Currently, 5 million Americans age 65 and up are actively suffering from dementia, a syndrome characterized by significant cognitive impairment – at a cost of $203 billion per year, which doesn’t include the 17.5 billion hours of unpaid care from caregivers. Dementia (the original Latin word for madness) encompasses both short and long-term memory loss but also includes dramatic changes in personality as well as behaviors that are difficult to handle. This often surprises people given that they don’t expect their well-mannered elderly relatives to act petulantly or unreasonably. Furthermore, caregivers bear a large burden because basic life-sustaining skills, such as eating and going to the bathroom, are no longer routine for the affected people. In addition to the living-assistance these patients require, the cost of taking care of a demented patient can reach exorbitant sums which are unaffordable for many families. Dementia is not a curable disease so its exigent conditions demand that we educate the public on the early identification of symptoms. Fortunately, there is effective medical treatment, which if received early can significantly improve a person’s quality of life.
Dementia is formally defined as a major impairment in learning and memory which interferes with an individual’s work performance and through which he/she experiences a decline from their previous level of functioning. The disturbances associated with this condition are progressive and can involve difficulty with reasoning, orientation, language, and handling of complex tasks (e.g. balancing a checkbook). There are different types of dementia syndromes: Alzheimer’s (most common form characterized by brain tissue degeneration over time), Lewy Body (identified by a special type of protein formation on the brain’s nerve cells), Frontotemporal (named after the brain sections affected by the disease process; typically involving changes in behavior), Vascular (characterized by numerous areas of strokes), and Parkinson’s (cognitive abnormalities associated with this disorder). The diagnosis of dementia is mostly clinical and is usually brought to attention by a family member who notices the changes. Neurologists might consider brain imaging studies to consider other causes like brain cancer or head bleeds. The medical treatment varies and is tailored to the specific type of dementia. Donepezil is one of the most commonly used medications and works by increasing acetylcholine, a neurochemical which is depleted in demented patients. Some physicians prescribe Vitamin E for their patients although the data on this is ambiguous. If the patient manifests behavioral disturbances such as hallucinations, agitation, and aggression, other medications can be included.
Demented patients can be difficult to care for because their cognitive deficits interfere with normal functioning. Moreover, if they have behavioral complications such as aggression or disorientation, it’s virtually impossible to keep these patients safely at home without proper medication and monitoring. Given the enormous physical and financial burden on most caregivers, many demented patients end up at a nursing home where 24 hour care can be provided. Ultimately, as we continue to search for better medications and a cure to this increasingly common disease we must be attentive to our aging grandparents and our parents who will live much longer lives going forward. Frequent communication and vigilance regarding their behavior is the best chance we have to provide them full support and help them sustain a dignified life.