Now where did I put my keys? Why did I walk into this room? What’s
the word I’m thinking of …? Everyone forgets things from
time to time; it’s normal. And it’s normal to become more
forgetful with age—that doesn’t mean you have dementia. Unfortunately,
forgetfulness combined with other symptoms of diminished mental and physical
acuity—confusion, disorientation, amnesia, language and visual spatial
problems—can signal the onset of dementia in older individuals.
When these symptoms affect tasks like keeping a checkbook, using a computer
or remote control, cooking a meal and driving, then a diagnosis of dementia
is made. For all types of dementia, aging is the biggest risk factor,
according to Torrance Memorial Medical Center neurologist and associate
professor of neurology at UCLA, Bernard Ullman, MD. With 30 years of experience,
Dr. Ullman estimates that roughly 50% of people aged 95 and older have
some form of dementia. There are various types, including Alzheimer’s
disease, which is the most common and accounts for an estimated 60% to80%
of cases. The disease can be caused by genetic inheritance, especially
with onset before age 65. After 65, the genetic component of dementia
becomes much less pronounced.
REDUCING THE RISK
While we can’t control our genes, Dr. Ullman notes we can control
the risk factors for vascular dementia, also known as multi-infarct or
post-stroke dementia. Vascular dementia is less common than Alzheimer’s,
but still accounts for a significant number of cases. Vascular and Alzheimer’s
disease can occur together in “mixed dementia,” especially
in those with significant
cardiovascular risk factors. These risk factors are the same risk factors
as coronary heart disease and stroke. They include: hypertension, elevated
cholesterol and lipids, diabetes, cigarette use, and lack of exercise.
Controlling these lifestyle factors is possible and “very important
in terms of reducing your risk or delaying the onset of dementia,”
says Dr. Ullman.
NEVER TOO SOON
When should you start thinking about keeping your brain fit? The earlier
the better, says Dr. Ullman, but even in midlife, adopting a brain-healthy
lifestyle can help keep you sharp as a tack for years to come. Besides
lifestyle and genetics, there are other risk factors for dementia: exposure
to heavy metals, low vitamin B12, viral encephalitis and repetitive brain
injury.“ There are protective factors, too. Epidemiologic studies
have shown that higher levels of education, higher socioeconomic status
and high work complexity correlate with lower levels of dementia, although
the relation between them isn’t fully understood,” says Dr.
Ullman. He suggests that early education, good nutrition and healthy living
environments for our children now would reduce levels of dementia in the
future. While we can take measures to reduce our risk of developing some
forms of dementia, currently there is no medication to prevent or reverse
it. Physicians can test individuals’ genetic predisposition for
Alzheimer’s and can perform brain scans and test spinal fluid for
the buildup of amyloid and Tau proteins associated with Alzheimer’s
disease. In young patients who have families with strong family histories
of early onset Alzheimer’s disease, “We can predict when they
are going to get the disease,” says Dr. Ullman. Brain scans can
detect amyloid plaque some 15 years before symptoms of the disease become
apparent, and spinal fluid tests can detect amyloid up to 25 years in
advance of symptoms. However he adds, the benefits of this testing are
still controversial until we have effective treatments. Treatments to
eliminate amyloid proteins from the brain of patients with Alzheimer’s
disease have so far failed. But some of these treatments are now being
evaluated in clinical trials targeting patients from families with genetic
forms with early onset, as well as a group of older patients who are relatively
asymptomatic. Dr. Ullman is hopeful these current studies will be fruitful,
as well as new approaches to inhibit brain degeneration.