Alzheimer's Disease: Other Forms of Dementia

Ask Glen!

Q. Glen,I like your blogs very interesting, if I had more time I would have really gotten in to it. I read a few of them, but you got my interest. What you need to do is get more information about Alzheimer's Disease. That is where I am really trying to get more info about the disease. I try to find everything I can about it. I know there is no cure but there are different things out there that help me understand more clearly, and about what can be done about research? Wendylon

A. Ok Wendylon lets see what we can find out!

Dementia is the loss of mental functions -- such as thinking, memory, and reasoning that is severe enough to interfere with a person's daily functioning. Dementia is not a disease itself, but rather a group of symptoms that are caused by various diseases or conditions. Symptoms can also include changes in personality, mood, and behavior. In some cases, the dementia can be treated and cured because the cause is treatable. Examples of this include dementia caused by substance abuse (illicit drugs and alcohol), combinations of prescription medications, and hormone or vitamin imbalances. In some cases, although the person may appear to have dementia, a severe depression can be causing the symptoms. This is known as pseudo-dementia (false dementia) and is highly treatable. In most cases, however, a true dementia cannot be cured.

Dementia develops when the parts of the brain that are involved with learning, memory, decision-making, and language are affected by one or more of a variety of infections or diseases. The most common cause of dementia is Alzheimer's disease, but there are as many as 50 other known causes. Most of these causes are very rare.

Because some causes of dementia can be cured or partially treated, it is very important that your doctor is thorough when making the diagnosis, so as not to miss potentially treatable conditions. The frequency of "treatable" causes of dementia is believed to be about 10%.

What Causes Dementia?

There are several things which could cause dementia:

• Diseases that cause degeneration or loss of nerve cellsin the brain such as Alzheimer's, Parkinson's and Huntington's.
• Diseases that affect blood vessels, such as stroke, which can cause a disorder known as multi-infarct dementia.
• Toxic reactions, like excessive alcohol or drug use.
• Nutritional deficiencies, like vitamin B12 and folate deficiency.
• Infections that affect the brain and spinal cord, such as AIDS dementia complex and Creutzfeldt-Jakob disease.
• Certain types of hydrocephalus, an accumulation of fluid in the brain that can result from developmental abnormalities, infections, injury, or brain tumors.
• Head injury -- either a single severe head injury or longer term smaller injuries, like in boxers.
• Illness other than in the brain -- kidney, liver, and lung diseases can all lead to dementia.

Alzheimer's disease causes 50-60% of all dementias. But researchers have found that two nervous diseases, which were originally incorrectly diagnosed as Alzheimer's, are emerging as major causes of dementia: Lewy body disease and Pick's disease.

How Common Is Dementia?

Diseases that affect blood vessels, such as stroke, which can cause a disorder known as multi-infarct dementia.

Dementia caused by nervous system disease, especially Alzheimer's disease, is increasing in frequency more than most other types of dementia. Some researchers suspect that as many as half of all people over 80 years old develop Alzheimer's disease. Also, the increased incidence of AIDS dementia complex, which results from HIV infection, helps account for the increased dementia in recent history, although with the invention of newer and better drugs to treat HIV, the occurrence of AIDS-associated dementia is declining.

Who Gets Dementia?

Dementia is considered a late-life disease because it tends to develop mostly in elderly people. About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It is estimated that as many as half of people in their 80s suffer from dementia.

Which Dementias Are Treatable?

• Dementia due to long-term substance abuse.
• Tumors that can be removed.
• Subdural hematoma, accumulation of blood beneath the outer covering of the brain that result from a broken blood vessel, usually as a result of a head injury.
• Normal-pressure hydrocephalus.
• Metabolic disorders, such as a vitamin B12 deficiency.
• Hypothyroidism, a condition that results from an under-active thyroid.
• Hypoglycemia, a condition that results from low blood sugar.

What Are Some of the Non-treatable Causes of Dementia?

• Alzheimer's disease.
• Multi-infarct dementia (Dementia due to multiple small strokes).
• Dementias associated with Parkinson's disease and similar disorders.
• AIDS dementia complex.
• Creutzfeldt-Jakob disease (CJD), a quickly progressing and fatal disease that consists of dementia and muscle twitching and spasm.

