By Brookdale Senior Living
Dementia has been a part of the human condition for as long as we’ve had the ability to write about it. In ancient Greece and Rome, it was considered a normal part of aging. As the body declined, undoubtedly the mind would follow.
This perception continued on through the Middle Ages and into the Renaissance, as evidenced by Shakespeare’s frightening depiction of aging in “As You Like It.” In the play, he refers to the final stage of life as a “second childishness and mere oblivion, sans teeth, sans eyes, sans taste, sans everything.”
For much of the 20th century, dementia was synonymous with aging. “I think there’s a stigma around all mental illnesses and cognitive challenges,” says Juliet Holt Klinger, a gerontologist with Brookdale. “But the stigma around dementia is very connected to ageism, and for many years it was almost ignored as a medical phenomenon. It was just seen as an inevitable, normal part of aging, which it’s not.”
The Race to Define a Disease
The first real scientific breakthrough related to dementia came in 1907, when German psychiatrist Alois Alzheimer performed an autopsy on a young woman experiencing confusion and hallucinations. He discovered the presence of “plaques and tangles” lodged in her brain, and these abnormalities would become the focal point of the race to cure Alzheimer’s disease for decades to come.
Dr. Alzheimer’s newly discovered disease was considered rare until the 1960s, when scientists finally realized the alarming disease was altogether different from cognitive lapses related to normal aging.
A Disease Beyond Understanding
Today, experts know Alzheimer’s as just one type of dementia. And herein lies the biggest misconception about the disease: “Most people think that Alzheimer’s and dementia are two different things,” says Holt Klinger. “Alzheimer’s is the leading cause of dementia, but dementia is the overarching term. Dementia describes many different diseases.”
Defined by symptoms related to memory and thinking problems, other types of dementia include Lewy body dementia, vascular dementia and frontotemporal dementias. Alzheimer’s disease is the most common type of dementia, accounting for 50 to 70% of all cases, but other forms of dementia, which are harder to identify and diagnose, are important to understand as well.
There is no single test for dementia, but rather a series of diagnostic and imaging results that typically solidify a diagnosis. The brains of people living with Alzheimer’s have distinctive beta-amyloid plaques, while other types of dementia feature lesions, protein clumps and other pathological brain abnormalities. These features can be visualized with more sophisticated tests such as PET scans.
Misdiagnosing Memory Loss
Even as researchers struggle to make breakthroughs in the science of dementia, this spring researchers experienced a stunning breakthrough — up to a third of Alzheimer’s patients may actually have a new kind of dementia called limbic-predominant age-related TDP-43 encephalopathy, also known as LATE. And this new kind of dementia could be even more prevalent than Alzheimer’s.
LATE typically affects one in five people over the age of 80, leading to a more gradual memory decline than Alzheimer’s. While Alzheimer’s is linked to the accumulation of the proteins amyloid and tau, LATE involves the accumulation of TDP-43.
Some are calling the new research “the most important dementia finding” in years. Misdiagnosis related to LATE may possibly help explain why curing dementia has proved to be so difficult and so unsuccessful. Given the difference in these proteins, drug trials aimed at Alzheimer’s may have failed because some patients actually had LATE.
“Dementia as a condition is far more complex than just Alzheimer’s and people in their last decades of life, so it’s no surprise that we’re discovering new types of dementia,” says Holt Klinger. “When I first started in this field 30 years ago, Alzheimer’s diseases was diagnosed as ‘senility’ or ‘organic brain syndrome,’ so it doesn’t surprise me that it’s not a single disease. We’re just getting much more sophisticated at figuring out the differences in these diagnoses.”
What We Know Now
As we struggle to come up with effective treatments and perhaps even a cure for some forms of dementia, it’s important to focus on what we do know.
While dementia takes many forms, symptoms include memory loss, confusion, depression, poor planning and problem solving, changes in personality, issues with speech, attention problems and difficulty walking and performing everyday tasks.
If a person experiences several of these symptoms, they’ll often receive a definitive diagnosis after neurological and neuropsychological evaluations, lab tests and CT, MRI or PET brain scans.
Treatments That Work
While there is no cure for these progressive conditions, drugs like cholinesterase inhibitors and memantine may be able to slow the disease, while sleep and depression drugs may help manage some of the symptoms.
Other treatments may include modifying and simplifying a person’s home environment and keeping them on a routine. Dedicated memory care programs like the kind available at Brookdale strive to keep people living with dementia safe and engaged in life.
“One of the biggest misconceptions we fight against is that people living with dementia can’t do anything,” says Holt Klinger, “but in our dementia care communities, folks continue to be very talented and skilled and they still have a lot of contributions to make.”
While science races toward a cure, people may practice healthy living in an effort to slow the symptoms of dementia. Genetics play a part, but a healthy diet and consistent exercise program may also go a long way.
“A lot of the emerging science is really about lifestyle,” says Holt Klinger. “Many of the top killers are lifestyle related. And all the things that are good for your heart are also good for your brain — meditation, diet, walking 30 mins a day, getting enough sleep and above all maintaining socialization as you age. It’s also important to remain mentally and cognitively engaged. Mental workouts are as important as physical ones. You may not be able to prevent Alzheimer’s, but you can possibly slow the effect it has on you. The more you build up your brain throughout your life, the more neuronal connections you have, the longer it takes a disease like Alzheimer’s to ravage through it.”
Besides developing new hobbies and staying socially active and mentally alert, managing health conditions like diabetes, high blood pressure and high cholesterol are also ways that may delay the onset of symptoms.
Hope for the Future
While a cure may seem a long way off, the discovery of a new kind of dementia is a sign that researchers are zeroing in on the mechanics of this mysterious cluster of diseases.
“I think we’ll get there eventually — there are an awful lot of scientific endeavors going on,” says Holt Klinger. “The science is progressing, but even if a magic cure was in sight, we would still have all of the folks currently living with the disease to support. Fortunately, advances are being made all the time and we’ve come a long way in terms of funding.”
We’re Here to Help
If your loved one has dementia, there is hope for living an optimum life. More than 30 years ago, Brookdale developed our Clare Bridge concept to reflect a greater understanding of living well with dementia.
Today, we’re the country’s leading provider of Alzheimer’s and dementia care. Contact us today and see how we can help you or your loved one live the best life possible.
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