Dementia

 My mother’s birth date is rapidly approaching .She would’ve been 113 years of age. Mom lived into her 90s. Number of things stand out, especially her memory. She  sang and played the piano; slaughtered the competition at Scrabble– I would not play her. She was delighted  when she scored  a bingo and received 50 points.She loved music and enjoyed Laura’s theme from Dr. Zhivago and  I Could Have  Danced  All  Night  from My Fair Lady. She loved  Mario Lonza and  sang and played the piano for the captain on a cruise ship to Mexico.Mother even caught one of  Tom Jones hankies at a concert. She was terrific at crossword puzzles too. Tony’s mother lived in her 90s and was terrific at crossword puzzles, word puzzles and knew all the  vegetables by name in her garden.Tony  did not know their names.This disquisition  focuses on dementia.

For a brief review, the brain is made up of neurons. Neurons have three parts which include dendrites  which take in information, a cell body, and axons which send out information. The chemical messengers that pass between the axon of one to the dendrite of another is called a neurotransmitter. There are known to be over 30 different neurotransmitters in the brain A few selected neurotransmitters and their proposed function: 1. Acetylcholine–autonomic NS regulation, signal transmission from nerves to muscles, memory formation-declines in brain during aging 2.Noradrenalin–motivation, energy, socializing, basal metabolic rate 3. Dopamine–concentration, socializing, food seeking and sexual desire, motor neuron control declines  in brain aging 4.Serotonin–mood, food intake regulation, vomiting, limbic system functions, pain and sleep 5. GABA-major inhibitory NT, associated with emotional balance, sleep patterns, anxiety . 6.Glutamate-major excitatory NT, associated with potentiation of other NT’s  7. Endorphin–affects perception of pain, analgesia and euphoria.

Additionally, the human brain reaches  maximum size in the teens and then in the 20s begins to decline . There is loss of neurons and  neurons lose some connections with other neurons . There is also reduced blood flow to the brain. However , in aging dendrites involved in  learning deteriorate. In  the most advanced aging ,thicker dendrites involved in old learning typically are more preserved.  With a reduction in neurons, loss of synaptic connections and declining levels of neurotransmitters, deterioration of myelin also affects new learning in the processing speed of old learning.  Thicker dendrites continue to improve with good brain health.Much of the memory decline in aging is due to slowing the ability to encode information efficiently so it can be recalled later . Briefly, some other causes of slower processing include:1. Visual impairment  2. Medical conditions 3. Fatigue and sleep disturbance 4. Physical and mental inactivity  5. Medications

Research at Massachusetts General Hospital found that heavier people had smaller brains with the most atrophy in areas involved in cognitive functions such as memory, attention, planning, and decision-making . Midsection obesity promotes insulin resistance, diabetes, and robs neurons of glucose leading to cell injury and death.  Obesity was also associated with vascular damage in the brain from high blood pressure and elevated LDL which impedes oxygen and nutrients to neurons. However, strenuous exercise has been shown to protect these areas despite being overweight.

With that brief overview we  proceed to a limited focus on dementia.  Dementia is a progressive loss of cognitive function. It is also accompanied by disturbances of mood ,behavior ,and personality . It leads to significant impairment in the ability to perform normal activities of daily living . Dementia is not a specific disease but a term for a group of symptoms caused by different disorders that affect the brain.

Because human life expectancy is increasing, age is the biggest risk factor for dementia. It is becoming more common and currently found in 14% of Americans aged 71 and older. Increased age is the biggest risk factor . The risk doubles every five years after age 65 . However, age is not the only factor. Lifestyle factors and genetic expression also affect the risk .With  dementia ,people usually experience numerous problems  that render them unable to carry-on normal activities of life. Memory loss is a common symptom of dementia but memory loss by itself is not dementia.

Signs of dementia include: 1.  Asking the same questions over and over  again during the day like what are we doing today; what was  the doctor’s name   2. Inability to do complex tasks like cooking or reading recipe directions for a meal 3. Becoming lost in once familiar places like streets and street names 4. Forgetting names of friends and not recognizing the voice on the telephone 5. Forgetting  dates of birth; names of cities ,states  and countries; appointments and schedules ; the time people are coming over to visit 6. Neglecting personal hygiene 7. Showing signs of mental confusion such as directions to a familiar place that has become unfamiliar 8. Experiencing mood symptoms such as anxiety, irritability, anger or depression 9. Acknowledging current limitations with frustration and discouragement 10. Difficulty remembering and saying nouns; calling the computer a camera and vice versa; not remembering how to dial a telephone; not being able to read certain clocks that indicate the month with  a number. These signs of dementia become very stressful not only for the individual but also for the family caretaker as well.The family member becomes well aware of the  cognitive deterioration. Seeing an independent individual becoming more and more dependent during the aging process is a sad experience. It demonstrates the importance of brain health to the 10th degree.This is a terrible diagnosis and progressive condition.

The American Medical Association presents guidelines that distinguish normal aging from dementia. This description first will present normal aging followed by-  present dementia:  1. Remains independent in activities of daily living–Dependent on others for activities of daily living 2. Complaints of memory loss, but provides details-Complaints  of memory loss only when asked with no details 3.More concerned about forgetfulness than family   -Close family members are more concerned about memory 4. Recent memory for events/conversations not impaired-Recent memory for events/conversations noticeably impaired  5. Conversations with word finding not impaired-Difficulty  in conversations and finding words 6. No pauses in speech or word substitution-Pauses in speech and word substitutions 7. Doesn’t get lost in familiar places but pauses-Gets lost walking or driving;  may take hours to get home  8. Operates  common appliances; reluctant to learn new-Can’t operate common appliances unable to learn new ones 9. No decline in personal relationships or social skills-Loses interest in social activities, socially inappropriate 10. Normal mental status exam for age, education , culture-Abnormal mental status performance for age, education, culture.

A brief listing of negative lifestyle factors include excessive alcohol use ,and tobacco smoking; basic inflammation and parental disease; anxiety and depression; drug effects and interactions; respiratory problems; metabolic diseases or abnormalities ; normal pressure hydrocephalus; sleep problems and disorders; chronic stress; dietary deficiencies; hospitalizations; delirium’s for developing dementia during aging.These will be addressed at a later date.

 There are, In fact, non-reversible  dementias that include Alzheimer’s; Parkinson’s; Lewy body; Vascular dementia and stroke; Chronic traumatic encephalopathy; Frontotemporal dementia; Progressive supranuclear palsy; Huntington’s disease;Creutzfeldt-Jakob disease.These non-reversible dimensions affect the ability and diminish hope for  improvement. Dementia is a  terrible diagnosis.

All in all , this elementary overview presents a grim picture for those that have experienced dementia. Generally, some aspects of dementia may be slowed down at best. However, once again a positive  lifestyle continues to be the prescription for mental, emotional, brain and physical health. This country Is severely sick and is proceeding in the wrong direction.Thank you mother for modeling vigorous brain health. You were a tremendous model to imitate.I was lucky to have you as a mom. Remembering your birth date remains special.

Reference

Understanding Dementia. Institute For Natural Resources.