A mind in pieces

If we think we’re hearing a lot right now about Alzheimer’s disease and other age-related dementia disorders, wait another decade or so. The sheer demographic weight of an aging population will more than likely make dementia one of the most significant health issues for American society – not just for the people who have dementia but for their families as well.

Are we ready for it? Locally and statewide, efforts are under way to help communities become what’s known as dementia-competent, with adequate education, resources and high-quality services to appropriately support people with age-related dementia and their caregivers. It’s a measure of progress that this is being discussed openly and that state leaders are trying to prepare for it.

The learning curve is steep, however, especially for the average family whose knowledge of Alzheimer’s disease might be vague – that is, until they’re confronted with the reality of dementia in a parent, spouse or sibling. When I interviewed a group of people recently about their experiences as caregivers, this was one of the strongest messages that came through. As one of them said, “I don’t think anyone knows how to do it until you live it.”

For starters, take the name: Alzheimer’s disease. Although this has become a generic term for all age-related dementia, there actually are at least half a dozen forms of dementia, of which Alzheimer’s disease is the most common. Dementia can also be vascular in origin, often resulting when a series of strokes reduce blood flow to parts of the brain. Mixed dementia has the hallmarks of both Alzheimer’s disease and another form of dementia, most commonly vascular dementia. Dementia also can occur in the later stages of Parkinson’s disease, and it sometimes develops as well among people who have a buildup of fluid on the brain.

The 2010 edition of the Alzheimer’s Association collection of facts and figures contains a wealth of valuable information, including the latest findings in what we know about this disease that affects an estimated 5.3 million Americans and is the seventh leading cause of death in the U.S.

What is dementia, anyway, and how can you recognize when someone might have it? From the report:

Dementia is characterized by the loss of or decline in memory and other cognitive abilities. It is caused by various diseases and conditions that result in damaged brain cells. To be classified as dementia, the following criteria must be met:

It must include decline in memory and in at least one of the following cognitive abilities:

1) Ability to generate coherent speech or understand spoken or written language;

2) Ability to recognize or identify objects, assuming intact sensory function;

3) Ability to execute motor activities, assuming intact motor abilities, sensory function and comprehension of the required tast; and

4) Ability to think abstractly, make sound judgments and plan and carry out complex tasks.

The decline in cognitive abilities must be severe enough to interfere with daily life.

Researchers still aren’t sure what causes Alzheimer’s disease, but the current thinking is that it’s likely triggered by multiple factors rather than one single thing. The greatest risk factor is age; most cases of Alzheimer’s develop in people over age 65, although it can also strike people in middle age.

Older adults with mild cognitive impairement seem to be more likely to eventually develop dementia. It’s thought that as many as 15 percent of these individuals progress to dementia within three to four years. But it’s not clear which mechanisms contribute to mild cognitive development or what role they might play in the development of dementia. Researchers believe that in at least some cases, mild cognitive impairment may represent a transitional phase from normal aging into Alzheimer’s, or is perhaps an early stage of the disease.

More women than men have Alzheimer’s disease but this appears to be because women on average simply live longer, not because gender is an independent risk factor. Some interesting studies have suggested that people with less education are more likely to develop age-related dementia – but again, it’s not clear whether someone’s education level is a risk factor in and of itself or whether lesser education is part of a broader risk factor, such as income level and access to medical care.

The really discouraging news is that there’s no current treatment available to slow or stop the progression of brain-cell deterioration that is the hallmark of Alzheimer’s disease. Although five drugs have been approved for use in the U.S. for earlier-stage Alzheimer’s disease, in most cases they only slow the progression of the disease for six to 12 months, and in only about half of the people who take them.

More encouraging is the evidence that good medical management can significantly improve quality of life for people who have dementia and their caregivers. The report explains:

Active management includes appropriate use of available treatment options, effective integration of coexisting conditions into the treatment plan, coordination of care among physicians and others involved in maximizing quality of life for people with Alzheimer’s or other dementia and use of such supportive services as counseling, activity and support groups and adult day center programs.

It’s clear that caregiving will become an increasingly critical piece of the puzzle. What should worry all of us is whether we have a professional workforce that’s adequately prepared and family caregivers who are adequately supported. The Alzheimer’s Association report notes a significant shortfall in the number of doctors, pharmacists, physician assistants, registered nurses and social workers who have some training in geriatrics. Meanwhile, a staggering number of family members and friends – an estimated 10.9 million – serve as unpaid caregivers for someone with age-related dementia, often at considerable emotional, physical and financial cost.

So back to the original question: Are we ready for a rising tidal wave of Alzheimer’s and other forms of dementia among the aging population? We seem to be bracing for it. Compared to 10 years ago and perhaps even five years ago, more services and a greater variety of services are available. Awareness is higher, and families have more resources to turn to. There’s still a road to travel, though, before we arrive at where we need to be.

Photo: Wikimedia Commons

Leave a Reply

Your email address will not be published. Required fields are marked *