Understanding Memory Loss and Dementia

What is dementia?

Dementia is a progressive deterioration of intellectual abilities which are significant enough to interfere with the social and occupational functioning of the individual.
Dementia is NOT a normal part of aging regardless of the age of the individual.

Early Warning Signs


Are you or someone you know experiencing any of the following?

  • Memory loss that affects job or lifestyle

  • Difficulty performing familiar tasks, such as cooking, driving, paying bills on time

  • Problems with language, such as forgetting common words

  • Disorientation to time or place, including getting lost

  • Poor or decreased judgment

  • Constantly misplacing things

  • A change in mood or behavior

  • A change in personality

  • Loss of initiative

These symptoms may indicate a memory disorder or dementia such as Alzheimer’s disease.

Symptoms are usually mild in the early stage of the disease, allowing most individuals to continue to do simple daily routines. Many are aware of the changes that are taking place, including difficulty with many of the symptoms mentioned above.

You may not be able to identify someone with Alzheimer’s disease by appearance.

Many individuals with mild and moderate cognitive impairment seem as alert and as physically fit as anyone their age. Individuals may also maintain their social skills or behave in a socially appropriate manner in familiar settings. In addition, some people may hide or deny their symptoms. These factors make identification of a person with Alzheimer’s disease more difficult.

Because the disease progresses at different rates in individuals, symptoms and behaviors vary.

Prognosis ranges greatly. Therefore, it is most helpful to monitor symptoms based on progression of stages observed by the patient’s family and care team, as well as keep in touch with The Memory Center team for ongoing support and continuity of care between visits. 

Understanding Memory Loss and Changes in Behavior

People with Alzheimer’s disease share certain cognitive and behavioral characteristics.
MEMORY LOSS

In Alzheimer’s disease, recent memories are lost first, while distant ones are often retained.

The affected individual may not remember his or her name, phone number, address, or caregiver. However, he or she may easily recall things that were learned decades ago.

WANDERING

People with Alzheimer’s are prone to wander. They can become lost (even in familiar settings) and leave a safe environment.

Wandering can happen anytime or anywhere, and can be life-threatening for the individual. The Alzheimer’s Association’s Safe Return Program assists in the return of individuals with Alzheimer’s who may wander and become lost. Click here for the Safe Return Program.

CHANGES IN MOOD & BEHAVIOR

A person with Alzheimer’s disease may react with agitation to events taking place.

During a catastrophic reaction, moods and behavior often change quickly. Individuals may become angry and combative, cry, or lash out verbally or physically at those who try to help them. It is important to remember that the person is not acting like this on purpose.

Changes in behavior can be triggered by various factors such as physical discomfort, fatigue, overstimulation, or frustrating interactions.

Causes of Dementia

Scientists are still not certain what causes dementia. Age and family history have been identified as potential risk factors.

Researchers are exploring the role of genetics in the development of Alzheimer’s but most agree the disease is likely caused by a variety of factors. Each year, scientists are uncovering important new clues about potential causes of the disease which is helping to generate more accurate diagnostic tests and better treatment options for affected individuals.

Currently, there is no single diagnostic test that can detect if a person has Alzheimer’s disease.

However, new diagnostic tools and criteria make it possible for physicians to make a positive clinical diagnosis of Alzheimer’s disease with an accuracy of approximately 90 percent. Although as yet, the onset of the disease cannot be stopped or reversed, an early diagnosis gives affected individuals a greater chance of benefiting from existing treatments and allows them and their families more time to plan for the future.

The diagnostic process may take more than one day and will involve a visit to a specialty physician.

Parts of the evaluations commonly performed to determine the diagnosis include: medical history, mental status evaluation, physical examination, neurological examination, laboratory tests and psychiatric, psychological and other evaluations. The only way to confirm a diagnosis of Alzheimer’s disease is through autopsy.

Since dementia can be caused by many things, it is important to see if it is due to a cause that is curable.

