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Expert Q & A about Dementia with Linda A. Hershey, MD, PhD

Linda A. Hershey is chief of neurology at the VA Western New York Healthcare System and a professor of neurology and pharmacology at the University at Buffalo School of Medicine and Biomedical Sciences, State University of New York. She obtained her M.D. and Ph.D. degrees at Washington University in St. Louis. She received residency and fellowship training in neurology and clinical pharmacology at Barnes Hospital in St. Louis and Strong Memorial Hospital in Rochester, NY. Her current research focuses on the management of stroke and dementia.

What are the initial symptoms of dementia?

Patients with Alzheimer's disease usually complain of poor memory. They forget to take their medicines on time, for example, or they may take too many pills (forgetting that they had already taken today's dose). They might get lost while they are driving, because they lose cells in the right parietal lobe. Loss of organizational skills (cell loss in the right frontal lobe) can cause difficulty with balancing a checkbook, paying bills or preparing meals.

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Those with early vascular dementia are more likely to complain of a gait disorder or behavioral changes rather than memory problems. Personality changes are the presenting symptoms of frontotermporal dementia, or Pick's disease. Parkinsonism usually precedes memory problems in those who have dementia with Lewy bodies.

Are certain people more likely to develop dementia than others?

Age is the biggest risk factor for dementia of all types (3 to 5 percent prevalence among 65-year-olds, 10 percent at 75 and 20 to 30 percent at 85). A family history of dementia can predict an earlier onset of memory problems. Poor education, hypertension and diabetes are other risk factors.

What questions should loved ones ask their health-care providers?

Ask the provider about whether the patient has Alzheimer's-type dementia or some other type. This affects the choice of therapy. Cholinesterase inhibitors (donepezil, galantamine and rivastigmine) have been shown to slow the progression of Alzheimer's, vascular dementia and dementia with Lewy bodies, but they are not effective for those with Pick's disease, where there is no cholinergic deficit.

Can the progression of dementia be slowed?

There is good evidence that cholinesterase inhibitors delay the need for nursing home placement among those with Alzheimer's. Memantine allows many moderate Alzheimer's patients to remain in the home for longer periods of time because it reduces agitated behavior. Several studies have shown that aspirin (or other anti-platelet agents) can slow the progression of vascular dementia.

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What is happening in the brain to cause dementia?

Depending on the type of dementia, different degenerative processes are involved. For example, a normal protein (beta-amyloid) accumulates to an excessive extent in the brains of Alzheimer's patients. Another normal protein (alpha-synuclein) develops in excess in the brains of those who have dementia with Lewy bodies. Abnormal tau proteins accumulate in the brains of people with Pick's disease. Toxic amounts of these proteins are thought to be a factor contributing to cell death and inflammation in these diseases.

Are patients with dementia at greater risk for injury?

Yes. Patients with Alzheimer's are more likely to have automobile accidents because they have poor judgment and impaired concentration. Patients with vascular dementia and dementia with Lewy bodies are more likely to fall because their diseases cause poor balance and slowing of gait. Families can help prevent injury in dementia patients by taking away the car keys and by installing safety equipment in the home.

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How can loved ones help dementia patients to cope with their illness?

Contact your local Alzheimer's Association. In most communities, there are support groups available for patients as well as for caregivers.

Are there any alternative /complementary therapies (such as light therapy or dietary supplements) that are effective in preventing or slowing dementia?

Light therapy is effective for dementia patients who happen to have seasonal affective disorder. Vitamin E might be effective in delaying nursing home placement in patients with moderate Alzheimer's disease. Lecithin was popular years ago, but it has since been discredited as being ineffective. I do not recommend using ginkgo biloba because it carries the risk of excessive bleeding. A Mediterranean diet (vegetables, fish, chicken and wine, but minimal animal fat) has been shown to delay the onset of Alzheimer's in those with mild cognitive impairment. Exercise can help prevent the physical changes in the brain that are associated with Alzheimer's disease.

 

Last updated August 2008

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