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Older Adults

Alzheimer's Disease

What is Alzheimer's?
Alzheimer's Disease (AD) is the most common cause of dementia in older people. A dementia is a medical condition that disrupts the way the brain works. AD affects the parts of the brain that control thought, memory, and language. Although the risk of getting the disease increases with age, it is not a normal part of aging. At present the cause of the disease is unknown and there is no cure.

AD is named after Dr. Alois Alzheimer, a German psychiatrist. In 1906, Dr. Alzheimer described changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal deposits (now called senile or neuritic plaques) and tangled bundles of nerve fibers (now called neurofibrillary tangles). These plaques and tangles in the brain have come to be characteristic brain changes due to AD.

Symptoms Include:

  • initial mild forgetfulness
  • confusion with names and simple mathematical problems
  • forgetfulness to do simple everyday tasks, i.e., brushing their teeth
  • problems speaking, understanding, reading, and writing
  • behavioral and personality changes
  • aggressive, anxious, or aimless behavior

Statistics

It is estimated that currently 4 million people in the United States may have Alzheimer's disease. The disease usually begins after age 65 and risk of AD goes up with age. While younger people may have AD, it is much less common. About 3% of men and women ages 65-74 have AD and nearly half of those over age 85 could have the disease.

Diagnosis

No definitive test to diagnose Alzheimer's disease in living patients exits. However, in specialized research facilities, neurologists now can diagnose AD with up to 90% accuracy. The following is some of the information used to make this diagnosis:

  • a complete medical history
  • basic medical tests (i.e., blood, urine tests)
  • neuropsychological tests (i.e., memory, problem-solving, language tests)
  • brain scans (i.e., MRI scan, CT scan or PET scan)

Research for Possible Risk Factors

Scientists are trying to learn what causes AD and how to prevent it. This list may not be all inclusive or definite. However, research has lead scientists to consider these as possible risk factors:

  • Genetic factors
  • Environmental factors - aluminum, zinc, and other metals have been detected in the brain tissue of those with AD. However, it isn't known whether they cause AD, or build up in the brain as a result of AD.
  • Viruses - Viruses that might cause the changes seen in the brain tissue of AD patients are being studied.

The only known risk factors are age and family history. Serious head injury and lower levels of education may also be risk factors. AD is probably not caused by any one factor. Most likely, it is several factors together that react differently in each person. Unfortunately, no blood or urine test currently exists that can detect or predict AD.

Treatment

Alzheimer's disease advances in stages, ranging from mild forgetfulness to severe dementia. The course of the disease and the rate of decline varies from person to person. The duration from onset of symptoms to death can be from 5 to 20 years.

Currently, there is no effective treatment for AD that can halt the progression. However, some experimental drugs have shown promise in easing symptoms in some patients. Medications can help control behavioral symptoms; making patients more comfortable and easier to manage for caregivers. Still other research efforts focus on alternative care programs that provide relief to the caregiver and support for the patient.

For More Information:

Contact your local Mental Health Association, community mental health center, or:
National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center
800/969-NMHA
TTY Line 800/433-5959

Alzheimer's Association
919 N. Michigan Ave.
Suite 1000
Chicago, IL 60611
Phone: (800) 272-3900

Alzheimer's Disease Education and Referral Center
PO Box 8250
Silver Spring, MD 20907-8250
Phone: (800) 438-4380
http://www.nia.nih.gov/alzheimers

Eldercare Locator
Phone: (800) 677-1116

Multi-Infarct Dementia

What is Multi-Infarct Dementia?
Multi-infarct dementia is the second most common cause of dementia in older people. Sometimes it is difficult to distinguish from Alzheimer's disease, which is the most common cause of dementia in older persons. It is possible for a person to have both multi-infarct dementia and Alzheimer's disease, making it hard for the doctor to diagnose either.

