Posts Tagged 'dementia'

What is dementia? A quick synopsis.

Dementia is the name given to a group of disorders characterized by multiple cognitive deficits. Dementia may have many different causes. Among them are traumatic brain injury, Parkinson’s disease, Lewy bodies (small “lumps” of protein) that form in brain cells, Alzheimer’s disease, nutritional or hormonal deficiencies, infection, and tumor. This is not an exhaustive list. There are many potential causes of dementia. Treatment depends on the cause.

When someone has dementia, what are we saying? Dementia is more than memory loss. Symptoms vary among individuals. There may be personality changes, e.g., inappropriate behavior. There may be changes in mood, e.g., depression. There may be difficulty planning tasks. There may be changes in motor function. Symptoms vary with the location in the brain that is affected.

Diagnosis in the early stages can be difficult because of this variability of symptoms. Is it stress? Depression? A psychosis brought on by exposure to a toxic substance? Or is it one of the progressive dementias, such as Alzheimer’s disease?

Bottom line? Consult a healthcare professional if symptoms persist or seem to be getting worse. Treatment may be as simple as hormone replacement. If it is truly one of the progressive dementias, there is no cure. But medication can slow the process and give many quality years following diagnosis.

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Diabetes: Part IV – Nerves

Your nervous system controls all of your body’s functions, including thinking and emotions. Your nervous system has two parts:

  • The central nervous system – the brain and the spinal cord
  • The peripheral nervous system – the nerves that come out of the spinal cord and affect both voluntary functions, for example, walking and involuntary functioning, for example, breathing.

There is a feedback system in the nervous system. This works something like a thermostat. The thermostat monitors the temperature in the home. When it senses the need for heat, it sends that message to the furnace. The furnace kicks on and sends heat throughout the home. The thermostat continues to monitor the temperature. When the temperature is at a predetermined level, the thermostat sends that message to the furnace and the furnace turns off.

 

So, in order for the nervous system to function properly, both parts must be functioning well.

 

Diabetes affects the nervous system in two possible ways:

  • A direct effect by bombarding the nerves with too much glucose (sugar) and causing damage
  • An indirect effect by narrowing blood vessels and depriving the nerves of needed food and oxygen.

Good control of blood sugar levels is crucial for avoiding the nervous system complications of diabetes!

 

Some of these nervous system complications include:

  • Numbness in fingers and toes
  • Tingling or pain in fingers and toes
  • Damage to the feedback system in the feet, causing difficulty walking
  • Erectile dysfunction (difficulty getting or keeping an erection)
  • Diminished sensation in the genitals leading to an inability to have an orgasm (women and men)
  • Poor mental functioning and possibly dementia.

How can you avoid or at least minimize the nervous system complications of diabetes?

  • Keep your blood sugar under control – diet and exercise
  • Do not smoke! Smoking narrows blood vessels.
  • Follow your healthcare provider’s advice regarding medicine.

Diabetes, both Type 1 and Type 2, is a chronic, lifelong condition. But you can do something about it. Take control of your diabetes, manage it and live a full life.

 

It’s all linked together

Wednesday’s blog was about dementia. Sunday’s blog was about diabetes. Today’s blog will mesh the two – as did today’s online New York Times.

Poorly controlled diabetes leads to elevations in blood sugar. In turn, these elevations affect the memory area of the brain. Dementia is a loss of cognitive function, often first noticed as lapses in memory.

According to Bruce S. McEwen, of Rockefeller University, these findings are “compelling” because of the increase of Type 2 diabetes in children and adolescents.

“Compelling” indeed! At a time when intelligence and education give a competitive edge in the economy, we are looking at a potential decline in intellectual functioning in an increasing large segment of our population. Even worse, this segment holds the future of our country.

Regular exercise has been found to improve cognitive function in older individuals, both with and without diabetes. Exercise helps control blood sugar levels. Exercise is also important in weight maintenance or reduction. Being over-weight is a risk factor for heart disease. Diabetes increases the risk of heart attack in men and even more in women.

