Medical News Today recently published information on both dementia and Alzheimer’s Disease (AD). I think that most of us have experiences with family and friends with impaired cognitive function. Is it dementia or AD or something else? Regardless of the specific disease, we see the person’s quality of life decline as the disease progresses.
There are several types of dementia, according to the National Institute on Aging – AD, Lewy body dementia, frontotemporal dementia, and vascular disorders, to name a few. AD is the most common and affects nearly 6 million Americans. Dementia is not a normal part of the aging process, but we see more elderly with various cognitive impairments.
The brain operates smoothly until there is a fly in the ointment. For several centuries, ‘a fly in the ointment’ meant a small defect that spoils something of value. Dementia, as with other diseases, doesn’t happen overnight. It takes years before symptoms begin to appear.
Early symptoms of dementia are memory loss, difficulty planning, difficulty with everyday chores, confusion, challenges understanding, problems speaking or writing, misplacing things, poor judgment, mood swings, changes in personality, withdrawal, and not interested in participating with others.
We tend to see family members with AD having a gradual loss of memory over time. Not every person has the same symptoms or progress. One American will develop AD every 68 seconds. By 2050, the rate of development will occur every 33 seconds.
AD has been five stages. They are preclinical, followed by mild cognitive impairment, then mild dementia, moderate dementia, and severe dementia. I have seen some articles with three stages and other articles claiming seven distinct stages of AD. Since AD affects people differently, it is easy to understand slightly different classifications for this disease.
The preclinical stage of AD has no symptoms. If there were a reason to do a brain scan, there might be some small accumulations of the beta-amyloid protein. AD usually does not become symptomatic for decades. What causes this small accumulation of the beta-amyloid proteins?
Inflammation is the cause of nearly every disease in the body. It starts as chronic low-level cellular inflammation and can affect the whole body. C-reactive protein (CRP) is created as a result of the inflammation. A CRP blood test will tell you if you have inflammation in your body, but not where.
Oxidative stress is present when the number of free radicals attacking the cells of the body is not balanced with an adequate supply of antioxidants. Inflammation and oxidative stress become the actual cause of disease. In the brain, the amyloid precursor protein (APP) is subject to attacks by inflammation and oxidative stress.
These attacks cleave the APP molecules with resultant beta-amyloid protein. Neural damage occurs when these proteins clump together. These plaques are sometimes called ‘senile’ plaques. Additionally, tau proteins form neurofibrillary tangles that also destroy neurons. There are a few other contributors to the destruction of regular brain operation.
Between fifteen and twenty percent of people over the age of 65 have some form of mild cognitive impairment. They forget things more often than they did a few years ago. They don’t make typical decisions they used to, or feel overwhelmed when making them. Time flies by more quickly for them. Their personality changes become noticeable to family and close friends.
Healthy aging has several of these symptoms in common but is not the same as stage 2 of AD. Not everyone with a form of mild cognitive impairment will develop dementia or AD. It will be a good time for a doctor’s intervention if you begin to see depression, irritability, aggression, apathy, or anxiety becoming more commonplace.
As AD progresses, mild dementia begins. Symptoms include difficulty remembering newly learned information, repeatedly asking the same question, lapses in judgment, becoming withdrawn, uncharacteristically irritable or angry, getting lost, and misplacing items. At this stage, doctors will declare their patients with AD.
Moderate dementia is the next stage. Patients may need help with daily tasks. They want to be in familiar surroundings and feel confused or uncomfortable when they are not. They confuse family and friends. Favorite memories are used to fill gaps. Occasionally, they will lose control of their bladder or bowel. Some have aggressive physical outbursts.
Severe dementia manifests itself with an inability to speak or communicate coherently. Patients need assistance with personal care and eating. Some are unable to walk without help. Bladder and bowel control issues and inability to swallow are common symptoms. Not all stages are experienced in the same way, and sometimes they overlap. Symptoms occur and then disappear and occur again. It is a difficult disease to treat.
Pneumonia is a common cause of death with AD patients. Other causes of death include dehydration, malnutrition, and infections. There are many options available, but the earlier the diagnosis, the better quality of life can be expected.