Causes Of Multi-Infarct Dementia
Multi-infarct dementia is caused by a series of strokes that damage or destroy brain tissue. A stroke occurs when blood cannot get to the brain. A blood clot or fatty deposits (called plaques) can block the vessels that supply blood to the brain, causing a stroke.

Who is Affected?
Multi-infarct dementia usually affects people between the ages of 60 and 75. Men are slightly more likely than women to have this disease. However, the most important risk factor for multi-infarct dementia is high blood pressure. It is rare for a person without high blood pressure to develop multi-infarct dementia.

Symptoms
Symptoms that begin suddenly may be a sign of multi-infarct dementia. In addition to confusion and problems with recent memory, symptoms of multi-infarct dementia may include:

  • wandering or getting lost in familiar surroundings.
  • moving with rapid, shuffling steps.
  • loss of bladder or bowel control.
  • laughing or crying inappropriately.
  • difficulty following instructions.
  • problems handling money.

Multi-infarct dementia is often a result of a series of small strokes, called ministrokes or TIAs (transient ischmic attacks). The symptoms of a TIA often are very slight. They may include:

  • mild weakness in an arm or a leg.
  • slurred speech.
  • dizziness.

The symptoms generally do not last for more than a few days. Several TIAs may occur before the person notices any symptoms of multi-infarct dementia. People with muti-infarct dementia may improve for short periods, then decline upon having further strokes.

Diagnosis
People who show signs of dementia or who have a history of strokes should have a complete physical exam. The doctor will ask the patient and the family about:

  • the patient's diet
  • medications
  • sleep patterns
  • personal habits
  • past strokes
  • other medical problems
  • recent illnesses
  • stressful events

To look for signs of stroke, the doctor will check for weakness or numbness in the arms or legs, difficulty with speech, or dizziness. To check for other health problems that could cause symptoms of dementia, the doctor may order office or laboratory tests. Tests may include:

  • blood pressure reading.
  • an electroencephalogram (EEG).
  • a test of thyroid function.
  • blood tests.
  • x-rays.
  • computerized tomography (CT) scan.
  • magnetic resonance imaging (MRI).

Both CT scans and MRI tests take pictures of sections of the brain. The pictures are then displayed on a computer screen to allow the doctor to see inside the brain. (CT scans and MRI tests are painless and do not require surgery.) In addition, the doctor may send the patient to a psychologist or psychiatrist to test reasoning, learning ability, memory, and attention span.

Treatment
While no treatment can reverse damage that has already been done, treatment to prevent additional strokes is very important. High blood pressure, the primary risk factor for mutli-infarct dementia, can be treated successfully. Diabetes also is a treatable risk for stroke. To prevent additional strokes, doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. They will counsel patients about good health habits such as exercising, avoiding smoking and drinking alcohol. The patient may require a special diet.

Doctors sometimes prescribe aspirin or other drugs to prevent clots from forming in the small blood vessels. Drugs also can be prescribed to relieve restlessness or depression or to help the patient sleep better. Sometimes doctors recommend a surgery known as carotid endartectomy. This surgery is done to remove blockage in the carotid artery, the main blood vessel to the brain. Studies are under way to see how well this surgery works in treating patients with mult-infarct dementia. Some scientists are also studying drugs that increase the flow of blood to the brain.

Helping Someone with Multi-Infarct Dementia
Family members and friends can help the patient cope with mental and physical problems. They can encourage daily routines and regular social and physical activities. By talking about events and daily activities they can help reinforce mental abilities. Lists, alarm clocks, and calendars may help to remind the patient of important times and events.

For More Information:
Contact your local Mental Health Association, community mental health center, or:

National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center
800/969-NMHA
TTY Line 800/433-5959

Alzheimer's Association
Phone: (800) 272-3900

Alzheimer's Disease Education and Referral (ADEAR) Center
Phone: (800) 438-4380

Eldercare Locator Service
Administration on Aging
Phone: (800) 677-1116

National Institute of Neurological
Disorders and Stroke
Phone: (301) 496-5751


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