Differences Between Mild Forgetfulness and More Serious Memory Problems

Jeanne’s story:

Jeanne couldn’t find her car keys. She looked on the hook just inside the front door. They weren’t there. She searched in her purse. No luck. Finally, she found them on her desk. Yesterday, she forgot her neighbor’s name. Her memory was playing tricks on her. She was starting to worry about it. She decided to see her doctor. After a complete check-up, her doctor said that Jeanne was fine. Her forgetfulness was just a normal part of getting older. The doctor suggested that Jeanne take a class, play cards with friends, or help out at the local school to sharpen her memory.

What is mild forgetfulness?

It is true that some of us get more forgetful as we age. It may take longer to learn new things, remember familiar names and words, or find our glasses. These are usually signs of mild forgetfulness, not serious memory problems.

If you’re worried about your forgetfulness, see your doctor. You also can do many things to help keep your memory sharp. Finding a hobby, spending time with friends, eating well, and exercising may help you stay alert and clear-headed.

What is a serious memory problem?

Serious memory problems affect your ability to carry out everyday life activities such as driving a car, shopping, or handling money. Signs of serious memory problems may include:

Getting lost in a place you know well may be a sign of a serious memory problem.

• Asking the same questions over and over again.
• Becoming lost in places. you know well.
• Not being able to follow directions.
• Getting very confused about time, people, and places.
• Not taking care of yourself — eating poorly, not bathing, or being unsafe.

What to do about serious memory problems

If you are having any of the problems listed above, see your doctor. It’s important to find out what might be causing a serious memory problem. Your treatment depends on the cause of the problem.

Alzheimer's Disease: Treatment Overview

Is There a Cure for Alzheimer's Disease?

At this time, there is no cure for Alzheimer's disease and no proven way of slowing its progression. Because the exact cause of Alzheimer's disease is unknown, there is also nothing that can be done to prevent it.

However, there are a number of medicines available that can help improve the intellectual functioning of people with Alzheimer's. If they are given early enough in the course of the disease, these medicines enable people to carry out their daily activities for a longer period of time and may prolong the time that patients can be managed at home.

There are also medicines available to help manage some of the most troubling symptoms of Alzheimer's disease, including depression, behavioral problems, and sleeplessness.

Although there is currently no cure for Alzheimer's disease, planning and medical/social management can help ease the burden on both patients and family members. Exercise, good nutrition, activities, and social interaction are important. A calm, structured environment also may help the person with Alzheimer's disease to continue functioning as long as possible.

How Is Alzheimer's Disease Treated?

Your doctor will determine the best treatment for you based on various factors, including:

• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medicines, procedures, and therapies
• Expectations for the course of the disease
• Your opinion or preferen

What are the medicines used to treat Alzheimer's disease?

• Aricept. Aricept is the most widely used drug for Alzheimer's disease. Aricept works by slowing down the breakdown of acetylcholine, a chemical that helps nerve cells in the brain communicate with each other. Aricept doesn't cure Alzheimer's or keep it from getting worse, but it can help relieve some of the memory loss. Aricept is most effective when given in the earlier stages of Alzheimer's disease. Side effects are usually mild and include diarrhea, vomiting, nausea, fatigue, insomnia, and weight loss.
• Exelon and Reminyl. These newer drugs also work by inhibiting the breakdown of acetylcholine. They are most effective when given in the earlier stages of Alzheimer's disease. They also have side effects similar to Aricept. In April 2005, Reminyl’s label was changed to include information about the deaths of 13 elderly patients who were taking the drug during a study. The deaths were due to various causes, including heart attack and stroke.
• Namenda. Namenda is prescribed to treat moderate-to-severe Alzheimer's. Namenda works by a different mechanism than other Alzheimer's treatments; it is thought to play a protective role in the brain by regulating a chemical messenger called glutamate. Glutamate plays a role in learning and memory by acting as a kind of "gatekeeper" of some of the brain's other chemicals -- allowing certain amounts of these other chemicals (such as calcium, which is required for information storage) to enter the brain's nerve cells.People with Alzheimer's brain cells fire off too much glutamate. Namenda helps regulate glutamate activity. That, in turn, can improve the brain's ability to process information and retrieve memories. It is the first drug to be approved for this stage of the disease; other Alzheimer's drugs are indicated for mild-to-moderate symptoms. Namenda may have increased benefit when used with Aricept, Exelon, Reminyl, or Cognex. Side effects of Namenda include tiredness, dizziness, confusion, and headache.
• Cognex. Cognex also works by slowing the breakdown of acetylcholine. Side effects of the drug include nausea, vomiting, diarrhea, abdominal pain, skin rash, and indigestion. In addition, Cognex can damage the liver, so your doctor will need to perform tests regularly to make sure this isn't happening. Cognex is no longer actively marketed by the manufacturer

Aricept, Exelon, Reminyl, and Cognex seem to help only those with mild or moderate symptoms of Alzheimer's disease; Namenda is prescribed for patients who have moderate-to-severe Alzheimer's. In addition to these medicines, vitamin E has been shown to be modestly effective in slowing progression in some patients with dementia.

