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What is dementia?

Dementia describes a long-term, usually irreversible condition involving gradual degeneration in brain function. The brain functions affected depend upon the type of dementia. For instance, in dementia from Alzheimer’s disease, memory loss is usually a significant feature while in other types of dementia, language or emotional problems can be the significant deficit. Many dementias involve multiple areas of brain function.

What is Alzheimer’s disease and how is it different from normal aging?

Alzheimer’s disease is an abnormal loss of function from certain areas of the brain that progressively worsens. The definite diagnosis of Alzheimer’s disease can only be made in an autopsy by pathologists trained to find certain abnormal structures in the patient's brain.

In normal aging, some mild and progressive memory loss and minor deficits in other types of brain function, such as intellectual response time slowing, can occur. If these losses do not affect a person's level of personal and social function, then they are not considered abnormal.

However, in Alzheimer’s disease, a distinct pattern of dysfunction arises, which involves short-term memory loss, as well as language and visuospatial deficits and leads to loss of personal and social function. Alzheimer’s disease patients eventually cannot perform Instrumental Activities of Daily Living (IADLs) or Basic Activities of Daily Living (BADLs).

What is a typical visit to the Penn Memory Center like?

There are two major types of visits to the Penn Memory Center (PMC), a new visit and a follow-up visit.

During a new visit to the PMC, the patient and the patient's caregivers will be seen by a number of different health care professionals. A typical new visit might begin with an intake interview by a social worker or other professional. Following that a nurse might interview the caregiver and patient followed by psychometric testing of the patient. Once the psychometric tests are completed, a physician will usually also interview the caregiver and patient and then perform a physical examination of the patient. Depending on the results of the psychometric tests and the health care professionals other findings, the health care team might recommend further tests, the involvement of other health care professionals and follow-up visits.

Follow-up visits typically take less time and are used to assess changes in the patient and caregiver since the last visit or to perform tests that were not completed in the initial visit. Follow-up visits might involve the entire team or just a few members depending on the goal of the visit.

If someone in my family has Alzheimer’s disease, does that mean I will get it as well?

No. Although there is an inherited component factor to Alzheimer’s disease, which increases your risk for getting Alzheimer’s disease if others in your family have it, many people who have the disease in their family do not get it themselves. Scientists do not yet know what causes the disease or exactly which factors in a person's life lead to getting the disease. Additionally, elderly people are sometimes labeled with Alzheimer’s disease even when it is not confirmed, so you may think it is in your family, when it is not.

Is there a cure for Alzheimer’s disease?

Not currently. A good deal of research time and money is being spent to investigate various treatments for Alzheimer’s disease.

I've heard about ginko biloba supplements as a treatment for Alzheimer’s disease. Is there any evidence that this treatment is effective?

A study in 1997 showed a slight slowing of cognitive decline in some patients with mild to moderately severe dementia. There is no evidence that ginko biloba can cure or prevent Alzheimer’s disease. There are possible side effects to ginko biloba such as excessive bleeding especially when used with aspirin. You should consult your doctor before trying ginko biloba for yourself or someone you care for. Also note that ginko biloba supplements, like other dietary and herbal supplements are not standardized, which means that you do not know how much of the extract you are actually getting in each pill or capsule.

Other studies of ginko biloba are currently on-going.

I've heard about Vitamin E as a treatment for Alzheimer’s disease. Is there any evidence that this treatment is effective?

Studies have shown that Vitamin E ( An essential vitamin that may help delay the progression of Alzheimer’s disease, found naturally in nuts and oils, but only in small amounts. Vitamin supplements may be necessary in order to receive beneficial amounts. ) can slow cognitive decline in some patients with moderately severe dementia. There is no evidence that Vitamin E can cure or prevent Alzheimer’s disease. You should consult your doctor before trying Vitamin E for yourself or someone you care for.

What is the usual treatment for Alzheimer’s disease?

Anticholinesterase drugs, such as donepezil (Aricept) and rivastigmine (Exelon), are usually used to treat the symptoms of Alzheimer’s disease. In addition, the FDA recently approved a new drug, memantine (Namenda), for the treatment of moderate to severe Alzheimer's disease. A doctor might also recommend Vitamin E . Various behavior management treatments are used depending on the types of behavioral symptoms a patient displays. As the disease progresses other symptoms are treated as they occur. Attention to the difficulties and rigors of caregiving are usually included in a patient's treatment plan, since the caregiver's health is just as important to maintain.

What is the goal of treatment for Alzheimer’s disease?

Currently, attention to the patient's and caregiver's quality of life are central to Alzheimer’s disease treatment. Since there is no cure, one goal might be to slow the progression of the disease. Keeping a patient happy and comfortable might be another. As mentioned above, the caregiver's health is also of primary importance.

Where can I go for help in taking care of a person with Alzheimer’s disease?

Your local Alzheimer's Disease Clinic is good place to start. Also contact the Alzheimer’s Association chapter in your area. Geriatricians, psychiatrists and neurologists are all physicians who have special training regarding Alzheimer’s disease.

I am taking care of person with Alzheimer’s disease. Will this person eventually need to be in a nursing home?

It is not necessarily true that all Alzheimer’s disease patients eventually need to enter nursing homes. There are many factors involved in making the decision to put a patient in a nursing home. The rate of progression of disease, the resources available to the caregiver(s), other health issues that the patient may have, and the original wishes of the patient should all be considered when making such decisions.

What are the options for long term care of Alzheimer’s disease patients?

There are many long term care services available for Alzheimer’s disease patients and their caregivers including in-home aides, adult day care, assisted living facilities, nursing homes and at the end of life, hospice care. As mentioned above when considering among these options, many different factors should be carefully considered by the patient's family, caregivers, and health care team.

What is hospice care?

Hospice care is care for patients for whom the focus of their condition as been changed from curative to palliative. This means that the patient's caregivers are concerned first and foremost with increasing the patient's quality of life and comfort. Physical, mental and emotional pain are addressed and efforts are made to reduce all of these types of pain to a minimum. Hospice care can take place in the home or in a special hospice unit within an institution. For more on hospice check out the Hospice Foundation .

What other diseases cause dementia besides Alzheimer’s disease?

Although 60-80% of dementia is caused by Alzheimer’s disease, there are other diseases that cause dementia.

Frontal dementia causes approximately 10% of dementia and usually occurs at ages 60 to 70. Frontal dementia often begins with personality, behavior, or language changes followed by memory changes. This is the opposite of the usual course for Alzheimer’s disease.

Dementia with Lewy bodies causes approximately 10% of dementia and usually occurs between ages 60 to 80. Dementia with Lewy Bodies has symptoms similar to Alzheimer’s disease, but often also includes delusions and delirium early in the disease.

Ischemic vascular dementia causes approximately 5% of dementia and can occur at any age since it is a disease associated with stroke. If a portion of the brain important to cognition is deprived of blood flow (ischemia), symptoms of dementia can follow the insult.

Depression causes approximately 10-20% of dementia and can occur at any age. The symptoms are similar to Alzheimer’s disease but often the patient's complaints of memory loss are in excess of memory loss measured objectively. A positive response to antidepressant therapy is a clue that depression may be the dementia's cause.

Other diseases that cause dementia are Huntington's disease, Jacob-Creutzfeld disease, Progressive Supranuclear Palsy, Parkinson's disease, and Cortico-basilar degeneration. Most of these diseases have a more rapid progressive nature.

What research is going on at the Alzheimer's Disease Center?

Please go to Our Research page.

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