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October 14, 2009

Alzheimer's, how can we forget?

The Canadian Charger

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Alzheimer's should receive far more media, public and government attention than it currently receives.

Alzheimer’s should receive far more media, public and government attention than it currently receives

Many elders from all segments of society suffer from it.  But they do so in silence due to the perceived stigma. 

According to Dr. William Dalziel, chief of the Regional Geriatric Program of Eastern Ontario, half of those over 90 are affected by Alzheimer’s.  Marg Eisner, a nurse who is a former president of the Alzheimer Society, said that one out of three seniors over 85 suffers from Alzheimer’s or a related dementia. 

Dalziel says that dementia is common in nursing homes, where it often goes undetected.  That is because the nursing home resident does not take in activities such as preparing meals and going shopping, where deterioration can be apparent. 

He says that typically dementia has been present for two and a half years before it is detected.  That is time lost for treatment to lessen symptoms and delay full onset.  It is also time lost for planning for the person and the family, including time to create a power of attorney.

He recommends screening for seniors in the high risk category, such as those in nursing homes.  The best option is screening by a geriatric psychiatrist, but they are in such short supply that other health professionals will ordinarily need to make the assessment.

Alzheimer’s Disease International (ADI) estimates that 35.6 million people worldwide will be living with dementia in 2010.  This is a 10 per cent increase over previous global dementia prevalence reported in 2005 in The Lancet.  According to the new report, dementia prevalence will nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

“The information in the 2009 World Alzheimer Report makes it clear that the crisis of dementia cannot be ignored,” says Debbie Benczkowski, Interim CEO of the Alzheimer Society of Canada.  “Unchecked, dementia will impose enormous burdens on individuals, families, health care infrastructures, and global economy.”

Medicine has made significant strides but there is still not cure for Alzheimer’s, which is the most common of a group of conditions called dementias.  While older usage of the term dementia included a variety of mental illnesses, the word now generally connotes a condition involving organic change or injury to the brain.  Loss of memory is one of the symptoms of dementia, along with understanding and judgment problems, but not all forgetfulness is the result of this condition. 

The fact that you forgot where you left your glasses does not mean that you are suffering from Alzheimer’s or some other dementia.  However, if you put them in the refrigerator there may be cause for concern.

It is normal for people to experience a decline in memory as they get older, but only certain kinds of memory.  Those aspects that are apt to falter are short-term memory and memory about things that need to be done.  By short-term memory we mean remembering things for as long as a few minutes up to a few days. 

Short-term memory is not the same as immediate memory such as remembering what someone just told you, for instance a code to open a door or a phone number to be dialled right away.  And while a person may forget to go to the store, if the store list is on the refrigerator door a normally aging person will then remember. 

In normal aging a person retains long-term memory, the memory of things long ago.  Also not affected by age alone is memory of general information, such as the names of capital cities or location of the pyramids.  Nor is the memory of how to do things such as driving or tying one’s shoes affected. 

So even if you forget where you left your glasses or need clues to remind you to bring home some milk, you are not necessarily on the road to dementia.  However, if you can’t remember what someone just told you, if you no longer remember where you lived as a child, if you don’t know anymore that the pyramids are in Egypt, or if you’ve forgotten how to drive or to cook, you may have a serious problem.

According to Eisner, in normal forgetfulness a person will recognize people and places even if unable to recall names.  He or she will remember the day and time, and even if details of a recent experience are lost, the experience itself will remain.  Items that are forgotten will in many cases be remembered later.  “Oh, yes, I remember now.  My glasses are on the coffee table!” 

By contrast, abnormal forgetfulness is more extreme, involving the inability to recognize people or places, day and time, recent experiences.  Signs of Alzheimer’s include forgetting that affects performance of day-to-day activities, difficulty performing familiar tasks, difficulty with language and with judgment, changes in mood, behaviour, and personality, and apathy. 

The disease gets worse over time, with a developmental duration of three to 20 years.  It is irreversible and there is no cure and no known cause, though it seems to run in families.

There are things that can help us keep our memory in good shape. 

Things that can affect memory negatively include certain medical conditions, physical problems such as heart disease, stroke, or hormonal changes, and mental states such as anxiety and depression.  Also, some medicines have side effects that impair memory.

Eisner suggests ways in which we can help ourselves to remember better. 

She says we can keep lists and a detailed calendar, make mental associations between things, repeat the names of new acquaintances, and put things in the same spot each time—glasses next to the radio, for instance.

She also recommends following a routine, but new and interesting experiences are also a plus.  So we might follow routine but balance that routine with new and exciting experiences.

When memory loss goes beyond normal, even at the beginning stage, medical attention is important.  While there is no cure for the dementias, there are medicines that can help.

Dementia needs to be distinguished from delirium and depression. 

People living with Alzheimer’s sufferers can contact the Alzheimer Society for information on how best to cope and what to expect over time.  Their website is www.alzheimer.ca .

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