For some types of diseases that cause Dementia to occur, there is a genetic association for having the disease by the time an individual is 60-years of age or older. It’s a subtle distinction, but people who have the altered gene inherit the risk and not the disease itself. In fact, Dementia is not a disease, rather, it is the expression of the cognitive challenges that come about because of the changes in brain tissue, caused by a particular disease.
This post mainly focuses on Alzheimer-caused Dementia but there are many other causes, e.g., Lewy body, Vascular, Frontotemporal, et al.
On the bright side, knowing that you have an inherited risk factor gives you the opportunity to do those things known to reduce risk - maintain a healthy weight, refrain from smoking, engage in socially and intellectually satisfying activities, exercise, and eat a heart-healthy diet.
For the most part, the at-risk genes change how the body processes cholesterol and other blood lipids. Therefore, it’s not surprising to find that having high cholesterol blood-levels is another risk factor associated with having Dementia later-in-life.
Early-onset familial Alzheimer disease (eFAD) is inherited Dementia that affects people as young as 30 years of age. (1) Unlike traits that are observable shortly after birth, such as eye color, symptoms of eFAD do not appear until the individual is 30-years of age or somewhat older. By that time, it is likely he or she has one or more children and may have unknowingly passed the early-onset gene to them.
Fortunately, there are DNA tests that can identify the presence of the increased-risk genes as well as those that cause eFAD.
Making the decision to undergo testing is difficult. Will knowing make you feel anxious, relieved, or empowered? Will other family members also want testing? How might this information affect family planning for you or your adult children? Will having a positive test for a specific cause of Dementia risk factors or early-onset disease influence your employer, your career, or make it more difficult to receive health insurance? (2)
Often, people find talking with a genetic counselor can make the decision to test--or not--easier. The genetic counselor, by explaining the technical and emotional issues associated with genetic testing, can help you make a personally comfortable decision. Afterward, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. (2)
You can find more information about genetics and genetic counseling on the following webpages: National Association of Genetic Counselors (https://www.nsgc.org/page/find-a-genetic-counselor)and the American Board of Genetic Counselors (https://www.abgc.net/about-genetic-counseling/find-a-certified-counselor.aspx/). Both of these sites may help you find a genetic counselor located near your home.
Notes:
1. What is Early Onset Familial Alzheimer Disease? http://www.alzforum.org/early-onset-familial-ad/overview/what-early-onset-familial-alzheimer-disease-efad (accessed April 26, 2016)
2. Genetic Testing and Counseling for Early Onset Familial Alzheimer Disease, http://www.alzforum.org/early-onset-familial-ad/diagnosisgenetics/genetic-testing-and-counseling-early-onset-familial (accessed, April 26, 2016)
Want to Know Even More?
Alzheimer Disease Genetics Fact Sheet, https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-genetics-fact-sheet#genetics
(accessed, April 26, 2016)
Contributor:
Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the
author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.
The opinions expressed by contributing
authors are not necessarily the opinions of the Dementia Society, Inc. We do
not endorse nor guarantee products, comments, suggestions, links, or other
forms of the content contained within blog posts that have been provided to us with
permission, or otherwise. Dementia Society does not provide medical advice.
Please consult your doctor. www.DementiaSociety.org
The health benefits that various foods and diets to improve overall health or lower risk for disease is a newsworthy topic. Some reporters state that eating fiber-rich fruits, vegetables, and whole grains helps us to maintain a healthy weight as well as may lower risk for colon cancer. Others assert the Mediterranean diet, one which encourages replacing red meat for fish and chicken, saturated fats with olive oil, and refined carbohydrates with whole grains, reduces the risk for heart disease, certain cancers, and diabetes.
Many research studies are touting the benefits of red wine on lowering cholesterol blood levels and thereby reducing the risk of heart disease, strokes, cataracts, and colon cancer. Though a controversial area of research, some studies indicate drinking moderate amounts of red wine may slow declines in brain function.
With respect to consuming wine and other alcoholic beverages - moderation is the keyword. However, most people are unsure of how much is a moderate amount. According to the Dietary Guidelines for Americans, a low to moderate alcohol consumption is no more than one drink a day for women and older adults, and two for men. One drink is usually one 1/2 ounce or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor. (Note 1)
These dietary guidelines refer to the amount consumed on any single day and not as an average over several days. In other words - do not save your daily allocation for a weekend binge.
