused by different progressive neurological disorders resulting in brain cell death (91% of the dementia’s under this “umbrella” are irreversible). Nine primary neurodegenerative dementias were discussed with the focus on Alzheimer’s disease. This neurological disease constitutes (>65 – 85%) of our population in which only 30% have pure Alzheimer’s. The disease currently affects over 5.4 million people in the US and with a rapidly aging baby boomer population that figure is expected to rise to 7.7 million in 2030 without significant treatment for cure. Because of increasing human life expectancy and the fact that age is the biggest risk factor, dementias are becoming more prominent and found in 14% of Americans age 71 and older. The risk doubles every 5 yrs after the age of 65: only 1% of 60 years olds have dementia but 30-50% of those who are age 85 and older, have dementia. And interestingly enough, history of caregiving for a family member with dementia, increases the risk of the caregiver for developing dementia by 6%.
Age is not the only risk factor. Independent-living centurions do not have dementia. Both lifestyle factors and genetic predispositions play a role in the risk of developing dementia. Stress plays a key role in dementia and while memory loss is common in dementia- in and of itself- does not constitute dementia. Memory is a skill. If we work our brains, they need not decline.
There are many signs and symptoms of dementia. They vary within /with every individual.
- disorientation to time or place
- inability to concentrate
- loss of initiative
- trouble with executive functions such as planning
- language disturbances (aphasia)
- impaired motor performance (apraxia)
- problems with spatial reasoning
- failure to recognize common objects (agnosia)
- personality and mood changes
- neglect of personal hygiene and safety
- asking same questions over and over
- inability to do complex tasks like cooking a meal
- becoming lost in once-failiar places
- forgetting names of familiar people
- forgetting regular appointments
- neglecting personal hygiene
- showing signs of mental confusion
- experiencing mood symptoms of anxiety, irritability, anger and depression.
See your physician early if you or any family member elicit any of these signs and symptoms because, 55% of mild cognitive impairment progress to Alzheimer’s.
Studies have shown that pathological changes in the brain actually can begin as early as 20 years prior to diagnosis and so by the time the diagnosis is made; the disease has already been progressing for years, and signs and symptoms become progressively worse over time. Alzheimer’s disease risk factors include: genetics and family history, age and sex (more women than men), high blood pressure, cardiovascular disease, insulin resistance, metabolic syndrome and diabetes, traumatic brain injury, poor diet (Mediterranean diet has some hopeful benefits), other toxins, lack of exercise, smoking and alcohol consumption, chronic inflammation, poor dental hygiene, hearing loss, low social support, low mental stimulation, and lower educational levels all add to the mix of risk factors.
Stages of Progression of Alzheimer’s
Stage 1: Mild Confusional State (2-7 years)- usually diagnosed at this stage- independent living and work become gradually affected, memory problems develop for recent events, word recall, organizational planning, mislaying things, reading and recalling information. Procedural function intact (automatic repetitive learning- learned encrypted memory (i.e. riding a bike)
Stage 2: Mild to Moderate impairment (2 years)-significant decrease in memory for recent events, numbers, checkbooks, handling bills, sequential tasks like preparing a meal (procedural function), may deny there is a problem and become defensive, withdraws from conversations, social situations, or mentally challenging situations. The degree of procedural memory loss is at best, borderline at this point. Persons are also at risk for developing depression and anxiety.
Stage 3: Moderate Impairment (18 months) – this person cannot live independently and requires moderate assistance with ADL’s: impaired memory for personal history, day and time, confusion about location and difficulty following conversation, sleep disturbances begin. Declarative memory (cognitive functioning) begins progressively to be compromised.
Stage 4: Severe Impairment (2 1/2 years) – this person is unaware of present and recent experiences and the memory for person history is impaired. Often incontinent, severe sleep disturbances and agitated behavior late in the day and night “sundowning”, wonders off and gets lost, repetitive compulsive behavior, repeats self, requires safe and supervised care with ADL’s. Declarative memory (cognitive function) and procedural memory now are acutely compromised.
Stage 5: Very Severe Impairment (1-2 1/2 years) resulting in death. Death usually occurs as a result of other health conditions associated with complications of the chronic disease process. This person now requires 24maximum assistance, is often bedridden and loses the ability to respond to environment, communicate, and control movements. Often has severe impairment in visual, language, mobility functions as well as diminished swallowing reflexes, rigid muscles, and lack of awareness. Seizures are not uncommon as organ failure ensues. Both cognitive and procedural memories are gone. Survival now is dependent on the quality of care received.
Although there are no disease-modifying or curative treatments for Alzheimer’s or any of the major degenerative dementias, there is hope on the horizon. Research and medical breakthroughs in medications, vaccines, DNA testing (that may identify biomarkers for Alzheimer’s) and other diagnostic techniques have an 80% accuracy in identifying the disease from 2 to 5 years before symptoms begin. For more information, check out the website: FamilyDoctor.org, where you can find health information and resources about illnesses, diseases and conditions provided by the organization of American Academy of Family Physicians.
It is extremely frustrating and frightening not to be able to find a word to express one’s thoughts, lose one’s memories and familiar relationships with loved ones close to us. Sometimes, more than not prayer is our only option for us and others in this situation. Prayer is a sign of our care and concern for one another. Prayer works through God as God works through us and can change lives. It is part of our relationship with God and in God and through God.
Prayer for Those with Dementia
Hear the Words of Our Lord who truly turn to him; Come unto me, all ye that travail and are heavy laden, and I will refresh you. (Matthew 11:28)
Father in Heaven, God of mercy and compassion; Pour out your grace upon all who suffer from Alzheimer’s or any other forms of dementia. Bless them and those who care for them with your patience and loving kindness as they struggle through their journeys in this wilderness we know as dementia. In the face of daily struggles and frustrations, help them to do what they can with the time they have left together and may the peace of your presence each day bring a blessing, hope and greater love for one another. We ask these things, in the Spirit of Our Lord and Savior, Jesus Christ. Amen.
The Rev. Dn Stephanie Ulrich, RN, SD, Minister of Health All Saints Episcopal Church