9.24 Dementia/Secrets of Alzheimer's

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24. Dementia/Alzheimer’s - Update 14 Septr 2021 and see Dementia resource in Japan at bottom end of chapter.

Dementia means loss of mind. Its types, e.g., Alzheimer's et al., denote the pathological processes or causes. In dementia, memory, judgment and feelings are lost, and the loss is not sudden as in a stroke but gradual over years. Eventually - 5 to 7 years - what is left is a shell of consciousness that cannot think or even move until it dies of inactivity. In retrospect, the family realizes the victim is showing signs years before. The main causes are nutritional (overweight and too high cholesterol) and poor blood supply (arteriosclerosis with or without strokes); and, more and more now, degenerative (Alzheimer's and like). Also infectious (Mad Cow), metabolic (the dementia of infancy & childhood), and, vitamin B12 deficiency.   But very important is to rule out cases of severe old age major depressive disorder, which may look like Alzheimer`s dementia, so called pseudodementia, because it can be cured by simple anti depression medication. Similarly vitamin B12 deficiency.  A psychiatric and metabolic evaluation and a trial is of anti-depression medication is called for.

Alzheimer's (AD) focuses on the brain pathology. Because of its increased frequency due to today's longer-lived population, it dominates discussion of dementia. An MRI may predict AD and other brain degeneration dementia by a finding of cerebral atrophy (progressive shrinkage of brain substance; enlarged ventricles) or leukodystrophy (disorder of the white matter).

The yearly EEG brainwave is useful, even though its sensitivity is low, because it is so easy to do, noninvasive  and inexpensive.

Risk Factors are aging, heredity, overweight, high LDL-cholesterol and high BP, bangs on head and lifetime eating and drinking from aluminum pot and can. Alcohol intake is a potential risk. I recently stopped my regular daily wine with meals when my MRI showed mild atrophy and my EEG showed a slight increase in slow wave activity. Advancing age and heredity are things one cannot avoid, but one or the other should stimulate keeping low body weight, low LDL-cholesterol, and normal arterial BP – lower, better. And wear a long visor cap to protect forehead from absentminded banging.

Curable dementia, like those due to vitamin B12 deficiency, normal pressure hydrocephalus and severe old age depression, occurs; so it is advised that older persons take vitamin B12 daily and get an MRI and have a psychological evaluation, or even a trial of anti-depression medication, if they show suspicious symptom or sign of dementia.

Early and main clinical sign of dementia is failure in memory recall. At the start one can function but the gradually worsening memory fades in and out. Even a healthy person has occasional lapse in memory and inability to name a known person or thing and it worsens with aging. But in dementia this becomes speedily progressive and affects orientation and direction. A common first awareness is a person's getting lost, or being unable to locate familiar address.  Also subtle personality changes evidenced only to close family, and a tendency to get lost easily on the way home from work.

Prevention  Get down to BMI 20 or a little lower, get your LDL-cholesterol to below 60 and lower better with Statin medication, and lower your BP to average 120/70 with beta blocker, ACE-I medication and mild chlorthiazide-diuretic (progressive adding on, see chapter on hypertension). Do a blood check of toxic metal levels – Al, Hg, Cd and, even Fe - and act to lower too high level. Also check vitamin and mineral blood tests for deficiency or toxicity. And even with normal blood tests, the combination - mega vitamin C dose (2 grams) and folic acid (10 mg) and vitamin B12 1000 micrograms all 3 times a day - may help slow or prevent dementia. Also water! Water! Water! - at least 1 extra liter a day!  And reposes each day - not only asleep but light relaxation, thinking no stressful thought. Reduce stress in life. If it means leaving a bad partner, stopping unhappy work or separating from rotten children, then do it (but look for a good social network and find a good end-life companion and cherish helpful, cooperative offspring and if you already have one in your family, more cherish her or him and beware dangerous new relationships).  Review finances and availability of resources. All capital assets should be turned into cash available; do not worry about leaving money to anyone – use it for making your last years less stressful and more happy while you can. (But with free advice of a wise, disinterested, non-greedy friend or relative.) Continue useful work if you can and if you enjoy it. If of limited means, in USA get Welfare and Medicaid and food stamp card at local social security office. Also exercise your mind with good reading for new knowledge.

But, important before you panic because of an early MRI or EEG finding, is to look at your own life.  I am an excellent example. Despite changes on MRI and EEG since age 77 suggesting risk for dementia; at age 88 I am functioning with high-touch energy and my memory is good. (Exception, I have noticed mild anomia since age 70s but it has not progressed.) Also my cholesterol is healthily low. Recently I got a complete clinical neurological check up with no abnormal findings and my neurologist said, "You have nothing to worry about because despite the MRI and EEG showing risk signs, you are clinically 20 years younger than your actual age mentally and physically." The lesson is: do not be panicked by an MRI or an EEG findings in the face of a normal, and especially a better than normal, clinical picture.

Once it is certain that one has incurable, progressive dementia, then supportive psychotherapy (If not already started) should work to get a patient to accept the dementia humbly and when one cannot manage alone, one should get prepared to enter a hospice care, and not forgetting to consider body organ donation and autopsy to help science and other persons. 

Divest one's self of property and expensive possessions wisely while still thinking rationally. (Or a loving, non-greedy caretaker should arrange it with as much understanding as possible.) Rational informed death in a hospice or physician-assisted suicide may be an option in areas where it is legal and available.

Follows a wife’s comment on her AD husband."For some time it was hard to tell if it was his personality or if he was really ill. It seems to be at first just a momentary lapse, a forgetfulness, confusion that fades quickly and one is able to pick up the threads of memory and move on. It is as if there are two people in one body........one fades as the other grows more dominant....I do recall Leo asking me "What is wrong with me" and by the time I explained his illness (it took about one minute) his illness took over, blanking out his mind to my response. Perhaps diet could help; Leo did love his red meat and rich deserts and although he was not overweight he did have high blood pressure and was taking medication".
  Concerning love of red meat, in another case I saw, the AD hit a vegetarian. But, still, a mostly non meat diet is best.

   Dementia resource in Japan is good. National Health Insurance can cover 90% of the cost if over age 65 and not obviously affluent. (Be sure insurance card has the number 1 on its front; if not and applicable, arrange it with Kuyakusho —- District Government office.) Home assistance and care is available and covered by insurance but must be initiated by the physician in charge of the case.  Also nursing home care is partly covered by special so-called “Alz-byo” insurance that has been paid into by all registered residents of Japan.
 END OF CHAPTER. 
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  9.24a Bangs on the Head and Brain Trauma