How to Face Dementia: What to Do When There is No Cure

Article’s Highlights:

• There is no cure for any type of dementia, however, there are steps that can be taken to improve dementia symptoms.
• Different treatments and drugs have been FDA approved to treat the symptoms of different dementias.
• Some natural remedies can be used to alleviate the side effect of dementia treatments.
• Dementia should be treated on a case-by-case basis with different treatment plans.
• Be aware of all treatment options and dementia medications to ensure a high quality of life for your loved one.

Overview

There is currently no known cure for any of the different Types of Dementia. The number of individuals with dementia is increasing with the aging of our population and loved ones are in search of a cure. Although dementia is an incurable, progressive disease, there are some steps one can take to maintain quality of life. One must refrain from being lured in by the plethora of misinformation that may arise when in search of a treatment for their loved one. This article will focus on understanding current treatments for different types of dementia, typical symptoms exhibited by different brain changes, truths and myths about preventing dementia, and steps you can take now to help you or a loved one with dementia.

Recognizing Mild Cognitive Impairment (MCI)

Although age is said to be the greatest risk factor for Alzheimer’s Disease (AD), dementia is not a normal aspect of aging. Your loved one may have trouble finding the right word to say during a conversation, misplace their glasses or keys, or have trouble coming up with the name of someone they know. These cognitive deficits, however, are considered to be normal age-related decline. Mild cognitive impairment (MCI) is when an individual’s mental status is worse than expected for their age and education level, but they continue to be able to perform Activities of Daily Living (ADLs). There is currently no means to predict if these types of age-related changes will develop into dementia, however, Mild Cognitive Impairment with memory loss has a very high risk of progressing to Alzheimer’s Disease.

Monitoring for Dementia

In hopes of reducing the burden of dementia on both our aging population and their caregivers, Medicare guidelines now require screening for cognition and depression at the Medicare Annual Wellness Visit to monitor for changes in mental status. There is no reliable evidence that this screening is beneficial to older adults or their caregivers, but it does provide a baseline mental status of when the older adult is in a relatively healthy condition. Yearly monitoring of mental status is especially important because chronic illnesses and physical changes can make it more difficult for older adults to fight infection, process and store nutrients, recover from an illness, or heal after an injury.

Diagnosing Dementia

A baseline mental status exam is also helpful when illness, medication changes, worsening of a chronic condition, hospitalization, depression, hearing loss, or vision changes cause a serious mental condition called delirium. Delirium can be common among older adults, but it is much more likely when there is underlying dementia. It is extremely important to identify delirium quickly because this condition increases the risk of re-hospitalization, admission to long-term care, and death. Symptoms typically include confusion, changes in sleep patterns or activity levels, aggressiveness, and hallucinations that fluctuate through the day. Treatment is based on controlling the symptoms until the underlying cause is corrected.

With these changes in the older adult’s brain, how do you know if your loved one has dementia? A diagnosis of dementia is made when progressive brain changes affect memory along with one or more of the following areas: judgment, understanding language, learning and recall, or orientation (Khandelwal & Kaufer, 2014). The individual gets progressively worse until they can’t function independently or perform simple daily tasks such as bathing or dressing. The life expectancy is 3 to 15 years after a dementia diagnosis. Survival time varies with the type of dementia and the severity of any pre-existing chronic conditions (Harper, Johnston, & Landefeld, 2017). The ability of family and friends to provide care typically means the difference between keeping a loved one at home, or placing them in long-term care, a decision which can add a tremendous emotional burden to a dementia diagnosis.

The Progression from Old Age to Dementia

Martha G’s Story

Martha is 82 and lives alone since her husband passed away 4 years ago. Mrs. G loves her home and has lived there for over 40 years. Her daughter, Susan, who lives 30 miles away, hired a housekeeper to come in three times a week to help perform a few chores that Mrs. G is having trouble with these days. Mrs. G drives to church on Sundays and volunteers in the nursery, she plays cards with her friends at the community center 2 days a week, she cooks for herself, and keeps up with all of her medications. Yesterday Susan stopped by to pick her mom up for an appointment with the doctor. Mrs. G was not dressed to go out because she had forgotten about the appointment. Rushing to help Mrs. G get ready, Susan was shocked when she noticed her mom’s clothes were getting loose and there was spoiled food in the refrigerator. Susan gathered all of Mrs. G’s medicine bottles into a plastic grocery bag and hurried to the appointment wondering what was going to happen next.

