What is dementia?

Conway McLean, DPM

The holidays are here, a time for merriment and joy, basking in the warmth of loved ones. Families gather together, reminiscing of days gone by. But there is always change. You may see signs of a change in your elders, such as parents or grandparents. Those who you know well, but haven’t seen on a daily basis. These changes may be a subtle shift in their mood, mild anxiety, or possibly a mildly depressed attitude. However, it can be easy to miss these early signs if you don’t see elderly relatives that often or for that long.

But these subtle harbingers of change are often precursors of something more devastating, a condition often fatal, frequently leading to their demise. I am referring to dementia, a disease growing more frequent with each year, although there is much we do not yet understand. Changes in mood may be the first signal that a loved one may be developing this serious medical condition. A cloudy mood may be a sign a bigger storm is brewing because depression appears to be one of the earliest symptoms of dementia. Although memory problems are thought of as being the prototypical sign, a new study says otherwise.

It is an understandable inclination to want to chalk up memory problems to aging, the consequences to our brain of the passing of the years. These changes used to be referred to as senility. But this should elicit in the reader an obvious question “What is the difference between senility and dementia?” The answer is not clear-cut, mostly because many authorities think of the term ‘senility’ as being archaic, and no longer medically accepted. Senility, in contrast to dementia, is an old term which used to describe a decline in an older adult’s physical and cognitive health. Like dementia, senility can cause changes in mental function, such as memory loss or a decline in judgment.

Depending on the source of the publication you might read, it is possible to see the term ‘senility’ used synonymously with dementia. This would seem to be the view of a minority of physicians and scientists. Although the term may be bandied about by the lay public, by and large, it has gone the way of the dodo bird, like another phrase from bygone days rheumatism. But senility, as a descriptor of the consequences of aging, can produce various changes in mental and physical abilities such as stiff joints, a change in posture, decreased strength, brittle bones and bone loss.

Many of those reading this will agree that the term “senile” has taken on a negative connotation in recent years. A lack of understanding and sensitivity to the challenges of aging have led to an improper use of the word making it sound like a slur on someone’s mental capacity, instead of a true health condition.

A better question is what is the relationship between dementia and Alzheimer’s? People often mistakenly think that dementia is just another name for Alzheimer’s disease, when it’s actually a variety of medical conditions and illnesses that impair a person’s cognitive health. Alzheimer’s disease is one specific type of dementia, but there are others with the most recognizable being Parkinson’s. Unfortunately, Alzheimer’s accounts for about 70 percent of dementia cases.

Dementia is best treated when caught early, so identifying early symptoms in elderly relatives during the holidays can be helpful in getting them treatment. Some early signs include mood changes and anxiety. Difficulty moving and memory loss could also be signs of early dementia. It is common for a person with early dementia to experience apathy, depression or anxiety. These symptoms are directly linked to memory loss, with those living with dementia being unable to process certain emotions. Holidays can be a frustrating time for those living with dementia, since they rely on routine and a sense of familiarity. Avoid arguing with them over points, reminding yourself that their anger comes from a frustration they cannot control.

Other symptoms of dementia include forgetfulness, limited social skills, and thinking abilities so impaired that it interferes with daily functioning. They will have difficulty communicating or finding the words they want to use. Other surprising early signs of dementia may include a big change in the kinds of foods they crave–especially a newfound preference for sweets. New criminal behaviors such as stealing or trespassing may be an early sign of dementia. A decrease in walking speed can precede any cognitive symptoms of Alzheimer’s. New research suggests a buildup of a specific protein in the brain may be to blame. Those pieces of protein form the hallmark plaques thought to spur Alzheimer’s-related damage in the brain.

Research has revealed certain risk factors for dementia. Naturally, some of these are not controllable, such as age. The older you get, the greater your risk of developing dementia, although it is not a normal part of aging. And it can occur in younger people. Having a family history of dementia does increase the odds, but many with this positive family history never develop symptoms, while others without this history do.

Others risk factors have been identified over which you do have some control. These include heavy alcohol use (although certain studies have shown a protective effect of moderate consumption). High blood pressure, atherosclerosis (hardening of the arteries), and other cardiovascular risk factors seem to increase the odds of developing dementia. Poorly controlled diabetes, as well as smoking, seem to increase one’s risk.

Dementia can affect many body systems and, therefore, the ability to function. Without sufficient assistance, dementia can lead to poor nutrition. Ultimately, some sufferers become unable to chew and swallow food. Difficulty swallowing increases the risk of choking or aspirating food into the lungs, which can block breathing and cause pneumonia. As dementia progresses, it can interfere with bathing, dressing, brushing hair or teeth, using the toilet independently and taking medications accurately. Late-stage dementia results in coma and death, often from infection.

Prevention is not truly possible: we simply don’t know enough about this devastating condition. It may be beneficial to do a few things, thus possibly reducing your risk, such as keeping mentally active, being physically and socially active, not smoking, getting plenty of vitamin D by eating a good diet. Keeping your blood pressure down, of course, should be an obvious one. In other words, live a healthy lifestyle.

In 2010, more than 14 percent of Americans age 71 or older had dementia. By 2040, the total cost of dementia will increase to as much as $511 billion in inflation-adjusted dollars. America is aging: the statistics are clear. The cost of care for those individuals who will develop dementia, be it from Alzheimer’s or some other cause, will grow at an alarming rate. How will our health care system, one that is already in crisis, handle this burden? Many in the industry have been unable to answer this critical question. The health, and the care of its citizens, is in peril.

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.