The Challenges of Dementia and Alzheimer's

Understanding Dementia and Alzheimer's

Medical experts stress the fact that there is no physiological reason for an aging senior to develop dementia through the aging process. It is a misconception that aging automatically brings on dementia. It does not have to be so. Dementia is a disease process that eventually, sometime in the future, will be brought under control through treatment. Currently, there is little effective treatment available for dementia. All efforts at the current time need to concentrate on strategies to prevent incurring dementia.

"Dementia" is a general term describing a variety of diseases and conditions that affect the brain and that result in improper brain function. Alzheimer's disease is by far the most common form of dementia. Alzheimer's is characterized by a gradually decreasing ability for a person to function normally. Alzheimer's primarily affects cognitive ability and only in later stages affects motor abilities. As the disease progresses, patients eventually become bedbound and reliant on 24-hour care. At this point, the aging process accelerates rapidly, and the patient usually dies of some infection - often due to pneumonia. The typical Alzheimer's patient lives an average of eight years after symptoms are diagnosed but some individuals can go as long as 20 years with Alzheimer's. Currently, there is no cure.

The most common early symptom of Alzheimer's is difficulty remembering newly learned information because Alzheimer's changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain, it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but that communication usually has no cognitive meaning. At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired.

Here is a description of how dementia is classified and a list of most types of dementia.

Mild Cognitive Impairment
It is estimated that 10% to 20% of all individuals over age 65 exhibit mild cognitive impairment. Mild cognitive impairment is not considered dementia as it is not serious enough to interfere with daily life or independent function. The cause is not completely understood but it could be early-stage Alzheimer's or early stages of other dementias.

Mixed Dementia
This is a condition where more than one type of dementia listed below is present. Mixed dementia may or may not incorporate Alzheimer's disease, since an autopsy is necessary to positively identify Alzheimer's. A common form of mixed dementia might include Alzheimer's and a concurrent dementia with Lewy Bodies.

Alzheimer's Disease
This is the most common type of dementia and accounts for 60% to 80% of all dementia cases. Alzheimer's is characterized by amyloid protein deposits in the brain tissue which either cause or are the result of the death of brain cells. Currently it can only be positively diagnosed after death through autopsy. Alzheimer's is a progressive disease and eventually results in death.

Vascular Dementia
Vascular dementia is caused by reduced or blocked blood flow to brain cells. This results in lack of vital oxygen and nutrients and eventually results in dead brain cells. This type of dementia is considered the second most common cause of dementia and it is estimated it is responsible for about 20% to 30% of all cases. Mild vascular dementia may remain undiagnosed as it may not result in significant enough disability to warrant treatment. Vascular dementia may also occur as a result of a stroke, or a result of multiple tiny strokes called TIAs (transient ischemic attacks).

Dementia with Lewy Bodies
This is the third most common type of dementia, and it is estimated it may occur in about 10% to 25% of all dementia cases. It is caused by microscopic deposits of Alpha-synuclein protein that eventually kill brain cells. This type of dementia is generally more profound and more disabling from the outset than is Alzheimer's.

Fronto-temporal Dementia
This is a group of disorders that are caused by progressive cell degeneration in the frontal lobes of the brain. It is believed that it accounts for 10% to 15% of all dementia cases. For individuals younger than age 65 it may account for 20% to 50% of all dementia cases. This type of dementia is usually developed earlier in life as compared with the other types of dementia. Since the frontal lobe of the brain is responsible for personality and behavior, this dementia will primarily affect behavior, personality, language skills or the ability to speak. This dementia may also result in tremor, balance problems, stiffness and other movement coordination.

Parkinson's Disease Dementia
Parkinson's disease is a fairly common disorder with older adults and may affect up to 2% of seniors 65 and older. Approximately 1 million people have Parkinson's. It is estimated that 50% to 80% of those with Parkinson's disease eventually develop Parkinson's disease dementia. Even though Parkinson's is primarily a movement disorder, it is characterized by a brain that does not work properly and as such a Parkinson's brain can induce other disabilities. As the disease progresses, the same protein deposits that are found in Lewy Body dementia also develop in someone with Parkinson's. Thus, Parkinson's often leads to a form of Lewy Body dementia.

