How Alzheimer’s changes the Brain.
As a previous PCP in the community for many years, I was often asked questions about memory. Many are worried when they become forgetful and some are scared because they do not understand what it could mean. The number 1 concern is “do I have Alzheimer’s Disease?” I would like to take a moment to discuss cognitive impairment and dementia.
Mild cognitive impairment is when a person experiences a decline in how well they are able to process information which causes a decline in the function of memory/learning, complex attention, executive function, perceptual or motor abilities, language, or social cognition. When someone has Mild Cognitive impairment (or MCI,) they maintain their independence and only have a minor impairment of any function unlike when they develop dementia.
Dementia is a progressive loss of cognitive functions. What does that mean? It means that at least 2 of the processes in your brain that control your memory, language, executive functions, visuospatial function, and behavior are affected. Examples of these deficits include loss of the ability to balance your checkbook, difficulty remembering a conversation that occurred an hour ago, or difficulty feeding yourself because you cannot bring the spoon to your mouth. The progressive impairment of at least 2 of these functions, which normally happens over years, is when a person is diagnosed with dementia syndrome. As you may guess this can have a significant impact on your independence, life span, and quality of life. It also has a large impact on the people around you as they live through these changes with you.
The other questions revolve around risk factors for dementia, Alzheimer’s in particular. People ask about specific genes that can cause this type of dementia. It has been shown that the APOE e4 gene allele can place a person at increased risk for developing dementia. Other risk factors include head trauma, and mid-late life depression. Chronic medical disease such as Diabetes Mellitus, Cardiac Disease, Hypertension, Obesity, and Tobacco use are all risk factors for cognitive impairment as well as Dementia.
They also ask about aging and how aging affects their probability of developing dementia. The incidence of Dementia increases with increasing age, however normal aging does not mean that you will develop Dementia.
It is also important to know that there are different types of Dementia that are related to other neurological diseases or issues. Other types of Dementia may be caused by Parkinson Disease, Frontoparietal Dementia, Dementia with Lewy Bodies, Vascular Dementia, and of course Alzheimer’s Dementia. A form of dementia is also related to injury to the brain such as a stroke, traumatic brain, or brain lesions.
So the last question is what can we do to help Dementia? Normally once the diagnosis of Dementia is well-established, it is usually too late to have an impactful effect on the disorder with current treatments. The window of opportunity to help is in the beginning stages when it is merely mild memory difficulty or mild cognitive impairment. It is important to note that currently available medications can be helpful with the symptoms associated with Dementia, but they do not affect the process of how dementia happens. For this reason, the research community continues to investigate ways in which we can further help to slow this disease process and hopefully one day find a cure.
Apart from medications, a person can also try to maintain a healthy active lifestyle in addition to maintaining an active mind. Normally we encourage items such as puzzles, word games, or applications that have been developed around games to stimulate the mind. The medical community also promotes a well balanced diet and exercise as other key components to maintaining your functionality, which in turn maintains your independence.
MKSAP 18 (2018, June 30), Cognitive Impairment. Retrieved from https://mksap18.acponline.org/app/topics/nr/mk18_a_nr_s5/mk18_a_nr_s5_4_1