Alzheimer’s disease is not currently curable but it is treatable with medications and strategies that can enhance quality-of-life. Accurate and early diagnosis is very important.

Treatment Options

Currently, there are no cures for Alzheimer's disease or most other kinds of dementia.

However, there are many medical illnesses and medications that can either cause memory problems or worsen an existing dementia. For this reason, our evaluation is extremely thorough to uncover any such conditions.

In the absence of a cure, the goal is to find specific ways to help manage the patients' problems and improve the condition of the patient and the family who cares for him or her.


Certain medications and therapies are useful for managing the symptoms of Alzheimer’s disease and other dementias, and more treatments are on the horizon.

The Center for Comprehensive Care and Research on Memory Disorders is committed to going beyond the diagnosis by providing ongoing care and support to patients and families through out the course of the illness.

Backed with the resources of an academic medical center known for its innovative programs, physicians and researchers here at The University of Chicago advance the latest in medications and research, helping to manage symptoms and provide relief for patients with Alzheimer’s disease and other dementias.

A decade ago, very few compounds were being developed specifically for Alzheimer's disease. Within the last several years, a family of drugs have become available for the treatment of Alzheimer's.

Currently, these drugs include:

  • Exelon (rivastigmine)
  • Aricept (donepezil)
  • Razadyne (galantamine)
  • Namenda (memantine)

The first three drugs work by preventing a normal brain enzyme from breaking down a neurochemical used in making memories, called acetylcholine. Namenda works by protecting the brain from damaging effects of another neurochemical called glutamate.

Today, dozens of drugs that may improve cognitive and behavioral symptoms and slow progression of the disease are being studied. In addition, several experimental drugs have begun to show promise in enhancing nerve cell communication, regulating defective cell processes, protecting nerve cells from damage brought on by toxins, and repairing damaged nerve cells in the brain.

Living with Dementia

Who is afflicted?

No one is certain why some people get Alzheimer’s and others don’t. With continued research, more and more is being learned about this disease every day.

There are some factors that researchers believe can increase a person’s risk of getting Alzheimer’s disease. Scientists believe, for example, that those who have an immediate family member with Alzheimer’s may be more likely to develop Alzheimer’s themselves, although the causes and degree of risk are not clear.

Who is affected?

A diagnosis of Alzheimer’s disease has implications not only for the person with the disease, but also for his or her family and friends.

Everyone who cares for someone with Alzheimer’s will feel the effects of the disease and will need to understand how to cope with what is happening to his or her family member or friend.

Depression is found in 20% of persons with Alzheimer’s disease and in up to 50% of Alzheimer’s caregivers.

Types of Dementia

Alzheimer's Disease

Alzheimer’s disease is a progressive, degenerative disease of the brain.

It is not a normal part of the aging process or a mental illness.

Alzheimer’s causes abnormal proteins to accumulate in and around nerve cells throughout the brain, causing them to die. Loss of nerve cells results in memory loss, impaired thinking and behavior.

The disease is progressive and will eventually affect a person’s daily functioning. Eventually, an individual will require around-the-clock care and supervision, with death as the inevitable outcome.

Alzheimer’s disease affects an estimated 4 million Americans. It affects one in ten persons over the age of 65 and nearly half of those over 85 have Alzheimer’s disease.

It can occur in people in their 30’s, 40’s, and 50’s. The disease affects both men and women, and crosses all social, economic, and cultural boundaries.

Patients with Alzheimer’s disease may live up to 20 years after contracting the disease. However, in the final stages of the illness they lose all abilities to care for themselves.

Although many cases of Alzheimer disease may have a hereditary component, family history is not a guarantee of developing the disease. The precise cause of this illness is unknown.

Dementia With Lewy Bodies

Most experts estimate that dementia with Lewy bodies is the third most common cause of dementia after Alzheimer’s disease and vascular dementia, accounting for 10 to 25 percent of cases.