This story illustrates the insidious nature of the progression from age-related mental changes to the first signs of dementia. Around 5 million older Americans currently suffer from some form of dementia and have a story like Mrs. G. The prevalence of Alzheimer’s disease (AD), and other forms of dementia, will place a growing financial, emotional, and physical burden for our nation, families, and caregivers.

Options for Different Dementias

Alzheimer’s Disease

Alzheimer’s is the most common form of dementia, affecting about 70% of all individuals diagnosed with dementia. It is a progressive disease that causes neurons in the brain to die due to amyloid plaques that begin to develop before symptoms occur. As the neurons begin to die, cognitive loss and mental decline becomes more noticeable. Once a neuron dies, the brain connection is lost along with any vital function associated with it. Because these changes can not be reversed, it is essential to be able to predict who is at risk for Alzheimer’s disease and what preventative measures can be taken. A couple genetic risk factors have been identified, along with findings on the potential effects of environment, nutrition, and more. Inherited or genetic risks for developing Alzheimer’s Disease include age, family history of AD, APOE-4 gene, and Down’s Syndrome. Preventable risk factors consist of head trauma, hypertension, diabetes mellitus (DM), smoking, and depression.1

Early signs of Alzheimer’s include deficits in immediate recall (e.g., something that happened in the last few minutes) and difficulty with the memory task of naming items in a specific category (e.g., name as many fruits as you can in one minute). The National Institute on Aging (NIA) has reported some advances in locating where some of these changes first start inside the brain. Once the locations of changes in the brain are identified, the NIA hopes to diagnose Alzheimer’s in its earliest stages and monitor if certain methods of intervention can be effective. The NIA also reports some minor success in early detection with a simple blood test. The primary goal, however, is to be detect disease as early as possible and find effective means of treatment to slow or cure the disease.3

Vascular Dementia

Vascular Dementia (VaD) is due to neuronal death that occurs when there is limited or no blood flow to an area of the brain. Vascular dementia is the second most common form of dementia and is often identified with a diagnosis of Alzheimer’s disease. There is usually a history of head injuries, strokes, hypertension, diabetes mellitus (DM), and/or smoking which contribute to VaD. Symptoms are variable depending on the extent and areas of brain damage. There can be sensory changes (loss of sensation), motor changes (paralysis), problems walking, or psychiatric and behavior changes.1 Treating high blood pressure is the only preventative step that has shown consistent, reliable evidence for reducing the risk of VaD.

Lewy Body Dementia

Lewy Body Dementia (LBD) is the second most common form of degenerative dementia, after Alzheimer’s disease. LBD is very closely related to both AD and Parkinson’s disease (PD), making it difficult to diagnose. The Lewy Bodies, or clumps of protein that define the disease, are usually found in the brain stem. Symptoms of LBD vary more than other dementia types and may begin as early as age 50. Disturbing visual hallucinations, unusual sleep behaviors, movement problems, and fluctuating mental status help diagnose LBD. It is very important to diagnose this form of dementia early because common drugs given to control behaviors for AD can cause worsening symptoms or even death. Many factors influence how long an individual will live with LBD, but the average is 5 to 7 years after diagnosis. 5

Fronto-Temporal Dementia

Disease onset for Fronto-Temporal Dementia (FTD) is early, between age 45 and 64, and personality changes are usually noticed first. 1 This disease is progressive with an average life span of 10 years after diagnosis. In addition to early personality changes, FTD interferes with the ability to understand or formulate words and can cause motor changes that affect strength and mobility. The only known risk factor for FTD is a family history of the disease.

Dementia Type

Signs and Symptoms

Treatment Options

Alzheimer’s Disease

• Problems with immediate recall
• Difficulty naming objects
• Becoming lost, forgetfullness

The Food and Drug Administration (FDA) has approved three drugs for management of mild to moderate dementia; donepezil, galantamine, and rivastigmine. Memantine is the only FDA approved drug for severe AD and hasn’t been shown to have any long-term effects for improved function.