Alcohol-related brain damage, (ARBD) conditions that include Wernicke-Korsakoff syndrome (WKS) and alcoholic Dementia is the result of drinking too much alcohol over several years. (Note 2) Though both types of ARBD exhibit Dementia-like symptoms, neither condition is true-Dementia. (Note 2) The difference between ARBD and a Dementia such as Alzheimer disease is in the ability to treat or stop the progression of symptoms.
Consuming more than the recommended amounts of alcohol does increase the likelihood of developing Alzheimer disease and vascular Dementia later in life. However, researchers have yet to establish the scientifically measurable relationship between alcohol consumption and risk for Dementia. The reasons are many and include research entirely dependent on reported observations and evaluating the variables that, in combination with alcohol consumption, affect the long-term risk for Dementia.
However, one can state with certainty, the more you drink, the greater the likelihood of developing Dementia later in life. High alcohol consumption also increases the risk for stroke, heart and liver disease, and depression – all of which are well-known Dementia risk factors.
Contributor:
Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the
author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.
The opinions expressed by contributing
authors are not necessarily the opinions of the Dementia Society, Inc. We do
not endorse nor guarantee products, comments, suggestions, links, or other
forms of the content contained within blog posts that have been provided to us with
permission, or otherwise. Dementia Society does not provide medical advice.
Please consult your doctor. www.DementiaSociety.org
Notes:
1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition, Washington, DC; 2015, http://health.gov/dietaryguidelines/2015/guidelines/
(accessed June 15, 2015).
2. What is Alcohol-related Brain Damage?, https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=98 (accessed June 16, 2016).
This may surprise you, but it summarizes the impact Dementia may have on our families: we believe that more than 9 million Americans live with some form of Dementia today. Moreover, although the scientific community is attempting to shed additional light on the numbers, Alzheimer's-type Dementia alone is currently considered to represent more than half of the cases.* Even more shocking, according to the World Health Organization, when all forms of Dementia are combined, they are globally thought to be the 3rd leading cause of death, behind heart disease and stroke in high-income countries.*
Did you know? Dementia is not a disease. It is the umbrella term we apply to those cognitive diseases, e.g., Alzheimer’s, Vascular Dementia, Lewy Body, Frontotemporal and other conditions that can cause Dementia, which is the progressive loss of two or more basic brain functions and the accompanying activities of daily living. Yet, how you outwardly express Dementia is unique to you. People living with Dementia are still whole human beings and can experience joy, sadness, creative expression and much more.
Some would say that the number of deaths attributable to Dementia is significantly underreported due to the stigma associated with the various diseases, lack of education, or other coexisting health issues that can often occur at the end of your life. No matter what the numbers are, Dementia is costly in every way possible, both financially and emotionally.
Rich or poor, or somewhere in-between, you can die prematurely just because of Dementia. Alzheimer's disease, along with many other causes of progressive Dementia, cross cultural and socioeconomic divides. Today there are no cures or effective long-term treatments for almost all forms of Dementia.
However, you can get great satisfaction, and increased inner strength and sense of well-being in caring for someone living with Dementia, but it is still not easy. Even professional caregivers who are paid to give a helping hand, and assist those living with Dementia, experience occasional burnout. Person-centered care, and going further if possible to person-directed care, requires that we always treat individuals uniquely, with respect, and with dignity to the end of their lives. These are just a few of the keys to an optimal quality of life and the best possible tomorrows.
*Sources: see www.dementiasociety.org/home
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org
In the broadest sense, memory is the ability to retrieve information from specific areas of the brain. Types of memory fall into two categories – long-term memory and short-term memory. The kinds of information associated with long-term memory are the names, places, and dates that compose our personal history. Long-term memory also includes such things as the skills we have learned as well as the acquisition and use of language.
When Dementia damages our long-term memory banks, we forget such things as our address and birth date, and may no longer remember how to drive the car or to use the washing machine.
When we lose access to our collection of learned information and built-in skills, we require assistance to live safely at home. Short-term memory, or working memory, is the ability to retain small bits of recently learned information, such as phone numbers, login codes, and street addresses.
People who have short-term memory deficits may not remember they have already taken their medication or, just an hour ago, ate lunch.
The ability to recall and use language is one of many ways to assess the progression of Dementia. In addition, specific kinds of language difficulties can help clinicians differentiate Frontotemporal Dementia (FTD) from other types of Dementia such as Alzheimer’s disease.
Language difficulties most often associated with Alzheimer’s disease are difficulty in finding the right words, describing objects rather than calling them by name, repeated use of familiar words, relying on gestures to express ideas, and reverting back to speaking a native language.
