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About Dementia
Frequently Asked Questions

Is Alzheimer's disease the same as dementia?
Do people with Alzheimer's disease also get depressed?
Is dementia reversible?
Why don't all the symptoms get better at once?
How can I help with research on dementia?
We just received our diagnosis. What do we do now?



Is Alzheimer's disease the same as dementia?

The term "dementia" refers to a syndrome, which is a collection of symptoms and signs. Symptoms are things that people complain about, whereas signs are things that physicians observe in patients. Dementia is the syndrome in which people have memory problems, as well as problems with other things that the brain controls, such as language, or paying attention. These problems should be acquired (opposed to being present on a lifelong basis) and progressive. They should also be severe enough that they interfere with a person's ability to hold a job, or function the way they used to.

The syndrome of dementia has many causes, but the most common cause is Alzheimer's disease. Other causes of dementia are dementia after strokes a type of dementia like Alzheimer's disease known as dementia with Lewy bodies and a collection of dementias known as the frontotemporal dementias.

Do people with Alzheimer's disease also get depressed?

Scientists have known for a long time that depression and dementia are linked. Especially during the 1970s, when there was a lot of emphasis on so-called "reversible dementia," it was often held that depression had to be "ruled out" (including by a trial of antidepressants) before dementia could be diagnosed. Now, however, although the jury is still out, many experts feel that being depressed can increase the risk of dementia.

Depression can also exist together with Alzheimer's disease, including in people who become depressed for the first time when they are diagnosed. It seems two issues are at work here. One is that for some people, the diagnosis of such an illness is enough to trigger depression. The other is that the disease appears to affect brain chemicals causing depression. Exactly how to treat depression in someone who also has Alzheimer's disease is not clear, but in general, drugs that depress the amount of the brain chemical acetyl choline should be avoided.

For an in-depth, up to date review of this question, it is covered in the chapter by David M. Blass and Peter V. Rabins "Lessons from trials of psychotropic agents in Alzheimer disease" in the book Trial Designs and Outcomes in Dementia Therapeutic Research by Kenneth Rockwood and Serge Gauthier.

Is dementia reversible?

The idea of reversible dementia was very popular during the 1970s in particular. Given observations that some people have depression which looked like dementia, and that depression got better after treatment with anti-depressants, and other observations of improvement in cognition after treatment for thyroid disease or B12 deficiency, there is a lot of enthusiasm that dementia could be made to reverse. While this does happen occasionally, it is very uncommon.

Why don't all the symptoms get better at once?

Sometimes the people who care for those with Alzheimer's disease are surprised at how some symptoms can show so much improvement, while others seem to be staying the same or getting worse. How symptoms work in Alzheimer's disease is complicated. While it is generally true that a lot of symptoms come about because of a decrease in the brain chemical acetyl choline, not all of the symptoms do. Because of this, there are some symptoms which simply will not respond to changes in acetyl choline. Of course the situation is more complex. The brain can adapt and get used to having lower levels of acetyl choline. When a drug is introduced to raise the level of acetyl choline, the brain then has to adapt all over again to the new increase amount of neurotransmitter.

A striking example of this is sometimes seen in patients who have dementia with Lewy bodies. In dementia with Lewy bodies, people have a mixture of low acetyl choline and low dopamine. Dopamine in Parkinson's disease and other types of Parkinsonism In some people with Lewy body dementia, giving a drug that increases the amount of acetyl choline actually makes their Parkinsonism worse. This is because Parkinsonism sometimes comes about not just as a result of the absolute amount of dopamine, but the amount of dopamine in relation to acetyl choline. Thus, increasing the acetyl choline has an effect similar to lowering the amount of dopamine. Puzzlingly however, the response in dementia with Lewy bodies is very variable, so that in some people Parkinsonism gets better and in others Parkinsonism gets worse.

How can I help with research on dementia?

There are many ways to help with research on Alzheimer's disease. The Alzheimer's Association of the United States and the Alzheimer Society of Canada are two examples of fine national organizations that are well setup to receive research donations. One advantage ofdonating money to theseassociations is that it is well accounted for and it is only distributed to projects that are judged by other scientists to be worthy of research.Sometimes however, people prefer to give closer to home and it is likely that if you live in an area with a medical school there will be someone there doing research on Alzheimer's disease. Often tax-receiptable donations can be made to the donation's office of the university; for example,the Geriatric MedicineResearch Unit(www.cdha.nshealth.ca)is also very keen on donations.

Another way to help is to be a volunteer for studies. Most clinical research centers are glad to hear from people with Alzheimer's disease, or from peopleover the age 65 who do not have any impairment cognition. Alzheimer's disease is often studied in animals, but many studies can only be done in humans.

We just received our diagnosis. What do we do now?

People who are diagnosed with Alzheimer's disease often get two pieces of advice, each helpful but each limited. One is to try your best to plan for the future and the other is to live day by day.

Planning for the future is always wise. As soon as the diagnosis is made there are a number of questions that will come up. At the same time, it is important to realize that this is not an emergency and that things will not dramatically change overnight. Still, it is sensible to plan for things such as putting in place a power of attorney, a living will or other type of future health care directive. It is also worthwhile to make decisions about how finances are to be handled. Driving is a question that will inevitably arise and it is best to plan for it.

A person with Alzheimer's disease is going to want to know how the future is likely to change- what is the chance of a good response with treatment? What is the chance things will get worse? In truth, a lot of this is unknowable for the individual and the best we have to offer is statistical advice. It often takes 3-6 months before any firm decision can be made about how responsive treatment will be, so again there is the question of uncertainty.

This is where the second piece of advice "live a day at a time" comes in. People with Alzheimer's disease are no different from anyone else and certainly not different from how they were before the diagnosis. They want very much the same things. At the same time a worry for the future can impair their ability to appreciate each day. That is why it is important to savor the good health of each day and be aware of each day's blessings.

One thing that happens sometimes is that people with Alzheimer's disease lose the ability to think of themselves in the future. They have difficulty imagining a future where they are not competent. For sometime, to the extent that the physicians were aware of this, they thought of it as a psychological reaction. In other words, the person with Alzheimer's disease was overwhelmed by the diagnosis. Treatments with drugs that increase the amount of acetyl choline have shown the ability to think of the future often returns with treatment. It seems that the ability to think of one's self in the future as a competent agent is one of the important and up to now largely unrecognized functions of acetyl choline.

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Last updated April 11, 2014
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