SENIOR SCOPE

Dementia impacts patients, loved ones

2014-06-16T16:00:00Z Dementia impacts patients, loved onesCarrie Rodovich nwitimes.com
June 16, 2014 4:00 pm  • 

Forgetfulness is a normal part of the aging process and it can be hard to know when forgetfulness goes from a momentary lapse to a serious medical condition, experts say.

There are several diseases that fall under the umbrella of dementia, with Alzheimers accounting for a large percentage of those cases.

Dr. Timothy McManus, a neurophysiologist at Ingalls Health System, says dementia is a chronic disease that is characterized by changes in various areas within the brain.

“These changes occur in brain cells and gradually occur over time, so what we see is that there can be a slow change in one’s ability to do normal activities of living,” he says. “There is some level of normal forgetting that occurs across the age span, even at 85 and 90, there’s also normal forgetting at the age of 40. (But) when that forgetting interferes with the ability to be able to live our lives, is where it starts to become a concern.”

Dr. Mark Simaga is a neurologist on staff at St. Mary Medical Center and part of the Community Care Network of physicians. He says the difference between forgetfulness and dementia has a lot to do with repetition.

“When you make mistakes over and over again, ask the same questions over and over and people start to notice, then you have cognitive decline,” he says.

  Dementia is a change in one’s ability to remember events that are happening immediately or to track and remember day-to-day, and the lack of memory has to be combined with another problem, like being unable to plan and execute a certain behavior. 

“The confusion that occurs around dementia is we can remember what happened 50 years ago, but can’t remember today. The reason for that is that memories that are like trees. The memories are stronger the longer they’ve been around,” he says. “Being able to remember information and details and circumstances immediately and use those memories for as long as necessary, that failure is the hallmark for dementia.”

Dr. Simaga says people who believe they might be suffering from Alzheimer’s or dementia might be afraid to see the doctor, which delays the diagnosis. 

“People are afraid to get the diagnosis, so they delay seeing the doctor,” he says. “There could be a host of other issues that aren’t dementia, like being anemic, or having metabolic problems, that could be reversed.”

Once patients decide to see their primary care physician, that doctor can perform a series of basic tests to decide whether or not to refer the patient to a neurologist for further diagnosis. 

Patients in the mild stage of dementia typically can live independently, relying on external resources like Post-It notes, a calendar or cell phone reminders for help, Dr. McManus says. Family members can also make sure there are safety systems in place, like active smoke detectors and taking away the car keys, if necessary. 

“What you want to try to do is take a look at the problems and see where things are breaking down. So in addition to compensation strategies, you also need to reduce competing stimuli so the patients can focus on the information that is necessary,” he says. 

As the disease progresses, more supervision might become necessary, the doctors says. If a patient begins to wander, alarms might be necessary on doors, or the patient might need a constant companion. 

“Ultimately, you are looking at what is the extent of supervision necessary in order to keep this person safe,” Dr. McManus says. “At some point, when you exceed the family resources for what people can provide, you might need to look for institutional assistance, through extended care or a nursing home.”

There is a genetic component to dementia, so doing a genetic history might be a predictor as to whether or not you will be diagnosed with the disease. But many people develop dementia without a genetic component, and it seems to affect more women than men. Although it can be diagnosed as early as 50 years old, many times it doesn’t start until decades later. 

Although there is no way to prevent dementia, people who lead a healthy lifestyle and are active can slow down the progression of the disease, if it starts, Dr. McManus says.

Once diagnosed, it is important to stay active and continue to live your life the best way possible. 

“If you’ve been diagnosed and are functioning at 70 percent efficiency, don’t reduce your efficiency by withdrawing from any kind of activity. Instead, do what your capable of doing, give your 70 percent efficiency every day,” he says. 

And once Alzheimer’s or dementia is diagnosed, there is no way to know how fast the disease will progress. There is also no cure for dementia, and medications might be able to slow down the progression of the disease, but cannot restore lost memory.

“Medications we have all make the same claim, that they can slow down the decline. So maybe you can stay home longer,” says Dr. Simaga. The medications could give you up to two more years of living independently, or add up to three years to your life span.

“You’re still on a hill, but it pushes you a little back up the hill,” he says. “You’re on a hill, and you’re going to decline, but it isn’t going to be as steep.”

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