The hallmark brain abnormalities linked to DLB are named after Frederick H. Lewy, M.D., the neurologist who discovered them while working in Dr. Alois Alzheimer’s laboratory during the early 1900s. Alpha-synuclein protein, the chief component of Lewy bodies, is found widely in the brain, but its normal function isn’t yet known.

Lewy bodies are also found in other brain disorders, including Alzheimer’s disease and Parkinson’s disease dementia.

Many people with Parkinson’s eventually develop problems with thinking and reasoning, and many people with DLB experience movement symptoms, such as hunched posture, rigid muscles, a shuffling walk and trouble initiating movement.

This overlap in symptoms and other evidence suggest that DLB, Parkinson’s disease and Parkinson’s disease dementia may be linked to the same underlying abnormalities in how the brain processes the protein alpha-synuclein.

Many people with both DLB and Parkinson’s dementia also have plaques and tangles — hallmark brain changes linked to Alzheimer’s disease.

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Source: Alzheimer’s Association
http://www.alz.org/dementia/dementia-with-lewy-bodies-symptoms.asp

Visit the link above to learn more about symptoms, diagnosis, treatment and outcomes, support groups and links to other important information.

Mild Cognitive Impairment

There is a condition now known as Mild Cognitive Impairment where a person has problems with memory, language, or another mental function like calculation or judgment severe enough to be noticeable to others and may show up on neuropsychological testing, but not severe enough to interfere with their activities of daily life.

Because their cognitive problems don’t impair their daily life, they don’t meet criteria for dementia.

However, studies have shown that these persons with Mild Cognitive Impairment have an increased risk of developing Alzheimer’s disease over their life time especially in the next several years.

As yet there is no treatment for this disorder except for annual neuropsychological testing. It is recommended that patients with this condition be followed annually by their doctors to enable them to determine if and when the condition may develop into an Alzheimer’s dementia. Medication for Alzheimer’s disease is most effective when it is given early in the disease.

It is important not to dismiss memory and behavioral changes as simply old age. A thorough evaluation is necessary to determine the extent and cause of memory problems.

Alzheimer’s disease is the most common form of dementia, but there are many other reasons why people can have problems with their memory.

Many memory problems are treatable and a supportive and caring team of health care professionals can help virtually all patients and families.

Mixed Dementia

In the most common form of mixed dementia, the abnormal protein deposits associated with Alzheimer’s disease coexist with blood vessel problems linked to vascular dementia.

Alzheimer’s brain changes also often coexist with Lewy bodies.

In some cases, a person may have brain changes linked to all three conditions — Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.

Researchers don’t know exactly how many older adults currently diagnosed with a specific type of dementia actually have mixed dementia, but autopsies show that the condition may be significantly more common than previously realized.

Autopsy studies play a key role in shedding light on mixed dementia because scientists can’t yet measure most dementia-related brain changes in living individuals.

In the most informative studies, researchers correlate each participant’s cognitive health and any diagnosed problems during life with analysis of the brain after death.

Source: Alzheimer’s Association
http://www.alz.org/dementia/mixed-dementia-symptoms.asp

Visit the link above to learn more about symptoms, diagnosis, treatment and outcomes, support groups and links to other important information.

NPH (Normal Pressure Hydrocephalus)
Prion Diseases

Definition

The Prion diseases are a group of brain diseases caused by an infectious protein called a prion.

The most common human form of prion disease is called Creutzfeldt-Jakob Disease (CJD), named after the two physicians who, in the 1920’s, first described the clinical and pathological features of the disease. It is important to understand that the information shared below (symptoms and causes) primarily pertains to the clinical picture of CJD, since it represents the majority of patients who are evaluated. Yet, there are other more rare types of prion diseases with clinical presentations that differ slightly from CJD.

Symptoms

Most patients developing CJD first show signs of disorientation, general confusion, personality changes, and often have difficulty walking as well. These symptoms are associated with a rapidly progressive dementia.

Within months or even weeks, the patient may exhibit severe changes in behavior, lose the ability to recognize familiar objects or people, and have difficulty with speech and language, thus requiring complete care with all basic activities of daily living.

