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.

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.