Although there are the Betty Whites of the world – hosting Saturday Night Live at the age of 88 with her wit and split-second timing and even starring in a new sitcom – the harsh reality is that, after the age of 65, and most definitely after the age of 85, dementia becomes more and more likely.
What used to be called senility, dementia comes in many forms. The most common, representing 60-80% of all dementias, is Alzheimer’s. It is a progressive and degenerative disease that causes mental deterioration such as memory loss and disorientation. Although there are drugs that can slow its progression, especially if taken in the earliest stages, it is not reversible or curable.
The diabolical truth about Alzheimer’s and other forms of dementia is that they turn the later years of our aging, which should be a time to remember, reflect, and enjoy life to its fullest, into a time of confusion, memory loss, and the decline of other cognitive functions.
Today we'll look at the most common dementias including vascular dementia, which, unlike Alzheimer’s, may be reversible by proper management of cardiovascular risk factors, described below, as well as lifestyle and diet changes. We’ll explore how to get an accurate diagnosis if you suspect your loved one (or you) has dementia so treatment can begin as soon as possible, and if you are caring for a loved one with dementia, how you can be most helpful to your loved one and to yourself.
Common Types of Dementia
• Alzheimer’s, the most common type of dementia according to the Alzheimer’s Association, is a neurological degenerative disease; it is estimated to be present in one in ten persons over the age of 65 and as many as 50% of those over the age of 85. It is a progressive degenerative disease that leads to the loss of neurons in the brain. Its symptoms include impairment in judgment, memory, reasoning, and decision-making.
As the disease progresses, it can lead to the inability to perform basic everyday and self-care functions such as feeding, dressing or bathing oneself; becoming more socially isolated, and depression, may also occur. It is the 7th cause of death. (Early-onset dementia, before the age of 60, is relatively rare, but it does occur. See “Boomer Love.”
• Vascular dementia, the second most common type of dementia, occurs when the blood vessels to the brain are not supplying enough blood flow, causing a decline in memory and cognitive ability. According to neurologist Dr. Ralph Sacco, president-elect of the American Heart Association, there are multiple risk factors in vascular dementia; some, fortunately, are caused by lifestyle choices and, if those choices change, the risk factors can be reduced or eliminated.
Those risk factors include: high blood pressure, Type 2 diabetes, high cholesterol, and heart disease. Other lifestyle factors Boomers should be aware of as causes of vascular dementia include smoking, inactivity, and drinking too much alcohol, and a poor diet.
As Dr. Sacco says, “Many of the things that cause trouble to the heart also cause trouble to the arteries to the brain. To improve brain function and heart function, focus on healthy eating and living, and prevent high blood pressure.”
• Mixed Dementia is dementia that is caused by two medical conditions, most frequently Alzheimer’s and Vascular Dementia.
Lewy Body Dementia (LBD) is the overall term for two types of dementia: dementia with Lewy Bodies and Parkinson’s Disease Dementia. In the United States, the Lewy Body Dementia Association estimates that there are 1.3 million individuals with this form of dementia, but it is often misdiagnosed and grouped together with other types of dementia.
What distinguishes Lewy Body Dementia is that there are gait (walking) and sleeping issues as well as dementia and cognitive changes. According to the Lewy Body Dementia Association, the illness is caused by abnormal protein deposits that disrupt the brain’s normal functioning, depleting the brain chemical acetylcholine, causing a disruption in perception, memory, thought processes, and behavior. Again, there are drugs that can slow the progression but not stop it.
• Mild Cognitive Impairment (MCI) is defined as the cognitive and memory impairment that occurs in older individuals, estimated by the Alzheimer’s Association to occur in 10-20 percent of those aged 65 and up. It is usually associated with aging, such as misplacing the car keys or forgetting someone’s name. It can also be a precursor to Alzheimer’s, or it can stay at the same level, or someone’s behavior can even return to normal. A study by the Center for Gerontology at Virginia Tech, based on interviews with 99 families where one member had MCI, provides a useful guide of “Strategies to Compensate for Memory Loss” such as making daily to-do lists and keeping important papers and bills in a place where it is visible rather than filed away.
Additional dementias, although rarer than those listed and described above, include Frontotemporal Dementia, including Pick’s disease, Creutzfeldt-Jacob Dementia (CJD), Huntington’s Disease, Normal Pressure Hydrocephalus (NPH), and Wernicke-Korsakoff Syndrome.
Jacqueline Marcell is the author of “Elder Rage, or Take My Father… Please! How to Survive Caring for Aging Parents ,” and a radio host. She says, “Dementia starts very subtly and very intermittently, gradually comes and goes for many years, so most of the time the loved one appears normal. The subtle signs are often missed unless you are aware of what to look for and you are with the person all the time.” (Marcell gave up her 15-year career as a television executive to devote herself to helping other caregivers based on her personal experiences caring for her elderly parents, who both had Alzheimer’s and who were not properly diagnosed with the disease for over a year.)
