Dementia

Dementia

Dementia vs. Normal Aging

Normal aging - temporarily forget names or where you left your keys, forgetting the day of the week or why you entered a room, making a mistake when balancing checkbook, sometimes need assistance with an electronic device, occasionally struggle to find the right word, making questionable decisions at times, fatigued by obligations or irritable when routine is interrupted

Dementia = memory loss symptoms caused by a certain disease or condition

Dementia is the umbrella term for a decline in mental ability severe enough to interfere with daily life.

There are over 100 different types of dementia

Alzheimer’s Disease is the most common, accounting for 60-80% of dementia related cases Dementia is progressive and irreversible.

Other types of dementia, including but not limited to:

●         Vascular Dementia

●         Neurocognitive Disorder with Lewy Bodies

●         Frontotemporal Dementia

●         Mixed Type

Additional Types, not in the top 5

●        Parkinson’s Disease

●        Huntington’s Disease

Alzheimer’s Disease Facts and Figures:

●        6 million Americans have Alzheimer’s Disease

●        An estimated 120,000 Missourians have Alzheimer’s Disease

○     This number is expected to grow by 8.3% in the next five years

●        By 2050, around 13 million Americans will have Alzheimer’s Disease

Risk Factors for Dementia

●        Family History/Genetics

○     20% high risk if immediate blood relative has memory loss

●        Age

○     65-75 years old - 10% risk

○     75-85 years old - 30% risk

○     85 and older - 50% risk

●          Heart Health

○     What’s good for your heart is good for your brain

■     Diet

■     Exercise

■     Maintaining cholesterol

■     Maintaining blood pressure

■     Socially active

■     Limiting stress

■     Not smoking

■     Getting enough sleep

Dementia: The Top 5

Dementia is defined as memory loss symptoms caused by a certain disease or condition Dementia is the umbrella term for a decline in mental ability severe enough to interfere with daily life. Dementia is not part of the normal aging process. Normal aging is described as temporarily forget names or where you left your keys, forgetting the day of the week or why you entered a room, making a mistake when balancing checkbook, sometimes need assistance with an electronic device, occasionally struggle to find the right word, making questionable decisions at times, fatigued by obligations or irritable when routine is interrupted. There are over one hundred different types of dementia. The top five most common types of dementia are: Alzheimer’s Disease, Vascular Dementia, Dementia with Lewy Bodies (commonly referred to as “Lewy Body Dementia”), Frontotemporal Dementia, and Mixed Type Dementia.

Alzheimer’s Disease is the most common form of dementia, accounting for sixty to eighty percent of dementia related cases. It is a progressive and irreversible disease. Alzheimer’s Disease is marked by difficulty remembering new information, disorientation, mood changes, behavior changes, increased difficulty regarding time, events, and places, as well as delusions or suspicions related to family, friends, and caregivers that are untrue or inaccurate. It is estimated that six million Americans and 120,000 Missourians have Alzheimer’s Disease. This number is expected to grow by 8.3% in the next five years. It is also projected that by the year 2050, around thirteen million Americans will have Alzheimer’s Disease. There are many factors that impact the chances of acquiring Alzheimer’s Disease, such as age, genetics and family history, and hearth health. Individuals between the ages of 65-75 years of age have a 10% higher risk. Individuals between the ages of 75-85 years of age have a 30% higher risk, and individuals 85 and older have a 50% higher risk. Family history and genetics also impact a person’s chances of acquiring Alzheimer’s Disease, accounting for a 20% higher chance if an immediate blood relative has or had Alzheimer’s Disease, such as a parent or sibling.

Additionally, heart health plays a role in the acquisition of Alzheimer’s Disease, as well. As they say, “what is good for your heart, is good for your brain”. Eating a healthy diet, exercising regularly, maintaining good cholesterol and blood pressure, remaining socially active, avoiding smoking, limiting stress, and getting enough sleep, you are keeping your heart and brain healthy. Alzheimer’s Disease is progressive and will worsen over time, however the rate at which a person will decline is different from person to person. There is currently no cure for Alzheimer’s Disease, although there are FDA approved treatments like Aducanumab, which works to remove beta-amyloid plaques, which causes cell death and tissue loss which leads to memory loss. Another drug, Lecanemab, has just been approved, as I write this. Lecanemab has been approved as an early treatment for Alzheimer’s Disease.

The second-most common form of dementia is Vascular Dementia. Vascular Dementia is marked by inadequate blood flow to the brain, which causes cell death throughout the body, but especially the brain. The effects of Vascular Dementia depends on how severe the blood vessels have been damaged and what part of the brain has been affected. Vascular Dementia accounts for around 5% to 10% of dementia cases. There are many common symptoms of Vascular Dementia, including: confusion, disorientation, trouble speaking, trouble understanding speech, stroke symptoms such as a sudden headache, difficulty walking, poor balance, and numbness or paralysis to one side of the face or body. Vascular Dementia is often underdiagnosed, as symptoms of Vascular Dementia often overlap with Alzheimer’s Disease.

Many of the same risk factors for developing Alzheimer’s Disease apply to Vascular Dementia, as well, including cardiovascular health. There are also many ways to reduce your chances of developing Vascular Dementia, including not smoking, maintaining a healthy blood pressure, maintaining healthy cholesterol, maintaining healthy blood sugar numbers, eating a healthy diet, maintaining a healthy weight, exercising, and limiting the amount of alcohol consumed. There are currently no FDA approved treatments for the prevention or treatment of Vascular Dementia, however preventing and treating underlying cardiovascular conditions can increase the chances of not developing Vascular Dementia.

