Dr. Marc Siegel: Dementia -- what you need to know

My parents are now in their 90s, and though neither one is addled or demented, I do notice cognitive differences. I know I am fortunate to have parents who have lived so long, but as their son who has always relied on a certain pattern of behavior, it is disturbing to me to now encounter sudden changes.

A few years ago my father fell and hit his head and wasn’t the same for many months afterward. My mother immediately developed trouble making decisions and it is only when she recovered that I realized she was depressed rather than demented. The two go hand in hand.

As people age, they have less and less resilience. Sudden changes – whether due to their own health problems, losing a spouse or other loved one, moving out of their home, retiring from the workforce – have greater and greater impact.

Depression is treatable. Treatment with anti-depressants and psychotherapy can make a big difference in the lives of an elderly patient.

Millions deal with these issues in their loved ones every day. When memory problems become worse than expected for a person’s age, this condition is known as mild cognitive impairment. According to the Alzheimer’s Association, 10 to 20 percent of adults in the U.S. over 65 suffer from mild cognitive impairment, where forgetfulness progresses to the point that it interferes with daily life.

This interference affects not just the patient but the entire family. Mild cognitive impairment doesn’t generally go away. Studies have shown that 38 percent of the time it progresses to actual dementia, where decline in memory and other thinking and decision-making skills becomes pervasive.

Alzheimer’s disease is by far the most common cause of dementia among our elderly, affecting more than 5.5 million Americans according to the National Institute on Aging.

But the most devastating impact of this currently incurable disease is the effect on family dynamics. Primary caretakers of Alzheimer’s patients frequently sacrifice much of their independence in well-meaning compassionate efforts to care for their loved ones.

Alzheimer’s patients gradually lose not just their memory and understanding but the ability to meet their basic needs, such as feeding themselves, going to the bathroom unassisted and walking. People who could take care of themselves for many decades find themselves thrust back into a state of dependence they haven’t known since early childhood, needing a caregiver to survive.

Family members who care for partners or parents with Alzheimer’s disease should be praised for their courage, commitment, selflessness and skill.

Signs of Alzheimer’s disease typically begin when a patient is over 60. According to the National Institute on Aging: “The first symptoms of Alzheimer's vary from person to person. For many, decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may signal the very early stages of Alzheimer’s disease. As Alzheimer’s disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes.”

What can you do to slow mental decline?

Studies have shown that regular exercise and eating right slows mental decline in the elderly, specifically the Mediterranean-DASH Intervention for Neurodegenerative Delay or MIND diet. This diet emphasizes high amounts of fruits and vegetables, whole grains, nuts, and olive oil. Meat, butter, cheese, fried foods and sweets are kept at a minimum.

Treating co-existing depression is crucial, as is keeping the mind actively engaged with mental exercises, tasks, or regular use of a computer.

Perhaps the most important thing is to retain a sense of familiarity and dignity for as long as possible. This is why I am so supportive of my parents staying in their own home and so opposed to them moving to a nursing home.
Don’t get me wrong. For many people a nursing home is the only option, but it is too frequently accompanied by the cold compassionless assertion “you live here now.”

What about the future?

Luckily, help is on the way. After decades of research that focused on abnormal protein plaques building up in the brain of people with Alzheimer’s, there has been a recent shift in the direction of personalized genetics.

Researchers are using biomarkers to help find early changes. Scientists in Canada have now successfully used artificial intelligence to detect early cognitive changes that will lead to Alzheimer’s.

In addition, genetic home tests for Alzheimer’s risk are being developed that test for an Alzheimer’s susceptibility gene known as APOE4. As they are developed further, these tests could prove useful in terms of preparing patients and families, especially when accompanied by effective genetic counseling.

What about treatment?

The latest studies have focused on treatments to prevent the buildup of amyloid plaque or immunotherapy against amyloid and tau proteins to be used early in the disease, as well as attempting to utilize existing treatments that were intended for other diseases.

And some researchers are even considering infection as a possible cause of Alzheimer’s.

While treatment strategies evolve, Alzheimer’s disease continues to challenge families. In the early stages, when frustration and expectation run high, this is a good time to be on the lookout for falls, injuries, car accidents and depression. Up to 40 percent of people with Alzheimer’s disease suffer from significant depression. And depression, as mentioned above, can be treated.

Family members who care for partners or parents with Alzheimer’s disease should be praised for their courage, commitment, selflessness and skill. It is one of the most difficult roles of all to play in health care. Loved ones struggle to connect with Alzheimer’s patients for meaningful moments, hanging on to pieces of a life built together for as long as they possibly can.