Dr. Todd Semla, PharmD, pharmacist and past president of the American Geriatrics Society (AGS), recommends getting your elderly parents evaluated, “particularly if you’re concerned about driving and safety and leaving the stove on.”
If you think your loved one is showing signs of dementia, go with him or her to your family physician who may also make a referral a geriatrician, a neurologist, or a center for aging for further testing.
In “How to Keep Your Brain in Shape,” there are ten warning signs of Alzheimer’s, according to the University of South Florida’s Byrd Alzheimer’s Institute. They include difficulties with language, remembering where things are, personality, mood, or behavior changes; time and place disorientation; and difficult performing everyday tasks. Other dementias, like Lewy Body Dementia, also have symptoms that resemble Parkinson’s disease including changes in gait such as shuffling, walking stiffly, a proneness to falling, or tremors. http://www.lbda.org The Lewy Body Dementia Association points out that another sign of the disease is REM Sleep Behavior Disorder (RBD) which includes moving, gesturing, or speaking during sleep.
Dementia is sometimes diagnosed through a Mini Mental or a Mini Mental State Evaluation (MMSE). This is a test that asks a series of questions to evaluate someone’s cognitive ability and tries to quantify any brain function losses. The test is scored with a maximum of 30 points; anything below 20 signals cognitive deficiencies. Questions include: “What is today’s date?” “What city are we in?” When three words are said, the person being tested is asked to repeat all three words. Other parts of the test include asking the person to write a sentence as well as to read the words on a card.
Another test is the Mini-Cog, a three-minute test that asks someone to recall three items as well as to draw a clock.
CT (or CAT) scans, MRIs, and PET Scans are imaging procedures that make it possible to see changes occurring in the brain, making it possible to arrive at an earlier diagnosis of Alzheimer’s rather than waiting until behavioral changes occur. The would allow for earlier intervention, medications, treatment and lifestyle decisions such as where to live. (See “Diagnosing Alzheimer’s Early: Neurologists, Imaging Scientists Use Medical Physics to Spot Disease in Blood Vessels").
The medicines used to treat Alzheimer’s disease include the cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the NMDA antagonist, memantine. (Some of the names of popular commercial versions of these medications are Aricept®, Excelon®, Razadyne®, and Namenda®)Although none of these drugs can cure Alzheimer’s, studies have found that in some patients, they may improve some of the memory issues.
But do the drugs really help? As geriatric pharmacist Dr. Todd Semla says: “I tell people that you’ll find that one third will have a response that will be noticeable, another third will not tolerate the medication, and another third, and the drugs won’t appear to have done anything, adversely or beneficially.”
You and your loved one with dementia will have to work closely with a physician or neurologist to figure out which drugs, the proper dosage and in what combination will work best with whatever type of dementia your loved one has. Monitor the person taking the drugs for any possible side effects such as nausea, vomiting, and diarrhea that might necessitate either adjusting the dosage or switching to another medication.
Other treatments include physical therapy for those with dementia related to Parkinson’s or Lewy Body Disease as well as seeing a social worker, psychologist, or psychiatrist for the depression that often accompanies dementia.
Dealing with a loved one with dementia
Usually the memory changes do not happen overnight so enjoy your parent or loved one with dementia the way he or she is at whatever stage he or she is at now. Sadly, in most cases, it is only going to get worse. Try to avoid obsessing about your parent not remembering what day of the week it is if he or she still remembers who you are. That could change as their ability to recall who people are could be altered dramatically in a month, a year, or three years.
One key question everyone dealing with a loved one with dementia wants to know is whether or not they should tell them something they think is untrue. I found a variety of opinions on this.
Jacqueline Marcell, whose parents had dementia, found it worked best for all of them if she went along with their view of things such as allowing her parent to believe that a certain relative was still alive because to tell them that she was not would be upsetting.
But as Dr. Joe Verghese, a geriatrician specializing in neurology, cognition and motor aging, emphasizes, it depends on the patient. Dr. Verghese, says that “in general, it’s okay to try and correct the patient’s mistaken perception if they can take it. I would do it gently and to give clues about why that can’t be the case and try to get them to realize it.”
You can also help your loved one with their memory challenges by creating memory “triggers.” I recently read to my mother several letters that my late father had written to her back in 1943 and 1944. They were separated because he was serving as a captain in the Army in World War II. My mother had not heard those letters in 67 years and she was genuinely moved by what my father wrote. It helped make my late father, who died 14 years ago of a brain tumor and with whom my mother was happily married for 54 years, a stronger memory for her. She found it comforting to hear those letters because it reminded her in a concrete way of how much he loved her.
One of the most difficult types of dementia-related situations to cope with is if the dementia is accompanied with behavioral problems.