So – my advice? Take care of a lot of things at once: lower your blood sugar, maintain your weight and lower your risk of heart attack. Exercise! Exercise! Exercise!

Where are my keys?

Poor memory can be caused by many things, both physical and psychological. Yet, in an aging population, what immediately springs to mind with each misplaced key ring is the specter of dementia.

 

Dementia is the term used for a general loss of cognitive abilities, including memory, learning, behavior and communication. A few dementias, for example, the dementias caused by untreated thyroid deficiency or diabetes, can be reversed. However, many dementias are progressive, cause the death of brain cells and cannot be reversed.  Probable Alzheimer’s disease accounts for about 60 percent of all diagnosed dementias. It is the leading cause of irreversible dementia in people over 65.  

 

Diagnosis of probable Alzheimer’s disease is made after laboratory and radiological tests have excluded other, reversible, causes. However, Alzheimer’s disease can only be conclusively diagnosed after death, when an autopsy reveals the characteristic changes in the brain. That is why “probable” precedes Alzheimer’s disease as a diagnosis.

 

There is no cure for Alzheimer’s disease. The goal of treatment is to slow progression of the disease and improve quality of life for both the individual and the family.

 

However, reversible dementia is treatable. That is the main reason to screen for memory loss. If there really are signs of memory impairment, it is important to find out why. Screening is just that – screening. It is designed to either put the worry to rest or to indicate that there is a basis for concern and the concern should be pursued with a health care professional. It then becomes the professional’s job to find out the “why” behind the results of the screening.

 

So, if you are worried about memory loss (or, for that matter, any health or mental health issue) make use of the opportunity for a screening test. As Sir Francis Bacon said, “Knowledge is power”.

 

For more about memory screening, see the Alzheimer’s Foundation of America website http://www.alzfdn.org/.

Brave New World Or Same-Old, Same-Old?

An op-ed in today’s NYTimes discusses a commentary appearing in the December 11 issue of Nature.    The commentary’s authors, Henry Greely of Stanford University and others, brings into the open the use of cognitive enhancers by the healthy.

Cognitive enhancers are drugs that increase cognitive ability.  There are some drugs that are prescribed for cognitive enhancement, such as the reversible acetyl cholinesterase inhibitor, Aricept, used to treat Alzheimer’s dementia.  However, there are other drugs that are used “off label”, for their cognitive enhancing side-effects.  One of these is the commonly known stimulant Ritalin, used to treat attention deficit disorder.  

Greely, et al, assert that the use of off-label cognitive enhancers is wide-spread, should be legitimized and is a logical next step in human development.  In fact, the authors state that these drugs “…  along with newer technologies such as brain stimulation and prosthetic brain chips, should be viewed in the same general category as education, good health habits, and information technology — ways that our uniquely innovative species tries to improve itself”.

In the New York Times, Judith Warner, argues this stance from both sides without coming to a definite opinion.  However, what Warner does not do is discuss Greely et al’s proposition that the drugs be accepted and legitimized with the caveat that there be a policy put in place after evidence-based study.  In fact, the authors propose four mechanisms that should underlie such a policy.

The article is certainly worth reading as are the comments following the online version.  In my opinion, the article authors do a very good job of pleading their case.  Being a person who weighs the pros and cons before ingesting an over-the-counter pain reliever, I found myself moving from a stance of being totally appalled to being somewhat ambivalent.

What makes Greely et al different from Timothy Leary and his also learned followers is their proposal for study and policy.  Greely et al accept that the drugs are in current use and acknowledge a black-market on college campuses among other places.  They suggest that there is no going back and the next step is study and legitimization.

Science and innovation, medical or otherwise, have always stirred controversy.  And we have certainly come a long way since wise women were burned as witches for reducing the pain of childbirth.  At least Nature has allowed to be printed an article that is sure to stimulate discussion and, of course, dissension.

Would medicine-wary me take a cognitive enhancer?  For dementia, yes.  To stay awake more hours to write more blogs, no.


Mary Lou Bernardo, PhD, MSN

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