Life expectancy is usually 6 months or less after the onset of symptoms.

Causes

Most cases of prion disease are sporadic, meaning scientists don’t understand what initiates the disease process. The basic mechanism of CJD, as in any prion disease, involves a change in the 3-dimensional shape of the normal prion protein in the brain to an abnormal pathogenic shape. This pathogenic protein, also simply called a “prion”, acts to convert other normal prion proteins into pathogenic prions, simply by binding to them.

In the end, the accumulation of prions kills brain cells.

Some cases are iatrogenic, in which a person has been exposed to contaminated brain tissue (i.e., by injection of growth hormone, corneal transplant, or surgical instrument).

Familial CJD accounts for approximately 15% of all cases.

Sometimes taking a thorough family history can help trace the familial form of the disease. Familial CJD is due to the specific mutations, or defects, in the prion protein gene. The age of onset is often younger than usual (less than 55 years) and the duration of the disease is longer than usual (between 1 and 10 years). 

Genetic testing can reveal the presence of familial CJD in patients with the disease.

“Prion” became a household word in the 90’s with “Mad Cow Disease” (Bovine Spongiform Encephalopathy, or BSE). Infected cows with BSE were found to transmit the disease across species to humans who ingested contaminated beef, causing humans to develop “New Variant CJD”. The containment of this disease remains a concern worldwide. The US is focusing on careful FDA regulation of feed and cows as isolated cases of BSE have been detected in the US and Canada.

Diagnosis

In addition to the history and physical exam, diagnostic tests that support the clinical evaluation of prion disease include:

  1. EEG (the electrical activity of the brain is abnormal and shows periodic sharp wave discharges)
  2. MRI, especially diffusion-weighted MRI (high signal changes in deep brain structures such as basal ganglia and thalamus are seen)
  3. Lumbar puncture to test for the presence of the 14-3-3 protein.

Treatment

Unfortunately, there is no medical treatment or cure for any type of prion disease, but human clinical trials are on the horizon, and one has been started. Presently, the primary focus of treatment in prion diseases is based on comfort and symptom control.

Family members are faced with tough decisions, such as whether they are able to take care of the patient at home or if he/she needs to be transferred into an extended care facility. Hospice care is often a recommended option to provide ongoing comfort care at the bedside (either at home or in a facility).

Can Autopsies be Performed on Prion Disease Patients?

As with any type of dementia, autopsy is an important consideration for patients and families. The University of Chicago Memory Center strongly encourages autopsies, which are done at the Medical Center.

Once the autopsy is completed after death, the patient’s family can be absolutely sure that prion disease was the actual diagnosis.

Autopsy is the only method to confirm a diagnosis with 100% accuracy. Many find that having this information and knowledge allows for peace and closure with their loss.

Autopsy is also important in supporting research, which may help patients and families in the future with this most devastating disease in possible prevention and treatment measures.

Vascular Dementia

Inadequate blood flow can damage and eventually kill cells anywhere in the body. The brain has one of the body’s richest networks of blood vessels and is especially vulnerable.

In vascular dementia, changes in thinking skills sometimes occur suddenly, following strokes that block major brain blood vessels.

Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage.

A growing number of experts prefer the term “vascular cognitive impairment (VCI)” to “vascular dementia” because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer’s disease and dementia with Lewy bodies. Several studies have found that vascular changes and other brain abnormalities may interact in ways that increase the likelihood of dementia diagnosis.

Vascular dementia is widely considered the second most common cause of dementia after Alzheimer’s disease, accounting for 20 to 30 percent of cases.

Many experts believe that vascular dementia remains underdiagnosed — like Alzheimer’s disease — even though it’s recognized as common.

Source: Alzheimer’s Association
http://www.alz.org/dementia/vascular-dementia-symptoms.asp

Visit the link above to learn more about symptoms, diagnosis, treatment and outcomes, support groups and links to other important information.