The Alzheimer's Epidemic. Danton O'Day

abstract way or to make sound judgements;

      •The inability to function properly in daily life;

      •The ability to plan and carry out complex tasks; and,

      •The ability to carry out motor activities.

      In addition to Alzheimer’s disease, there are seven other common types of dementia that are summarized in Table 3.1.

      Several dementias have Alzheimer’s disease-like symptoms and this is why it is important for proper diagnostic tests to be carried out so that a disease-based therapeutic approach can be started. There are two other types of dementia listed in Table 3.1 that should be addressed as well. The extensive news coverage of “Mad Cow Disease” led many to be leery of eating beef. Mad cow disease is a prion-based disease. Prions are proteins that have misfolded. When they enter the body, prions induce proteins that are folded normally to misfold, thus interfering with normal cellular function. In the brain this leads to miscommunication between neurons and neuron death observed as holes in the brain.

      A second common cause of dementia is linked to the presence of Lewy bodies in the brain. Lewy bodies are precipitates or accumulations that are rich in the protein alpha-synuclein. They cause Parkinson’s disease and dementia linked to Lewy bodies. Alpha-synuclein makes up as much as 1% of the protein in brain neurons. Lewy bodies are fundamentally similar to amyloid plaques except the former consist of deposits of the protein alpha-synuclein while the latter are made up of amyloid beta. In addition, Lewy bodies form inside of neurons while amyloid plaques form outside of them. When they do appear, Lewy bodies interfere with nerve cell organization and function leading to malfunction of nerve cell communication, which underlies the dementia that is observed.

      Table 3.1. Common types of dementia.

      It is important to realize that certain other conditions can result in symptoms that mimic dementia. These conditions include depression, drug use, excessive use of alcohol, side effects from medications, thyroid problems and certain vitamin deficiencies, to name the most common. When those conditions are removed or corrected then the dementia-like symptoms disappear.

      The Three Stages of Dementia

      While the progression of dementia varies greatly from individual to individual, the World Health Organization (WHO) and other groups define three stages. Each of these stages falls within a relatively regular timeframe and each has specific characteristics. Here we will summarize the approximate timing and specific symptoms of each stage. These stages apply not only to Alzheimer’s disease, the most common cause of dementia, but also to other neurodegenerative diseases such as dementia with Lewy bodies and vascular dementia, among others.

      The three stages of dementia are the following:

      •Early stage—occurs within the first year or two;

      •Middle stage—occurs during year two to five;

      •Late stage—occurs from the fifth year onwards.

      The following Table summarizes some of the signs and symptoms of each of the three stages of dementia (Table 3.2).

      Table 3.2. The three stages of dementia.

      Thus it can be seen that early on, most people will discount many of the early-stage signs and symptoms of dementia as simply a reality of the aging process. After all, as we age we all are a bit forgetful, some more than others. We all find certain words or names elusive and may forget what day it is, especially if we are retired. It is not unusual for people at any age to show phases of anger, anxiety and depression. But when these mood changes and behaviors increase or appear in a person who normally doesn’t experience them, it is time for concern. Also, when these basic signs are coupled with several other symptoms, they may be due to the early stage of dementia.

      Dementia is progressive. Though it varies from person to person, the initial attributes of early-stage dementia become increasingly more pronounced as middle-stage dementia is attained. Thus early problems of forgetfulness—of words, names, time and place—are now much more common and more serious. At this stage as well, individuals are becoming less independent and much more dependent on their caregivers since help with personal care, using the washroom and dressing become a necessity. In the middle stage, serious changes in moods and behavior also become evident. While some like disturbed sleep are worrisome, others, such as wandering and hallucinations, can become dangerous.

      By the late stage of dementia, the individual is fundamentally no longer able to look after him- or herself. They are no longer aware of their surroundings and issues of time and space elude them. Family and friends no longer exist for them; they are strangers, except for lapses into lucidity on rare occasion. The individual’s healthcare needs are extensive and aggression, especially hitting or kicking caregivers, is not uncommon.

      The transition from a cognitively functioning person to one who only exists as a former shell of themselves is one of the most disconcerting and troublesome aspects of dementia. While a major goal of Alzheimer’s research is to find a cure, the search for pharmaceuticals that can slow or stop the progression of dementia is also of primary concern.