Vascular Dementia

• Sudden confusion or disorientation
• Speech impediment or trouble understanding speech
• Vision loss or visual impairment

Treating high blood pressure is the only preventative step that has consistent, quality evidence for reducing the risk of VaD.

Lewy Body Dementia

• Hallucinations or Visual Delusions
• Symptoms of Parkinsonism
• Fluctuating levels of confusion

Disturbing visual hallucinations, unusual sleep behaviors, movement problems, and fluctuating mental status help diagnose LBD. It is very important to diagnose this form of dementia early because common drugs given to control behaviors for AD can cause worsening symptoms or even death.

Fronto-Temporal Dementia

• Changes in behavior or personality
• Difficulty naming objects
• Difficulty walking, rigidity, tremor

This disease is progressive with an average life span of 10 years after diagnosis. In addition to early personality changes, FTD interferes with the ability to understand or formulate words and can cause motor changes that affect strength and mobility. The only known risk factor for FTD is a family history of the disease.

FDA-Approved Drugs

The Food and Drug Administration (FDA) has approved few drugs for the treatment of Alzheimer’s Disease and the management of mild to moderate dementia. These FDA-approved Alzheimer’s Treatments consist of Memantine, Donepezil, Galantamine, and Rivastigmine. These drugs aren’t always effective, can be very expensive, and can cause severe side effects.4 Memantine is the only FDA approved drug for severe AD and hasn’t been shown to have any long-term effects for improved function. No treatment has been found to stop the neurons from dying, or to prevent someone with Alzheimer’s from progressing to complete disability, and death. At most, existing medications help slow some of the symptoms of the disease in some people. Because of the severe side effects, it has been recommended that these drugs be stopped if there is no mental or behavioral improvement noted. Increased funding has brought about many promising advances in Alzheimer’s research, but thus far, no cure has been discovered.

Natural Remedies

The following natural remedies have also been studied, but to date there is no conclusive evidence that any of these products will slow down the progression of AD. It is promising that increased funding for Alzheimer’s research will allow continued trials for these therapies, but for now, they have not proven to be effective in large enough numbers to warrant acceptance as treatments for the different types of dementia.

• HupA– a plant extract from Chinese moss that works in the same way as donepezel and galantamine by influencing a different form of acetylcholinesterase (Ach). This extract has been shown to cross the blood brain barrier better than donepezil and rivastigmine. There are not enough quality studies to recommend this supplement.
• Polyphenols– plant derived substances that helps preserve neurons by protecting them from external chemical and physical stressors.6
• Reservatrol– found in red wine and peanuts, can help decrease inflammation and beta-amyloid, trials are in progress to test if reservatrol will slow progression of AD.
• Curcumin– a spice called turmeric that protects neurons by decreasing inflammation, preventing amyloid plaques from forming, and helps clear existing plaques, has problems with absorption when taken by mouth.
• Ginkgo biloba– there is research that confirms the anti-oxidant and anti-inflammatory properties can protect neurons and enhance neuron communication in AD, but it does not slow the onset of dementia. There is no evidence this supplement helps adults with MCI.
• Apple Cider Vinegar– has been around for thousands of years as a food additive. Vinegar’s safety has been established as a food product and some human studies indicate it is useful for minimizing blood sugar spikes in diabetics. There is no consistent evidence that vinegar fights infection, reduces inflammation, or prevents dementia.7
• Coconut Oil–Dr. Mary Newport is the author of the book Alzheimer’s Disease: What if There Was a Cure? who explored the use of coconut oil as a treatment for her husband who developed early onset Alzheimer’s. Her experience as a physician helped her document the process and communicate to the world her experiences as her husband benefitted from the use of coconut oil. Dr. Newton openly admits that her book was designed to inspire clinical trials in the study of coconut oil and the effect ketones have in the brain of patients with AD. She understood that the improvements made in her husband’s mental status were not enough to translate into helping everyone with AD. Dr. Newton also makes clear that her discovery was that her husband’s AD stabilized and saw an improvement of symptoms. The coconut oil did not cure her husband but it did lead the NIH to increase research in the effects of ketone esters on plaques and tangles in the brain–an important step in Alzheimer’s research.

Reduce Dementia Risk

There is no reliable clinical evidence to support behaviors that prevent or reduce the risk of developing dementia. The Alzheimer’s Association does recommend several lifestyle changes that seem to be associated with protective cognitive benefits.