The third most common form of Dementia is Dementia with Lewy Bodies (also referred to as “Lewy Body Dementia”). Dementia with Lewy Bodies causes a decline in thinking, reasoning, and independent function, as well as changes in attention and alertness, visual hallucination which recur, disruption to REM sleep, which may cause reenactments of dreams physically and vocally, slow movements, tremors, and muscle rigidity. Additionally, individuals who have been diagnosed with Dementia with Lewy Bodies may have difficulty interpreting visual information, issues within the autonomic system within the body, which controls sweating, blood pressure, heart rate, digestion, and sexual response. Currently, the only way to diagnose Dementia with Lewy Bodies conclusively is by an autopsy performed after death, however Dementia with Lewy Bodies can be diagnosed by a physician using their professional judgment. There is currently no known cause of Dementia with Lewy Bodies. There are also no known cures or treatments to slow or stop the disease process, however there are medications that can help to treat the symptoms of Dementia with Lewy Bodies including, but not limited to: Aricept, Namenda, and Namzaric.

The fourth most common form of Dementia is Frontotemporal Dementia. Frontotemporal Dementia is a group of disorders caused by nerve cell damage leading to the loss of function in the frontal lobes or temporal lobes in the brain, which are located in the forehead and behind the ears, respectively. This leads to changes in behavior and personality and difficulty producing and comprehending language. Most people who are diagnosed with Frontotemporal Dementia are between their 40s and 60s. There are three subtypes of Frontotemporal Dementia: (1) Behavioral Variant Frontotemporal Dementia, (2) Primary Progressive Aphasia, and (3) disturbance of motor function. Behavioral Variant Frontotemporal Dementia can develop in people as early as 20 and as late as 80. It is marked by changes in personality and behavior, such as: conduct, judgment, empathy, and foresight. Another subtype of Frontotemporal Dementia, Primary Progressive Aphasia, is marked by degeneration that affects language skills, speaking, writing, and comprehension. Primary Progressive Aphasia typically occurs before the age of 65, but can occur later in life. There are two types of Primary Progressive Aphasia: (1) semantic variant Primary Progressive Aphasia, where the ability to understand and form words into a spoken sentence is lost and (2) nonfluent/agrammatic variant Primary Progressive Aphasia, where speech is hesitant, labored, not grammatically correct. Frontotemporal Dementia can be diagnosed by a physician using their professional judgment, along with brain scans such as a magnetic resonance imaging, or MRI, scan or a glucose positron emissions scan. Frontotemporal Dementia has been found to have a genetic link in about a third of all Frontotemporal Dementia cases, however there are currently no known risk factors. There are no known treatments for Frontotemporal Dementia, however there are medications available to treat the symptoms of Frontotemporal Dementia, such as medications that help reduce agitation, irritability, and depression. Frontotemporal Dementia is progressive and will worsen over time, however the rate at which a person will decline is different from person to person.

Lastly, the fifth most common form of dementia, Mixed Type Dementia, which is caused by changes to the brain from more than one type of Dementia. Most commonly, Mixed Type Dementia is caused by abnormal protein deposits in the brain, which are associated with Alzheimer’s Disease, and problems in the blood vessels, which is associated with Vascular Dementia. Mixed Type Dementia is also commonly composed of Alzheimer’s Disease and Dementia with Lewy Bodies. Most commonly, individuals with Mixed Type Dementia were diagnosed with Alzheimer’s Disease while they were alive and diagnosed with an additional form of Dementia during an autopsy after death. There are no known treatments to specifically treat Mixed Type Dementia, however treatment is typically focused on the type of Dementia diagnosed prior to death. There are also many ways to reduce your chances of developing

Mixed Type Dementia, including not smoking, maintaining a healthy blood pressure, maintaining healthy cholesterol, maintaining healthy blood sugar numbers, eating a healthy diet, maintaining a healthy weight, and exercising.

A diagnosis of Dementia can seem overwhelming and heart breaking. You might feel like you have no one to turn to. After receiving a Dementia diagnosis from your or your loved one’s physician, finding a mental health clinician who is knowledgeable in Dementia, it’s various types, the progression of the disease, and what to expect can help you feel less overwhelmed and help you to focus on your own mental health and being present for your loved one during this journey. It is also beneficial for a person with Dementia to see a mental health clinician themselves. These benefits include improved quality of life, improved mood, and can also improve symptoms of dementia at times. Additionally, learn about your loved one’s specific type of Dementia, the symptoms associated with their type of Dementia, the typical disease progression, and what to expect as the disease progresses. Reach out to your support system for help or contact your local chapter of the Alzheimer’s Association, which provides support and resources for many types of Dementia, and utilize their twenty-four hour helpline or attend one of their many support groups.  Document your loved one’s likes, dislikes, and routines, as well as their past history including information about their families of origin, including parents, siblings, spouses, children, and grandchildren, their hometown, schools they attended, their career and any important accomplishments, their religion, and hobbies, etc. It is also important to talk to a Financial Advisor and Elder Law Attorney to ensure all legal steps have been taken including creating a Durable Power of Attorney, Advanced Medical Directive, planning for

long-term care, and to decide on issues such as organ donation or whether they would like to a Do-Not-Resuscitate (DNR) order. This also gives your loved one a chance to have a say in their final arrangements and wishes at the end of their life. Taking these steps can help prepare you for the journey ahead and give you more time to enjoy with your loved one.

Brigid A. McGuire, MA, PLPC, NCC, CRC, provides private therapy for young adults, adults, older adults, and caregivers. She has significant experience working with older adults and their families who face a variety of issues including memory loss, depression, anxiety, grief, isolation, and end of life planning. She also provides therapy for frontline/healthcare/essential workers who worked through the pandemic, people with disabilities, and their caregivers/families.

In addition to private practice, she is the Assistant Director of Social Services at Parc Provence. She has a deep passion for learning and continuing education. She also enjoys participating in various professional organizations and doing volunteer work in the St. Louis community.