Understanding Dementia, Senility and Alzheimer's Disease

What is Dementia?

• Dementia is the permanent, relentless, progressive loss of many intellectual functions.
• The word "dementia" comes from the Latin words "de men," meaning "out of mind."
• Dementia is caused by the death of nerve cells. Once a nerve cell dies, it cannot be replaced and its function may be lost.
• Nerve cell death is caused by:
  • Alzheimer's Disease 60-70%
  • Multiple small strokes 15%
  • Multiple other causes 10-15%
• Five to 20% of elderly patients who appear demented have treatable diseases, for example:
  • Depression
  • Hormone imbalance (eg. hypothyroidism)
  • Drug (medication) induced confusion

What is Alzheimer's Disease?

• Alzheimer's Disease (AD) is one type of dementia, although it is often used synonymously with dementia.
• Alois Alzheimer was a German physician who first described this disease in 1906, in a brain specimen from an autopsy.
• There is no clear consensus of why the nerve cells die in the brain of AD patients.
• Inheritance plays some role;
  • 5% clearly inheritable (autosomal dominant)
  • 20-60% may have a genetic predisposition

How many people are affected?

• Approximately 4 million Americans are afflicted with AD. In Alabama, it is estimated that 57,000 people suffer from dementia.
• Alzheimer's Disease is the fourth leading cause of death among adults in America.
• Approximately 10% of the population over 65 years of age have AD.
• Forty-seven percent of those over the age of 85 have dementia. This is the fastest growing segment of the population in the United States.
• Dementia afflicts both men and women in all racial, religious and socioeconomic groups.
• Sixty percent of all nursing home patients are demented.

What are the symptoms?
Intellectual losses include:

• Amnesia: Loss of memory function. Distinct memories remain clear while recent memories are lost. Patients lose the ability to store the memory of an event as it occurs; for example, a patient may not remember the course of a conversation from one moment to the next.
• Aphasia: Loss of ability to understand spoken/written words and /or inability to speak coherently. Patients may get words confused, jabber incessantly or become mute.
• Apraxia: Loss of ability to perform pre-programmed motor tasks or tasks that a normal person completes without any concentration. Some examples include: buttoning a shirt, brushing their teeth, writing their name, and eating with utensils.
• Agnosia: Loss of ability to remember what things look like, including the face of a close relative and even their own reflection in a mirror.

Psychiatric problems include:

• Major personality changes.
• Poor judgment, irritability, inappropriate behavior.
• 25% suffer from depression that should be treated.
• 30-40% suffer from hallucinations and delusions.
• 50% of demented individuals will wander or become aggressive.

Non-neurological symptoms:

• Only the brain is damaged in AD. Other organ systems are not damaged.
• Patients have a long survival rate because other organ systems are not damaged.

What is the course of the disease?

• No two patients are alike.
• No patient's course is predictable.
• Early: (3 to 5 years)
  • Mild amnesia
  • Good functions at home
  • Few psychiatric symptoms
• Middle: (3 to 10 years)
  • Many intellectual impairments
  • Poor function at home
  • Many psychiatric/behavior problems
• Late: (5 to 20 years)
• Multiple severe intellectual impairments
• No function at home
• Total care of patient to include feeding tubes
• Loss of bowel and bladder function

What treatment is available?

•  Current:
  • The drugs, Cognex, Aricept, and Exelon, have been approved for the treatment of Alzheimer's disease. A small percentage of patients on these medications improve. For most patients, the progression of the disease is delayed.
  • There are approximately 50 drugs in development for Alzheimer's disease.
  • Neither the experimental drugs nor the approved drugs appear to affect the underlying disease process.
  • Psychiatric symptoms can be treated with medications.
• Future:
  • Future therapy will try to prevent the death of nerve cells and maximize the function of surviving nerve cells.
  • Adequate preventive measures may be as much as 10 years in the future.

What is the cost of care?

• 70% of all Alzheimer's patients are cared for in the community by families. The cost of a family caring for an AD patient at home averages $18,000 per year.
• The annual cost of nursing home care ranges between $40,000 and $58,000.
• Paying for Alzheimer's Disease is estimated to be more that $80 billion each year. The federal government and the states cover less than $9 billion. Much of the remaining costs are borne by patients and their families.

How can families cope with this disease?

• Realize that denial of the problem will not make it go away.
• Education about the disease should be the family's first line of defense.
• Seek out a knowledgeable, caring physician who will work with you to manage the patient's behavior problems, as well as their physical complaints.
• Plan ahead. Take care of financial issues and issues like a living will and durable power of attorney.
• Seek out services that will ease your burden like adult day care, Meals on Wheels, and local support groups.
• Remember Alzheimer's Programs are here to help!!

For more information contact:

• Alzheimer's & Dementia
  Help Line: 1-800-457-5679

• Southern Alabama Regional Council on Aging (SARCOA)
  Post Office Drawer 1886
  Dothan, Alabama 36302
  (334) 793-6843 or
  (800) 239-3507

• Alzheimer's Resource Center
  2246 Montgomery Highway
  Dothan, Alabama 36302
  (334) 702-2273 or
  (888) 702-8689

This information is being furnished to you by the Southern Alabama Regional Council On Aging (SARCOA)'s Alzheimer's Program.