First Aid Mental Health

What Alzheimer’s Dementia really is?

“Doc, she can’t recognize me anymore?” laments a bewildered husband.

“Something is not right. He used to be very sharp and now, he can’t even use the phone,” complains a frustrated son.

“Doc, I’m too forgetful. Do I have Alzheimer’s?”

I’m surprised when some patients and caregivers confuse memory loss and Alzheimer’s as one and the same. Each time a family member is suffering from memory loss, Alzheimer’s disease seems to be the only logical explanation.

Is it reasonable to label all types of forgetfulness as Alzheimer’s?

As a clinician, my typical answer is that Alzheimer’s dementia is only one of the many causes of memory impairment. Aside from Alzheimer’s disease, other memory disorders and dementias exist.  In fact, normal aging is the most common cause of forgetfulness. Not surprising. As we age, we become less mentally sharp. It’s not uncommon to see seniors who look for their eyeglasses that they’ve been wearing all along. Some easily forget the names of close family members.

Dementia with lewy body, Vascular dementia, Parkinson’s disease with dementia, and dementias due to various neurologic and medical conditions are just some of the causes of significant memory impairment. If one has B-12 deficiency or thyroid disease, or has been drinking alcohol excessively for many years, dementia can be an unfortunate consequence.

Furthermore, some highly anxious and depressed individuals have memory troubles that mimic the forgetfulness seen among individuals with dementia.

How will you know if a person is suffering from Alzheimer’s dementia?

Alzheimer’s dementia is a neurologic disorder characterized by a progressive and irreversible cognitive decline associated with impairment in functioning. The cognitive deterioration consists of memory impairment. Initially, recent memory becomes impaired as shown by misplacing things a lot, forgetting what words to say, or asking the same questions repeatedly.

As the disease progresses, even long-term memory becomes problematic. During this time, names of spouses and children, dates of birth, names of common objects, and addresses are forgotten. Some can’t even recognize their immediate relatives.

Besides memory problem, a person with dementia has impairment in at least one of four cognitive areas: aphasia, apraxia, agnosia, and executive functioning. Although these are highly technical terms, let me simplify them for you.

Aphasia is a language problem characterized by inability to express oneself or difficulty understanding what is being said. Apraxia is the inability to adequately perform a usual physical activity, such as combing the hair or brushing the teeth, despite no paralysis or musculoskeletal abnormality. Meanwhile, agnosia is the inability to recognize objects or things despite no sensory deficits. For instance, a demented person cannot recognize a key or a pen placed in his or her hands without looking at it.

Impairment in executive functioning is characterized by difficulty in abstract reasoning and in organizing things, schedules, and activities. Individuals with this problem give concrete meaning to proverbs. For example, when a person is asked what “don’t cry over spilled milk” means, he or she responds, “It’s easy. Just wipe it!” Moreover, knowing the specific similarities and differences of certain things (for example, apple versus orange) is a struggle for some individuals.

What are the possible causes of Alzheimer’s?

The definitive cause of Alzheimer’s is still unknown. However, several risk factors have been identified. One major risk factor is age. The risk of developing dementia increases as our age advances. Seniors therefore are more at risk. Having said this, Alzheimer’s can also happen to young individuals—in their late 40s or early 50s.

Other important risk factors include the presence of apolipoprotein E4 allele, the predominance of plaques and tangles in the brain, and the brain’s impaired cholinergic system.

Is there any successful treatment for Alzheimer’s?

Alzheimer’s disease is irreversible so current medications, called acetylcholisterase inhibitors, only slow down the memory deterioration. These memory medications namely galantamine, rivastigmine, and donepezil improve the acetylcholine (a brain chemical) supply in the brain by inhibiting the enzyme that destroys it.

With increased acetylcholine availability, we expect the cognitive functioning to stabilize or for some, to improve. But it requires a few months before the medication works, so patience is essential to cope with the long, exhausting wait.

Although initially indicated for mild to moderate dementia, recent evidence has shown that some of these drugs can potentially benefit those with moderate to severe dementia, especially in combination with memantine—another dementia drug. Further studies however are warranted to determine their efficacy in this group.

About the Author:

Dr. Michael G. Rayel — author, game inventor, and psychiatrist — has created the Oikos Game Series to promote emotional health. Since 2005, he has published Oikos’ Insights! www.oikosinsights.com— an online resource for personal development. Suggest a topic at www.oikosglobal.com.