Original Air Date: March 22, 1998

What is dementia?

• Dementia is defined as a decline in intellectual ability to a point that it interferes with social or occupational functioning.

What are the different types?

• You can explain the disease using a department store analogy: Eatons is one type, Sears in another, Wal-Mart is another, but theyre all department stores. With dementias, theres Alzheimer disease, vascular dementia (stroke), alcoholic dementia, and others. Theyre all dementias, but all different. Some are reversible (drug or alcohol-induced), some aren't (Alzheimers).
• The big 3 (most common) are Alzheimer Disease (6 of 10 people with dementia have AD), vascular dementia and frontal lobe dementia.
• Overall, 1 in 10 cases of dementia is curable.

Do we know what causes dementia?

• We sort of know: deposits of built-up proteins in the brain effect chemical neurotransmitters, causing electrical short circuits in the brain.

What do we know about genetic predisposition?

• Family history does mean slightly increased risk.
• By age 90, 10-15% of the general population will suffer from dementia. If you have a family history, that figure increases to 15-25%.
• In less than 3% of families where one parent suffers from dementia, half of their children will have it.
• The ethical problem, of course, is do people want to know? What purpose does it serve?

What type of things signal caregivers that something is wrong?

• The most common behavioral changes are increased passivity, irritability and suspicion.
• Anything thats an over-learned behavior (something you do without thinking) is usually fine.
• Examples of behaviors that trigger red flags with family members:
  • The person didn't pay their taxes this year;
  • They've forgotten how to play a favorite card game;
  • They're getting lost;
  • Repetition of a (wrong) word;
  • False thoughts (someone is out to get them, etc.).
• Often,the patient has no concerns whatsoever. The key is how their present behavior differs from how they've behaved historically.

How is it diagnosed?

• It takes about two hours worth of testing by a doctor: questioning the person and having them perform simple tasks.
• Its best to have a family member or someone else familiar with the persons history and behavior present to discuss the problem and fill in any blanks.
• Even then, diagnosis isn't certain (its about 90% accurate). (The only true diagnosis can be obtained via autopsy.)

Should you tell the person whats wrong with them?

• Often, the family doesn't want the person told; but, ethically, you should tell them.
• With dementia, very few people ever ask whats wrong with them, and when you do tell them, they dont seem to take it to heart. (Thats the blessing: they dont know whats happening to them.)

What other conditions are mistaken for dementia?
Depression:

• Depressed people can be bothered by thoughts like, I'm going crazy or I can't think straight that can be mistaken for dementia symptoms.
• When testing, however, differences will be noticeable. Depressed people likely wont' submit to the testing and won't answer. Demented people will give you an answer...but it might be entirely inappropriate.
• They differ in terms of onset. The onset of depression is quite acute, while dementia creeps in: it's progressive and insidious.

• Cough medication, bladder medication, anti-depressants and sleeping pills can all cause dementia-like symptoms.

What are the most troublesome behaviors for caregivers?

• These behaviors can be called the caregiver burden.
• The most burdensome behaviors for caregivers are
  • wandering;
  • aggression (brought on by delusions);
  • incontinence.
    
    • Its extremely stressful. The caregiver is often embarrassed by the persons behavior. Because they're embarrassed to take the person out in public, both of them can become prisoners in the home.
    • The caregiver burden is not measurable on any test or scale. You can't be objective about it, as each persons coping abilities are different.
    • If a caregiver is educated about what's happening to their loved one and why he/shes behaving that way, it's easier to cope.
    • The caregiver is just as much a patient as the real patient.

      How is it diagnosed?
      

      • It takes about two hours worth of testing by a doctor: questioning the person and having them perform simple tasks.
      • Its best to have a family member or someone else familiar with the persons history and behavior present to discuss the problem and fill in any blanks.
      • Even then, diagnosis isn't certain (its about 90% accurate). (The only true diagnosis can be obtained via autopsy.

      How important is support for caregivers?
      

      • Support groups, adult daycare and respite programs are incredibly important. Caregivers have to learn to accept help. (Caregivers use 30% more anti-depressants than the general population.)
      • There are sometimes cultural taboos which prohibit people from accepting help--to do so would be to admit failure.

      When is it time to institutionalize?
      

      • When the family just cant cope with the behaviors anymore. For example:
        • aggressive behavior causing safety concerns (for the patient or others);
        • incontinence beyond where caregivers can cope;
        • safety concerns around the home (i.e. leaving burners on);
        • giving away money;
        • wandering.

      Do people die from dementia?
      

      • Dementia per se doesn't kill you, but it causes dysfunction in body systems that can result in death (i.e. problems with swallowing can cause food particles to get into the lungs, resulting in pneumonia).
      

      What treatments are available?
      

      • Since September, 1997, we've been treating Alzheimer's with Aricept.
      • It's reasonably well tolerated, but it's not a miracle drug; it's a tiny step forward.
      • Since it is so new, we don't have any information on long-term effects of the drug on people.
      • There's no evidence that Aricept is useful in people with more advanced symptoms. It's really for people with mild to moderate Alzheimer's.

      What about non-drug treatments?
      

      • There is some evidence that mega-doses of Vitamin E (2000 I.U.) are helpful in slowing down the rate at which people deteriorate to a dependent state.
      • There are some observational studies that suggest post-menopausal women can benefit from estrogen therapy (onset is later and milder). (Elderly men don't suffer from lack of estrogen because their bodies convert testosterone to estrogen in the brain throughout their lives.)
      • Gingko biloba: the evidence is "less convincing" than that for Vitamin E, but it seems somewhat helpful. (No benefit to taking both.)
      • "Psycho-social care" is as important as other forms of treatment: a team approach, including interaction with family, health care workers, social workers, etc., is crucial to a patient's well-being. It's because the drugs we have "aren't sensational enough."

      What's on the horizon?
      

      • This is a very active area of investigation right now as researchers look for drugs that will interfere with the pathological process of this disease.
      • There are three more Alzheimer's drugs in various stages of approval in Canada.
      • There is one, propentosylline, that's before the Health Protection Branch (Health Canada) right now that should be available by the fall. It's a brain anti-inflammatory that may have some "protective" effects (act on underlying cause rather than just symptoms).It will also be helpful in vascular dementia, not just Alzheimer's.

      Will there be a "magic bullet" cure?
      

      • Within the next 5-10 years, there will be something that might have a significant impact.
      • This won't help today's sufferers, but it's promising for those caregivers who see themselves in their ailing parents and are terrified for their own futures.