As the Canadian population ages, the cases of dementia will increase dramatically over the next 25 years. Many people over 60 are concerned regarding their memory, but Dementia and Alzheimer’s disease are not just memory problems.
Dementia is a broad term that refers to a number of diseases that cause problems with thinking. This includes memory, but also can show up as difficulty performing familiar tasks, problems with language, disorientation of time and place, poor or decreased judgment, problems with abstract thinking, misplacing things, changes in mood or behaviour, changes in personality, and loss of initiative. This may cause problems with such activities as cooking, driving, doing your banking and shopping, or social activities.
Often as we age we can have changes in our memory, however dementia is defined as problems that have a significant impact on your day to day function. So for instance as you get older you may not be as good at remembering people’s names who you’ve met once or twice. We are more concerned about dementia if you can’t remember the names of people you know very well.
The most common causes of dementia are Alzheimer’s disease and strokes. Alzheimer’s disease is a brain disorder that usually attacks older people and slowly worsens over time. We think it is caused by abnormal protein in the brain, but are not yet sure what starts the disease process. However we do know that people with high blood pressure and high cholesterol, as well as those with low levels of education have higher rates of Alzheimer’s disease. Once the diagnosis is made, most people with Alzheimer’s disease will deteriorate over the next 10 years and eventually need high levels of care from family or in a nursing home. Eventually Alzheimer’s disease is fatal.
Presently there is no cure for Alzheimer’s disease, however with education, help at home and some medications a patient with Alzheimer’s disease can live a high quality of life for a number of years.
Strokes also cause dementia, both those strokes that show up with weakness and language difficulties and ‘silent strokes’ which can accumulate over time. With strokes the most important prevention is controlling high blood pressure, cholesterol, and diabetes. Again education and home help is often useful for patients with strokes. There are other more rare causes of dementia which may have other symptoms such as troubles walking and talking. People with dementia can have subtle thinking changes, and often people may look relatively intact with normal conversation. People may or may not realize they are having problems, and information from friends and family is very important. Behaviour changes such as irritability, anxiety and depression can all occur with dementia but is not present in everyone with dementia.
Depression, or persistent sadness, occurs with people with dementia more than usual. It can cause problems with eating, sleeping, and pain that has no clear physical cause or that is hard to treat. This is probably due to the changes in the brain as well as loss of functioning. It is always important to determine if depression is present in older people, as this is a treatable condition that can improve lives.
If you or someone in your family has changes that you are worried might be dementia, you should contact your family doctor for an assessment. The doctors and nurses will ask detailed questions about your problems to make a diagnosis. More specialized assessments or testing may need to be done, such as brain scanning or seeing a specialist in dementia such as a geriatrician, neurologist or psychiatrist. Services and education in the home are also available through your local health unit and the Alzheimer’s society.
It is important to remember that dementia is not normal, that getting older does not guarantee thinking problems. There is help out there for patients and families and if we can catch problems earlier we can prevent other problems from developing.
Dr. Janet Kushner-Kow BSc., MD, MEd., FRCPC
Specialist in Geriatric Medicine