It is important to know that new research findings are giving reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease, or improve memory or other symptoms for a period of time.

A vaccine has also been studied. However, because of unwanted side effects, the initial clinical trial was stopped. Studies are underway to modify the vaccine for improved safety. A number of other therapeutic approaches are being actively investigated.

Alzheimer's Disease: Research

Researchers continue to study drugs and other substances as possible treatments for Alzheimer's disease. Well-designed, thorough studies are necessary to give a clear picture of safety and effectiveness before making drugs available to the public.

Alzheimer's disease research is currently being tackled from many sides. Drug companies, the U.S. government, and the Alzheimer's Association are funding research to learn more about the disease and to find treatments that will reduce symptoms and prevent or cure the disease.

One of the most exciting areas of research involves looking at factors -- including aging, family history and genetic causes, past severe head injury, and low education -- that increase the risk of developing Alzheimer's disease. These factors can lead to theories about how they produce the abnormalities seen in the brains of patients with Alzheimer's.

Similarly, looking at factors that reduce the risk of Alzheimer's, like the use of nonsteroidal anti-inflammatory drugs (NSAIDs), other genetic factors, antioxidant therapies, and high education or occupational demand, could aid our understanding of the disease. Because of our increasing understanding of Alzheimer's, many potential therapies are currently being tested or will be tested, or are under development.

What Studies Are Currently Occuring That Evaluate Alzheimer's Disease?

• Genetic studies in Alzheimer's disease. The purpose of these studies is: 1) to collect information about affected family members about psychological and social factors that may influence the disease, and 2) to get blood and tissue samples from patients, their families, and volunteers without Alzheimer's disease. By evaluating and comparing this information, researchers hope to discover what places people at risk for getting Alzheimer's disease. It may also help researchers uncover a way to screen for the disease early on.
• Neurotransmitter receptor measurements in elderly people and patients with Alzheimer's disease. Neurotransmitters are chemicals that allow nerve cells to communicate. We know that one neurotransmitter, acetylcholine, is reduced in patients who have Alzheimer's disease. Comparing how these chemicals function in people with Alzheimer's could provide greater insight into the development of the disease.
• New Treatment: Nefiracetam. This is a clinical trial to test whether a drug called Nefiracetam can safely improve memory, thinking ability, and daily activities in patients with mild to moderate impairment caused by Alzheimer's disease.
• New Treatment: Ampalex. This is a clinical trial to evaluate the safety and effectiveness of the drug Ampalex in treating Alzheimer's. Early research found that the drug has a positive effect on memory performance.
• Study of melatonin for sleep problems in Alzheimer's disease.This study is evaluating the effectiveness of the hormone melatonin in alleviating the sleep disturbances often associated with Alzheimer's disease.
• A trial of Vioxx and naproxen in Alzheimer's disease. This is a clinical trial to evaluate the effectiveness of the anti-inflammatory medicines Vioxx and naproxen (Naprosyn, an over-the- counter medicine) in slowing the progression of mental decline in patients with Alzheimer's disease.
• Alzheimer's disease prevention trial. The purpose of this trial is to determine whether the hormone estrogen (or estrogen and progesterone) can delay the onset of memory loss or Alzheimer's disease in elderly women who have family members with the disease.
• B-amyloid vaccine trial. This trial was evaluating a vaccine that may prevent and even break down clumps of abnormal protein, called amyloid plaques, which accumulate in certain parts of the brain in Alzheimer's patients. However, because the vaccine produced unacceptable side effects, the trial was stopped before completion.

Reviewed by the doctors at the The Cleveland Clinic Neuroscience Center.

Thanks for the suggestion to write this article Wendylon!

My Mother, Ms. Florenda Brown suffers from Alzheimer's Disease!

Wishing You Great Health,

Glen Edward Mitchell

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