Much to the shock and dismay of those caring for a parent who used to be sweet and passive, if they have dementia with behavior issues, they can suddenly become aggressive and even verbally or physically abusive. As hard as it is, the only way to deal with these sudden outbursts is to avoid taking them personally.
Comfort yourself, if possible, with the realization that “it’s the disease” talking. You should also get expert advice about the safest environment for your loved one with dementia with behavior problems to be in. You want to make sure he or she is not a danger to himself or herself or to others, including you.
In addition to dealing with the physical, mental, and emotional aspects of your loved one’s dementia, remember that you also have to attend to custodial and legal issues. Who will take care of such everyday tasks as paying bills, as well as other caregiver and legal concerns? Registered nurse and lawyer Carolyn L. Rosenblatt discusses these issues in her book “The Boomer’s Guide to Aging Parents: The Complete Guide.” (See also: “Role Reversal for Boomers: Caring for Your Aging Parents.”)
Whether your loved one with dementia lives with you, independently, in an assisted living situation, a nursing home, or a dementia group home, you may find that you need support for yourself. It may help to join a support group with other caregivers with loved ones who have dementia. This way you will be able to meet other caregivers who have parents at different stages in the disease. Of course, if your parent is in the early stages of Alzheimer’s, or Lewy Body Dementia, and you are still able to share and do things together, you might find it more disconcerting than comforting to hear about those who can no longer recognize their loved ones. A support group should be educational as well as emotionally beneficial; you may want to try out several groups till you find one that is a comfortable fit.
Taking care of the caregiver
Caring for someone with dementia can be very stressful and demanding so remember to take care of you. Reach out to your friends and family. Keep up with your own healthcare appointments even though you may be sick of going to doctors because you may be going on so many appointments with your aging parent. But that has nothing to do with taking care of your own physical and dental health. As the Family Caregiver Alliance points out in, “Taking Care of You: Self-Care for Family Caregivers,” “If you are a baby boomer who has assumed a caregiver role for your parents while simultaneously juggling work and raising adolescent children, you face an increased risk for depression, chronic illness and a possible decline in quality of life.”
If your parent or loved one has any kind of irreversible dementia, be prepared that the day may come when you are not recognized. It will be a traumatic moment for you. This is the part of dementia that is so frustrating and challenging to everyone touched by it. It is also unpredictable. There can be moments of great clarity and times when the dementia seems to have disappeared or it can progress so that the past is completely erased. So enjoy each moment that you do have together now for you truly do not know how long that clarity, that ability to share and even to remember together, will last.
What boomers can do to reduce their chances of dementia
Neurologist Sacco points out that researchers are finding out that even some of the dementias that we used to think were totally related to aging and not preventable, are actually impacted by our lifestyle. There are changes we can make to promote a healthy brain that may slow down and possibly even reduce or eliminate the development of dementia including Alzheimer’s. As Dr. Sacco notes, “We don’t just want a long life, we all want a healthy one.”
As noted in “How to Keep Your Brain in Shape” we have learned that the same behaviors that lead to heart health (See “Heart Health for Boomers,”) impact on brain health and reduce the risk of getting vascular dementia.
If you find yourself falling into the Mild Cognitive Impairment (MCI) category of dementia disorders, there are coping strategies you can implement to offset your memory loss. Rehearse the names of people you will be seeing again at a social or business function. That will help cut down on the likelihood of going blank under pressure. Make sure you put all key appointments in one central appointment book. And consult with a physician to see if there are any reversible causes to your MCI and if any of the medications used to treat Alzheimer’s should be prescribed.
Keep up on the research and literature about Alzheimer’s and dementia. New studies and drug trials hold out much more hope for the Boomer generation in slowing down, or reversing, these diseases. And remember, there are steps you can take now to slow mental deterioration, perhaps long enough for science to one day find a cure.
- Alzheimer’s Association
- American Geriatric Society (AGS)
- American Heart Association
- Lewy Body Dementia Association (LBDA)
Articles and Reports
- Alzheimer’s Association. “2010 Alzheimer’s Disease Facts and Figures.” 70 page report.
- Jan Yager, “Friendships...When to Hold ‘em or Fold ‘em” Caring Today magazine.
- “Researchers Find Caffeine Effective Alzheimer’s Treatment,” ConsumerAffairs.com, July 6, 2009.
- “NINDS Dementia Information Page,” May 21, 2010
- Michael C. Campbell, “When Mom and Dad Need Help.” Painesville, OH: Iffenwen Publishing Company, 2010. (See the section on Alzheimer’s/Dementia Care Communities in Chapter Three, “What Types of Housing and Care Options are Available?”)
- Hugh Delehanty and Elinor Ginzler. Caring For Your Parents: The Complete AARP Guide. New York: Sterling Publishing, 2006. (See Chapter 5, “The Brain.”)