Cognitive Impairment, Dementia Common in Seniors, Proper Diagnosis Key to Treatment: Dementia Common among Seniors, Treatments Differ

By Ubelacker, Sheryl | The Canadian Press, February 2, 2012 | Go to article overview

Cognitive Impairment, Dementia Common in Seniors, Proper Diagnosis Key to Treatment: Dementia Common among Seniors, Treatments Differ


Ubelacker, Sheryl, The Canadian Press


TORONTO - Perhaps it begins with recurring forgetfulness, a struggle to find words or maybe needing repeated reminders about an upcoming event. Or it may be that some everyday tasks, performed over a lifetime with unthinking ease, suddenly seem overwhelming.

Such memory missteps could, of course, be signs of Alzheimer's disease. But specialists say there are many forms of age-related dementia and cognitive impairment, and nailing down the likely cause can ensure early and appropriate treatment.

"It is important to get a specific diagnosis because some medications work for one dementia and not another," says Dr. Tiffany Chow, a behavioural neurologist in the memory clinic at Baycrest in Toronto.

For some, memory and thinking problems could result from what's called mild cognitive impairment, or MCI, a sort of mid-step between the waning mental clarity that's normal as we age and the more exacerbated decline of dementia.

The condition is common in seniors, affecting about one in 10 of those aged 65 to 74, then rising to more than 60 per cent of those over 85.

Hockey legend Gordie Howe appears be one of them.

His son Murray, a doctor who specializes in radiology, says his father's symptoms don't fit either Alzheimer's or Pick's disease, a rare form of dementia that led to the death of his mother Colleen at 76.

Howe, now 83 and still active, is doing his bit to raise awareness. The Gordie and Colleen Howe Fund for Alzheimer's has raised more than $16 million.

While the onset of mild cognitive impairment can be frightening, Chow says the condition isn't necessarily the first step on the road to Alzheimer's or any other form of dementia. Some people will progress to that stage, but others never get worse and a few even improve.

Vascular dementia affects about 20 per cent of Canadians diagnosed with dementia, making it the second most common form. The disorder is caused by the death of brain cells, which have been starved of oxygen-rich blood as a result of high blood pressure, heart disease, high cholesterol or diabetes. A succession of mini-strokes can also lead to vascular dementia.

But with early treatment -- typically drugs that control these underlying disorders, plus changes to diet and exercise -- the progression of vascular dementia can be significantly delayed or even halted altogether.

Certainly, Alzheimer's is the most common form, accounting for almost two-thirds of the 500,000 cases of dementia among Canadians -- a figure that's expected to double to 1.1 million within a generation.

The disease, first described in 1906 by German physician Alois Alzheimer, arises from destruction of neurons linked to deposits, called beta-amyloid plaques, and tangled bundles of fibres that form in the brain. Starting in the hippocampus, a key structure involved in laying down memory, cell death eventually spreads to other parts of the brain and breaks down connections between neurons.

"It's just a neurodegenerative process," explains Dr. Mary Tierney, director of the Geriatric Research Unit at Sunnybrook Health Sciences Centre in Toronto, whose studies show that brain changes likely begin a decade before symptoms first appear.

"Whatever kick-started it in the first place, that whole cell loss, is just continuing. And that sort of relentless continuation is what we're really trying to stall."

Drugs to slow the progression of the disease and tamp down symptoms include cholinesterase inhibitors, which boost a chemical messenger called acetylcholine that's needed for memory, thought and judgment.

"They've been shown to help a bit with attention, recent memory, but they seem also to have an effect on progression of a decline in autonomy ... the ability to handle daily tasks," says Dr. Serge Gauthier, a neurologist at the McGill Centre for Studies in Aging in Montreal.

"And there are some behavioural effects, so there's less apathy, or lack of interest," he says of the drug class often prescribed for mild to moderate Alzheimer's. …

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