Unlike Alzheimer’s disease, people who have FTD often have difficulty in using and understanding spoken and written language. Language problems include repeated mispronunciations, such as “sork” for “fork” and the inability to make appropriate associations between names and objects. If your parent is not able to associate an object with a word, he or she may point to a sandwich and call it a baseball. People who have FTD are not aware of how they have changed.
Using words and phrases such as “this,” “that” and “over there” in the place of specific nouns and descriptions are language deficits typical of many types of dementia.
Memory loss and language difficulties often make communication awkward, difficult, and frustrating. It doesn’t take long before “never mind” replaces your efforts to engage in conversation.
Here are a few tips you can use to improve communication between you and your loved one. As you will read, most are expected norms of polite conversation.
· Give your loved-one the time to formulate a response
· Engage in one-on-one conversation
· Converse in a quiet space with few distractions
· Maintain eye contact
· Avoid criticizing or correcting misinformation
· Listen
· Avoid arguments
· Speak slowly
· Give step-by-step instructions
· Use written notes to prevent the frustration and confusion of remembering details.
Contributor: Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.
Alzheimer's Disease (AD) is thought to be the most common kind of Dementia. Researchers estimate that as many as 5.4 million people living in the United States have this type of Dementia.¹ Whereas, when you combine all forms of Dementia together, it is estimated to affect 9 million or more people in the U.S.
According to the Centers for Disease Control and Prevention, Alzheimer's Disease is the fifth most frequent cause of death for adults aged 65 years and older.² Further, in high-economic countries³ like the U.S. and Canada, when considering the larger domain - that includes of all types of Dementia - Dementia is thought to rank even higher as the third leading cause of death, behind heart disease as number 1 and stroke as number 2.
While it is hard to say what actually causes Alzheimer's Disease, we do know the deposition and accumulation of fibrous proteins accompanies irreversible brain damage. It is thought that these insoluble proteins form β-amyloid plaques that disrupt brain architecture alter how brain cells use energy, and promote cell death. The second hallmark of AD, also seen by Dr. Alois Alzheimer over 100 years ago under a microscope, are the neurofibrillary tangles of dead and dying neurons seemingly connected to Tau, another type of protein. That's why medical professionals will often speak of the "plaques and tangles" of AD.
The result is a slow and progressive decline in memory, thinking, and reasoning skills. Eventually people lose the ability to swallow and breathe in a coordinated fashion. Even in the absence of other catastrophic diseases such as kidney failure and cancer, Alzheimer's Disease is a terminal illness.
Alzheimer's Disease comprises a spectrum rather than a defined set of signs and symptoms. Slow progression, rather than sudden change, is often the key to differentiating Alzheimer's behaviors from those associated with other kinds of Dementia. Life expectancy after an Alzheimer's diagnosis can be anywhere from four to 20 years. People who have Dementia often die from other causes such as cancer, kidney failure, and cardiovascular disease.
The Alzheimer's Association lists the 10 warning signs of Alzheimer's Disease – the first of which is memory loss. After reading the list you might think, How are these behaviors different from what everybody does at one time or another? The difference is the frequency and the ability to make self-corrections.
Healthcare providers often use staging to describe the progression and severity of diseases such as cancer, kidney failure, and Dementia. The following staging criteria will help you understand your loved-one’s condition and plan for future caregiving needs.
Mild or Early-stage Alzheimer's Disease
In this first stage, people experience memory loss, difficulty remembering newly learned information, and have trouble completing complex tasks such as planning a family event. Personality changes such as uncharacteristic anger and increasing difficulty in finding the right words, getting lost, or misplacing items are other common signs. With help, your parent, spouse, or sibling may still be capable of independent living.
Moderate or Mid-stage Alzheimer's Disease
During this phase people may confuse family members with close friends, forget personal history details such as where they went to school or where they were born, and need help with dressing and personal hygiene. Some people may become restless, suspicious of others, and confrontational. At this stage, your relative will need close supervision and assistance during the day and perhaps a caregiver during the night.
Severe or Late-stage Alzheimer's Disease
In the course of this last stage, people who have Dementia lose the ability to speak coherently, need help with eating, dressing, using the bathroom, and walking. Eventually, Late-stage Alzheimer's patients lose the ability to swallow and control their bladder and bowels. During this final stage, your loved-one will need 24-hour care, either at home or in a Dementia care facility.
Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.
References
1. 2017 Facts and Figures: Alzheimer’s Disease Facts and Figures, Download source here: 2017 Alzheimer’s Disease Facts and Figures. (accessed September 18, 2017).
2. ibid
3. 2017 World Health Organization Factsheet Download source here: 2017 World Health Organization Factsheet.