Below are listed other less common dementias that are typically caused by other physical conditions, diseases or injuries.

• Down Syndrome
• Huntington's Disease
• Normal Pressure Hydrocephalus
• Posterior Cortical Atrophy
• Traumatic Brain Injury
• Korsakoff Syndrome
• Creutzfeldt-Jakob Disease

An Epidemic of Alzheimer's Disease

Here are some facts taken from the Alzheimer's Association website.

Some Alarming Facts

• One in every three seniors dies with Alzheimer's or another dementia. Even though the cause of death may be attributed to some other disorder or disease, dementia is still present.
• An estimated 5.4 million Americans of all ages have Alzheimer's disease in 2012. This figure includes 5.2 million people age 65 and older(and 200,000 individuals under age 65 who have younger-onset Alzheimer's
• One in eight people age 65 and older (13 percent) has Alzheimer's disease.
• Nearly half of people age 85 and older (45 percent) have Alzheimer's disease.
• Of those with Alzheimer's disease, an estimated 4 percent are under age 65, 6 percent are 65 to 74, 44 percent are 75 to 84, and 46 percent are 85 or older
• Most individuals with the disease are age 65 or older. The likelihood of developing Alzheimer's doubles about every five years after age 65.
• Of the 5.2 million people over age 65 with Alzheimer's in the United States, 3.4 million are women and 1.8 million are men. 16 percent of women age 71 and older have Alzheimer's disease or other dementias compared with 11 percent of men. The larger proportion of older women who have Alzheimer's disease or other dementias is primarily explained by the fact that women live longer on average than men.
• Many studies of the age specific incidence (development of new cases) of Alzheimer's disease or any dementia have found no significant difference by gender. Thus, women are not more likely than men to develop dementia at any given age.
• People with fewer years of education appear to be at higher risk for Alzheimer's and other dementias than those with more years of education. Prevalence and incidence studies show that having fewer years of education is associated with a greater likelihood of having dementia and a greater risk of developing dementia
• Alzheimer's disease is the 6th leading cause of death in the United States overall and the 5th leading cause of death for those aged 65 and older. It is the only cause of death among the top 10 in America without a way to prevent it, cure it or even slow its progression.
• Deaths from Alzheimer's increased 68 percent between 2000 and 2010, while deaths from other major diseases, including the number one cause of death (heart disease), decreased.
• While ambiguity about the underlying cause of death can make it difficult to determine how many people die from Alzheimer's, there are no survivors. If you do not die from Alzheimer's disease, you die with it.

Impact on Caregivers

• In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer's and other dementias - care valued at $216.4 billion, which is more than eight times the total sales of McDonald's in 2011.
• Eighty percent of care provided in the community is provided by unpaid caregivers.
• Nearly 15 percent of caregivers are long-distance caregivers, living an hour or more away from their loved ones. Out-of-pocket expenses for long-distance caregivers are nearly twice as much as local caregivers.
• More than 60 percent of Alzheimer's and dementia caregivers rate the emotional stress of caregiving as high or very high; more than one-third report symptoms of depression.
• Due to the physical and emotional toll of caregiving, Alzheimer's and dementia caregivers had $9.1 billion in additional health care costs of their own in 2012.

Cost to the Nation

• In 2013, the direct costs of caring for those with Alzheimer's to American society will total an estimated $203 billion, including $142 billion in costs to Medicare and Medicaid.
• Total payments for health care, long-term care and hospice for people with Alzheimer's and other dementias are projected to increase from $203 billion in 2013 to $1.2 trillion in 2050 (in current dollars). This dramatic rise includes a 500% increase in combined Medicare and Medicaid spending.
• The average per-person Medicare costs for those with Alzheimer's and other dementias are three times higher than for those without these conditions
• The average per-person Medicaid spending for seniors with Alzheimer's and other dementias is 19 times higher than average per-person Medicaid spending for all other seniors.