Alzheimer's and Dementia

Different types of dementia have different causes. In some cases, the underlying reason for the condition is not known yet. In others, a specific physical or genetic cause might be determined. Some types of dementia get worse over time and others do not. Some can even be reversed.

Progressive Dementias get worse over time. The most prevalent of these is Alzheimer’s disease which is characterized by a slow decline in cognitive abilities usually lasting seven to 10 years. Frontotemporal dementia causes language or behavioral changes that often lead to social decline. Lewy Body Dementia, named for protein clumps found in the brain, has symptoms similar to Alzheimer’s disease and Parkinson’s disease, as it also may include hallucinations and tremors.

Vascular Dementias result from brain damage caused by a restriction of blood flow in the heart or brain. People with strokes, high blood pressure, heart attack, endocarditis (infection in a heart valve) and amyloid angiopathy (accumulation of blood proteins in the brain) are particularly susceptible. In Frontotemporal Dementias, the nerve cells in the brain’s frontal and temporal lobes degenerate, causing noticeable changes in language, behavior and personality.

Reversible Dementias result from unrelated conditions that can be treated. When the underlying condition is resolved, the dementia often resolves, too. Examples include dementias caused by:

• Infections and immune system disorders such as meningitis, encephalitis, syphilis, Lyme disease, Leukemia and Multiple Sclerosis (MS).
  
• Metabolic and endocrine problems such as thyroid problems, hypoglycemia, insufficient or excessive sodium or calcium, and problems absorbing vitamin B-12.
  
• Nutritional shortages such as dehydration, insufficient amounts of vitamin B-1, B-6 and B-12.
  
• Subdural hematoma, which involves bleeding in the tissue between the surface of the brain and its outer membrane.
  
• Poisoning from substances like heavy metals, pesticides, alcohol, recreational drugs as well as certain prescribed medications.
  
• Brain tumors that are either benign or cancerous.
  
• Hypoxia, or lack of oxygen to the brain, resulting from heart attack, carbon monoxide poisoning, strangulation, severe asthma, prolonged exposure to high-altitude environments or too much anesthesia.
  
• Heart and lung problems which can deprive the brain of sufficient oxygen.

Other disorders associated with dementia include Huntington’s disease, an inherited condition marked by degeneration of nerve cells in the brain and spinal cord; Boxer’s Dementia, caused by repeated blows to the head; Creutzfeldt-Jakob disease, an unusual and fatal brain disorder; Parkinson’s disease, which is marked by tremors and stiffness; and HIV/AIDS, which attacks the immune system.

Since Alzheimer's and other dementias have so many possible causes, it’s a good idea to become aware of the risk factors and learn about the available diagnostic procedures such as Magnetic Resonance Imaging (MRI) and CT Scans as well as various treatment options that can improve quality of life. Baptist Neurology Group welcomes new patients at all our offices. Learn about our neurologists and choose one of our locations. Call 904.398.5405 for an appointment with any Baptist Neurology Group physician.

Risk factors do not necessarily cause Alzheimer's disease and other dementias, but they are correlated. This means that the presence of a risk factor increases the chance of being diagnosed with the condition. Some are uncontrollable. Others can be controlled or managed to some degree. Not all forms of dementia have the same risk factors. Still, it’s a good idea to know how these risk factors could affect your chances, or those of a loved one, of developing Alzheimer's disease or other form of dementia.

Uncontrollable risk factors

Age: One of the most significant uncontrollable risk factors is a person’s age. In most, but not all, forms of Dementia, risk increases with age—especially with Alzheimer’s disease, Vascular Dementias (i.e. from stroke, heart disease and other conditions related to blood vessels) and other forms.

Family History: People whose family members have had Alzheimer's disease or other Dementia are often at greater risk of developing it themselves. There are also certain specific genetic mutations that can put someone at significantly higher risk for dementia. Some of these mutations, such as a genetic predisposition for Huntington’s disease, can be tested for.

Risk Factors you can control

You can't control your age or family history, but several risk factors do fall within your control. If any of these dementia-related risk factors apply to you or a loved one, it’s a good idea to make whatever changes are necessary to reduce risk.

Alcohol abuse: Consuming large quantities of alcohol (more than one drink per day for women, two for men) is thought to increase the risk of dementia. Moderate alcohol use, especially red wine, may actually protect you.

Atherosclerosis: Hardening of the arteries occurs when fatty deposits called plaques develop on the inside of the arteries. This buildup reduces blood flow to the brain, which can lead to stroke and is a major risk factor for Alzheimer’s disease and Vascular Dementias. Atherosclerosis can be reversed through dietary changes, exercise, medications and in extreme cases, surgery.

Depression, especially late in life, could be a risk factor for Alzheimer’s disease. A variety of medications can treat this condition.

High blood pressure (hypertension), which increases the risk of Alzheimer’s disease and Vascular Dementia, can be controlled with diet changes, exercise and medication.