• Exercise-Maintaining vascular health with moderate physical activity such as walking 5 days a week, and management of weight, diabetes, and hypertension, can help support brain health.
• Smoking– Quitting smoking or abstaining from the use of tobacco, nicotine, and other recreational drugs . Research has shown that vascular health begins to improve as soon as smoking is stopped.
• Healthy Diet– A systematic review of current literature found the most evidence in support of the Mediterranean Diet for prevention of many age-related conditions, including cognitive decline. This diet is high in fruits, vegetables, and legumes, with olive oil as the main source of fat. The diet also encourages moderate fish and dairy intake, and low intake of other meat sources.8
• Cognitive Therapy– There is some research that indicates continued learning helps improve immediate and long term recall. There is not enough evidence to point to a specific intervention or type of learning that has a measurable effect on preventing dementia.9

Conclusion

As our country ages, there is an urgent need to identify risk factors for developing dementia as well as methods to prevent this progressive brain disease. Until we know what causes dementia, it is essential to maintain a healthy lifestyle, get regular check-ups as you age, take steps to manage and control the progression of chronic diseases, notify your doctor immediately when you notice a decline in mental ability, and be willing to participate in clinical trials for dementia research.

Martha G’s Conclusion

Mrs. G was diagnosed with depression and dehydration at her doctor visit. With a home health referral, Susan was able to get her mom back to a healthy weight, resolve the dehydration, and return to her previous level of functioning. An anti-depressant prescription helped Mrs. G get back to the activities she loved.
The sudden change in Mrs. G’s condition gave Susan and her mom the motivation to discuss Mrs. G’s affairs. They completed an Advanced Directive, A Durable Power of Attorney, and began talking about moving Mrs. G a little closer to Susan so Susan could help more often.

References

1. Khandelwal, C., & Kaufer, D. I. (2014). Alzheimer’s Disease and Other Dementias. In R. J. Ham, P. D. Sloane, G. A. Warshaw, J. F. Potter, & E. Flaherty, Ham’s Primary Care Geriatrics A Case-Based Approach (6 ed., pp. 201-213). Philadelphia, PA: Elsevier, Saunders.
2. Estruch, R. (2012). Effects of Mediterranean diet on the primary prevention of cardiovascular disease. Retrieved January 9, 2017, from http://www.nejm.org/doi/full/10.1056/nejmoa1200303#t=article
3. National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services. (2015, December). 2014-2015 Alzheimer’s Disease Progress Report: Advancing Research Toward a Cure. Retrieved January 11, 2017, from http://www.nia.nih.gov/alzheimers
4. Wollen, K. A. (2010). Alzheimer’s Disease: The Pros and Cons of Pharmaceutical, Nutritional, Botanical, and Stimulatory Therapies, with a Discussion of Treatment Strategies from the Perspective of Patients and Practitioners. Alternative Medicine Review, 15(3), 223-244. Retrieved January 7, 2017
5. Lewy Body Dementia Association. (2016). Learn about LBD. Retrieved from Lewy Body Dementia Association: https://www.lbda.org/content/diagnosis
6. Wollen, K. A. (2010). Alzheimer’s Disease: The Pros and Cons of Pharmaceutical, Nutritional, Botanical, and Stimulatory Therapies, with a Discussion of Treatment Strategies from the Perspective of Patients and Practitioners. Alternative Medicine Review, 15(3), 223-244. Retrieved January 7, 2017
7. Johnston, C. S., & Gaas, C. A. (2006, May 30). Vinegar: Medicinal Uses and Antiglycemic Effect. (G. Lundberg, Ed.) Medscape General Medicine, 8(2), 61. Retrieved January 8, 2017, from Medscape General Medicine.
8. Lourida, I., Sont, M., Thompson-Coon, J., Purandare, N., Lang, I. A., Ukoumunne, O. C., & Llewellyn, D. J. (2013, July). Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review. Epidemiology, 24(4), 479-489. doi:10.1097/EDE.0b013e3182944410
9. Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer’s and Dementia, 11, 718-726. Retrieved January 9, 2017, from http://dx.doi.org/10.1016/j.jalz.2015.05.016

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