Help, Hope for Some Forms of Dementia
Slightly more than one in five family members did not recognize symptoms of dementia in a relative, and of those who did, more than half did not seek a medical evaluation, according to a study published today in the Journal of the American Medical Assn.
With an estimated 2 million to 4 million people in the United States having Alzheimer’s disease or dementia, the findings show “there are 1.8 million people . . . who may have unrecognized dementia and are not receiving medical services,” the study’s lead author contends.
Dr. G. Webster Ross, of the Honolulu Veterans Affairs Medical Center, said the study also suggests that all elderly patients would benefit from the creation of routine cognitive function screening programs.
“We feel it should be the family doctors who should be administering these mental status screening evaluations routinely to individuals over age 65,” Ross said. Unless family members indicate concern, the authors noted, family physicians may not be screening for dementia.
“Attention to early recognition of Alzheimer’s disease and creation of a public environment that encourages appropriate assessment cannot come too soon,” said Marcelle Morrison-Bogorad, an expert on dementia at the National Institute on Aging, in an editorial accompanying the study. “These issues are important now for evaluating possible reversible dementias, for helping patients and families plan, and for determining the actual prevalence of dementia. . . .”
The study involved 191 Japanese American men, ages 71 to 93, with dementia who participated in a larger research project called the Honolulu-Asia Aging Study. Family members were interviewed about the subject’s cognitive abilities before the diagnosis of dementia. Dementia was defined in the study as an acquired decline in at least three of five categories of cognitive function or behavior.
Many families assume that little can be done for an elderly person whose mental abilities are slipping, Ross said. In reality, treatments are available for some of the causes of dementia, including subdural hematomas, drug intoxication, vitamin B-12 deficiency, hypothyroidism and central nervous system infections. These disorders account for about 5% of dementia cases.
Moreover, small strokes--the second most common cause (about 30%) of dementia--can often be prevented.
Less can be done about dementia related to Alzheimer’s disease, which causes the majority of cases.
“Some have argued that individuals with Alzheimer’s disease might be better off not knowing their diagnosis because there is as yet no definitive treatment for this condition,” Ross said. “This argument becomes less tenable when personal and public safety concerns are considered. For example, demented individuals may have twice the number of automobile collisions as non-demented elderly. Early recognition of cognitive decline gives patients and their families time to plan future care needs, make financial arrangements and address safety concerns.”
Moreover, new treatments for Alzheimer’s are imminent, said Dr. Jeffrey L. Cummings of UCLA: “We have to see Alzheimer’s disease as diagnosable and treatable. It’s not a diagnosis made at autopsy. We are now 90% successful in making the diagnosis during life and we have treatments available to help manage the disease.”
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Early signs of dementia include repeating comments, misplacing items, difficulty finding names for familiar objects, getting lost on familiar routes, personality changes, becoming physically passive and losing interest in activities once enjoyed.
Among the earliest signs of Alzheimer’s disease is the inability to recall recent events while still able to remember distant events.
But, Ross said, “family members may mistake a demented individual’s recall of remote events as intact memory.”
And there are other reasons family members may not identify dementia or consult a physician.
“A caregiver’s expectations of his or her elderly relatives may decrease with age,” Ross said. “Elderly individuals may be less active or take part in activities that are less cognitively challenging, making a decline in cognition and functioning less evident.”
The study also found that the older the subject, the less likely relatives reported a memory problem. But the higher the subject’s educational level, the more likely dementia was recognized.
Relatives were most likely to report dementia when the symptoms involved behavioral disturbances, such as hallucinations or agitation, as well as a declining ability to perform daily activities, such as dressing.
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