High cholesterol, particularly low-density lipoprotein (LDL), raises the risk of Vascular Dementia and possibly Alzheimer’s disease. It can be controlled with medication and changes in diet.

High estrogen level, determined through a blood test and controllable with supplements, adds to Dementia risk.

High homocysteine, an amino acid normally metabolized by vitamins B-6, B-12 and folic acid, is associated with higher risk for Alzheimer’s disease and Vascular Dementia. Insufficient amounts of these essential nutrients causes homocysteine levels to rise. This condition can be remedied with supplements.

Tobacco smoking raises the risk of developing dementia by raising the risk of Atherosclerosis and other cardiovascular diseases. Quitting smoking reduces these risks.

Type-2 Diabetes raises the risk of Alzheimer’s disease and Vascular Dementia. In many cases, dietary and lifestyle changes can mitigate the risk of developing this form of Diabetes and therefore lower the risk of Dementia.

Learn about the various procedures used to make a definitive diagnosis of dementia. And if dementia is diagnosed, there’s an arsenal of treatment options available to prolong cognitive functioning for as long as possible. Baptist Neurology Group welcomes new patients at all our offices. Learn about our neurologists and choose one of our locations. Call 904.398.5405 for an appointment with any Baptist Neurology Group physician.

The varied and inexact nature of dementia makes it difficult to diagnose. There is no single, simple blood test that definitively establishes the diagnosis for it. For this reason, doctors rely on a series of diagnostic procedures. These usually include:

• Exam and history: A detailed physical examination and medical history to identify current or pre-existing health issues.
  
• Cognitive testing: A series of tests that measure academic, spatial and intellectual skill levels as well as language, attention, memory, judgment and reasoning.
  
• Neurological Examination: Assesses the patient’s reflexes, sensory functioning and balance.
  
• Brain scans: These include Computed Tomography (CT), Magnetic Resonance Imaging (MRI) scans, Electroencephalography (EEG) and Positron Emission Tomography (PET).
  
• Lab tests: Determine if other conditions, many of which are treatable, are contributing to a patient’s dementia symptoms. These tests can include:
  
  • Blood biomarker tests
    
  • Blood tests to evaluate liver and kidney functioning
    
  • Complete Blood Count (CBC)
    
  • Drug and alcohol screening
    
  • Genetic testing
    
  • Glucose test
    
  • Spinal tap (Lumbar puncture)
    
  • Thyroid analysis
    
  • Psychiatric evaluation: Patients usually undergo a psychiatric exam to see if symptoms might be associated with psychological problems.

Baptist Neurology Group welcomes new patients at all our offices. Learn about our neurologists and choose one of our locations. Call 904.398.5405 for an appointment with any Baptist Neurology Group physician.

Reversable dementias

If a reversible or controllable form of dementia is confirmed, the doctor will try to treat the underlying cause of the condition—usually with medications and possibly surgical procedures.

The patient’s ongoing medication regimen may need to be adjusted if it exacerbates Dementia symptoms. The doctor may prescribe antibiotics and other infection-fighting medicines, an antidepressant to treat dementia caused by depression, or medications to reduce high cholesterol or high blood pressure if those conditions are complicating the dementia. Other treatment options for reversible forms of dementia might include:

• Protease inhibitors and other drugs that control HIV and AIDS
  
• Surgery to remove a brain tumor, open a blocked artery or correct a structural defect that could be causing the dementia
  
• Thyroid hormones for hypothyroidism
  
• Vitamins, especially B-12, which is closely linked to several forms of dementia

Irreversable (Progressive) dementias

If the diagnosis is Alzheimer's disease or another irreversible form of dementia treatment will focus on minimizing the damage. In these cases, treatment strategies usually seek to preserve the patient’s mental functioning, maximize independence and ease the burden on caregivers for as long as possible. Treatment options for irreversible dementias may include:

• Education for patients, family members and caregivers about what to expect as well as tips for coping with the cognitive decline associated with the condition.
  
• Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl) or rivastigmine (Exelon). These medications help patients maintain or even improve cognitive functioning.
  
• Memantine (Namenda) to help slow the progression of Alzheimer’s disease, especially in the later stages, and may also help patients with milder forms of Vascular dementia.
  
• Antidepressants such as Lexapro or Cymbalta.
  
• Antipsychotic medications such as Zyprexa and Risperdal to relieve severe symptoms like hallucinations, aggression, agitation or anxiety. These are not FDA-approved for dementia treatment and require careful monitoring.
• Medical foods, such as Axona or Cerefolin, that improve brain function.

If you or a loved one think Alzheimer's disease or other form of dementia might be present, contact us for an evaluation. You’ll get the quality, compassionate, respectful care you deserve. Baptist Neurology Group welcomes new patients at all our offices. Learn about our neurologists and choose one of our locations. Call 904.398.5405 for an appointment with any Baptist Neurology Group physician.