What Is Dementia, and What Causes It?
Dementia is described in a variety of ways. It includes:
The most common type of dementia is Alzheimer's dementia, or Alzheimer's disease (AD). It accounts for 60% to 90% of cases of dementia. Other types of dementia are vascular dementia and Lewy body dementia. Each of these types accounts for 10% to 15% of cases.
Some people may have a combination of the different types of dementia. Experts do not totally understand the causes of dementia. It seems to result from various processes occurring in the brain. These processes destroy brain cells that affect memory, learning, and behavior.
Alzheimer's Disease in the United States
Nearly 4.5 million Americans have AD. The number actually may be greater because not all cases are diagnosed correctly. The number of Americans with AD will continue to grow as the number of seniors grows. By the year 2050, the number of people with AD could be as high as 11 million to 16 million.
AD will have a significant impact on the health care system, both in terms of medical costs and in terms of the care needed for people with AD. One in 10 Americans has a family member with AD, and 1 of every 3 people knows someone with the disease.
Certain people have a greater risk for developing AD. These people include:
What Are the Most Common Symptoms of AD?
The most common symptom is slow, progressive memory loss over a period of 1 to 5 years. Examples of this memory loss include:
As time goes on, these problems get worse. As AD progresses, behavior problems also may occur. The person may:
The disease can affect a person for 3 to 20 years, but the average length of time is about 10 years. If the dementia comes on fast, if the person has memory loss only part of the time, or if the person has behavior problems at an early stage, he or she may have a different form of dementia instead of AD.
How and Where Can a Proper Diagnosis Be Found?
AD can now be diagnosed accurately in more than 90% of patients. You may want to see a doctor who specializes in older patients (a geriatrician) or a neurologist who specializes in dementia. If you live in an area that has a memory disorders or dementia clinic, the social workers, occupational therapists, pharmacists, and psychologists who work there may be able to help.
What Nondrug Treatments and Support Systems Are Available?
Managing AD in other ways besides drugs is very important. Keeping an AD patient as active as possible with a variety of activities is an essential part of therapy. Simple puzzles, word games, exercise programs, and other activities that keep the body and brain busy can help. Other suggestions include relaxation, meditation, music, and pet therapy.
Adult day care centers are now available in many cities, offering scheduled activities for people with AD. These centers also give the caregiver some free time. Other programs commonly available through local associations include the Safe Return Program, Life Line, and other community support systems. The Table lists resources with their Web sites.
What Medicine Is Presently Available to Treat AD?
Researchers are attempting to find drugs to prevent AD. The present drug treatments produce only slight improvements. The oldest class of drugs includes Aricept, Razadyne (formerly called Reminyl), and Exelon. All 3 of these drugs work in the same way and have similar benefits. They slow the progression of the disease somewhat.
Another drug, which has been available for only a few years, is Namenda. It is used mainly for more severe cases of AD. This drug works differently and has shown some effects when used alone. It can be used in combination with one of the other drugs to help slow the progression of AD.
Other products have been studied, including estrogen, drugs that lower cholesterol, drugs that fight inflammation, ginkgo biloba, and vitamin E. None of these products have really been shown to help the person with AD, and they are not recommended for that purpose.
Medications to control behavior problems may be needed for patients in later stages of the disease. If families and/or caregivers wish to enroll their loved ones in drug research programs, information is available through the local chapter of the Alzheimer's Association or at the Web sites noted in the Table.
The Caregiver and AD
Caregivers of AD patients often are overlooked, even though 70% of AD patients are cared for at home. Caregivers may experience denial, anger, or guilt. They also may stop participating in social activities and may feel anxious or depressed. All of these reactions can lead to serious health problems.
One of the most difficult issues for caregivers is to know when to ask for help. Caregivers and families need to be aware of the resources available in their community and to make use of them. It is important for caregivers to become educated about the disease, to get help when needed, and to take care of themselves. They also may need assistance with legal and financial planning.
In late stages of the disease, patients may have increased caregiving requirements. They often will need to be placed in nursing homes. The ideal nursing homes are ones designed for AD patients.
The Pharmacist's Role in Managing AD
Pharmacists are trained to manage drug therapy. They can be a great resource. They can help with questions related to present and future therapies for people with AD. Some pharmacists have specialized certifications for working with older patients, including those with AD. If you work together with doctors and your pharmacist, and keep them informed of your concerns and needs, you can be a more effective caregiver.
Dr. DeMaagd is an associate professor of pharmacy practice at Ferris State University.
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