Dementias

Many patients ask me, “What is the difference between dementia and Alzheimer’s disease?”            Dementia is not a disease in its own right, but rather a cluster of symptoms that are caused by other diseases or altered brain states (such as Alzheimer’s disease).  Think of dementia as a car and the type of demntia as the car’s model.  A person might have Dementia of the Alzheimer’s type or a Vascular dementia.  Both of these disorders are dementias because they cause difficulty in various aspects of thinking (e.g., learning and memory), which causes problems in carrying out everyday activities (e.g., managing finances).

Dementia is not a normal part of aging and can in fact occur in people of all ages, depending on its origin in each patient.  It can be described as a progressive illness of the brain, characterized a marked loss of cognitive ability in a previously well functioning person.  A positive diagnosis for dementia can be made with the manifestation of nerve cell death, at least two types of cognitive impairment (such as memory, attention, language and problem solving) and notable difficulty performing daily activities.  The causes of dementia include:  infectious organisms, nutritional-metabolic factors, immune-inflammatory factors, vascular disease, prion diseases, and neurodegenerative disorders.

Alzheimer’s disease (AD) is the most common type of dementia.  It is progressive and terminal. Healthy brain tissue atrophies, causing a steady decline in memory and mental abilities.  It is believed that disease onset is triggered by a combination of heredity, environmental factors and lifestyle.  There are three main stages of the disease.  The first few years of the disease are marked by increasing impairment of learning and memory as well as potential impairment of language, perception, movement and problem solving.  As the disease progresses these symptoms worsen, and also include greater personality changes like indifference or irritability, and delusions.  By the final stage, the patient is completely dependent on their caregiver.  Dementia caused by AD can be treated with Anticholinesterase drugs like Razadyne, Exelon and Aricept. Another class of drugs that are effective is the Glutamate-Inhibitors like Namenda.

Parkinson’s disease (PD) is a progressive disorder of the central nervous system that mainly affects movement.  Evidence suggests that it is caused by low levels of a chemical called dopamine, which, among other things, activates cells in our brains that allow movement.  The primary (motor-related) symptoms include muscle rigidity, stiff posture and gait, and slowed movements.  Secondary symptoms include impairment of cognitive function and mild language difficulties.  In the later stages of the disease, some patients may develop dementia, but not all.  Risk factors include age, heredity, male gender, and exposure to toxins.  To treat PD, drugs like Selegiline focus on creating more dopamine in the brain.  Surgical treatments include Deep Brain Stimulation and are geared towards alleviating the movement symptoms.  To ameliorate symptoms of dementia, some of the common AD drugs are used.

Huntington’s Disease (HD) is an autosomal dominant hereditary disorder characterized by the death of neurons in several subcortical brain structures.  Early symptoms include a decline in cognitive ability and motor impairment (clumsiness, involuntary twitching and lack of coordination).  Other symptoms like depression, mood swings, and forgetfulness can also manifest. As the disease progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities deteriorate. Eventually the person is unable to care for him or herself. Death follows from complications such as choking, infection or heart failure.  Risk factors for HD include heredity.  Each child of a person with the disease has a 50% chance of inheriting the defective gene, the presence of which can now be detected through genetic testing.  Treatment is geared towards lessening the symptoms.   Xenazine has been approved for treating the chorea, and more generalized drugs like Haloperidol and Valium are often prescribed to help alleviate the concomitant movement and psychological symptoms.

Lewy Body Dementia:  Lewy Body Dementia (LBD) is an umbrella term for two related diagnoses.  It refers to both Parkinson’s disease dementia and dementia with Lewy bodies. The earliest symptoms of these two diseases differ, but reflect the same underlying biological changes in the brain. Over time, people with both diagnoses will develop very similar cognitive, physical, sleep, and behavioral symptoms.  Primary symptoms include prominent hallucinations and delusions, gait/balance disorder, sensitivity to traditional antipsychotics, and fluctuations in alertness.  Risk factors include age, male gender and heredity.

Frontotemporal dementia (FTD or Pick’s disease) refers to a group of disorders involving the atrophy of the frontal and/or temporal lobes in the brain.  These brain areas are generally associated with personality, behavior and language. The specific area that is affected determines major symptoms in each individual patient.  It is characterized by a very slow onset.  Behavioral symptoms include euphoria, repetitive behavior, impulsiveness, tactlessness, impaired social judgment, apathy, and depression.  In some cases, motor symptoms similar to PD can develop.  Treatment options thus far only address the management of symptoms. Risk factors include heredity.

Vascular Dementia (VaD) is the second most common form of dementia.  It is a group of syndromes of cognitive decline caused by different mechanisms that cause vascular lesions in the brain.  The onset is sudden after a series of strokes or infarcts due to occlusions of cranial arteries. Symptoms are those related to cognitive impairment, with some motor impairment to a lesser degree.  Risk factors include increasing age, male gender, hypertension, smoking, hypercholesterolemia, diabetes mellitus, and cardiovascular and cerebrovascular disease.   Certain drugs can prevent a secondary stroke and reduce the risk of developing dementia symptoms.  In addition, once dementia develops, certain drugs used for Alzheimer’s disease are also effective at treating symptoms.

So far, dementia is incurable, but there are several avenues of treatment geared towards slowing down its progress and ameliorating its symptoms.  Each specific type of dementia has its own best course of medicinal and surgical intervention. However, there are other, more generalized types of medications that all patients could benefit from.  These drugs, which include anxiolytics, antidepressants and antipsychotics, can be used to target the mood disorders that accompany dementia.

There are also non-medicinal treatments and preventative measures that take a holistic view of wellness and treat the whole body.  Physical exercise is strongly stressed.   Exercise increases brain cells, which is crucial in a syndrome characterized by mental and physical atrophy.  Mental exercise is also crucial, and includes word and number puzzles and memory games.  Social activity is a third key component, and works through ensuring that a patient feels ties to the world even as the disease promotes isolation.  Finally, there is nutrition.  Eating foods rich in antioxidants (fruits and vegetables) and rich in Vitamin E (sweet potatoes, wheat germ, almonds) and Omega-3 Fatty Acids (wild salmon, walnuts) all help.  In addition, it’s important to avoid starchy foods such as white potatoes, rice, pasta, white bread and processed sugar.  Changing a patient’s diet to avoid the things that are poisoning their bodies and add in the things that promote good physical and mental health can help them to achieve the best possible disease outcome and stave off some of the horrible symptoms for as long as possible.

 

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