Those who are diagnosed during the pre-Alzheimer's stage can live a near-normal life with very little decline, said Dr. Arden Aylor, Alzheimer's dementia director for the Center of Geriatric Medicine at Scott & White Memorial Hospital.
"It's like anything - if you wait until it's really bad, it's going to be really bad," Aylor said. "It's not like an infection; there's nothing we can do to make it go away and that's true for almost any neurological disease."
There is a misconception that the available medicines used to treat dementia don't have much of an impact on the disease, Aylor said.
"They don't do much for end-stage disease, but they do an amazingly good job if you catch it early," he said.
Dementia is evaluated by stages - mild, moderate and severe. There is a gray area called mild cognitive impairment - a pre-dementia state.
Those who fall into the mild cognitive area have an 82 to 85 percent chance of developing dementia in three to five years, Aylor said. It also means about 15 percent won't get any worse.
"You look at family history, history of TIAs (mini strokes), uncontrolled diabetes and if there is a decline in memory before age 60," he said. "For those, we recommend starting the medications before they actually develop true disease."
If a person has multiple family members with the dementia it's reasonable to begin screening by the time that person reaches late 50s.
There are 11 types of dementia. Alzheimer's accounts for about 65 to 70 percent of the cases.
The second most common dementia accounts for 25 percent of the cases and is caused by cerebral vascular dementia, diabetes and uncontrolled blood pressure.
Lewy Body dementia has both Alzheimer's and Parkinson's features and makes up 3 to 5 percent of dementia diagnosis.
Frontal temporal dementia and Parkinson's account for 2 to 3 percent of the cases.
Alzheimer's path
Patients with Alzheimer's decline at a certain rate and short-term memory is the first function to go, followed by long-term memory, Aylor said. Alzheimer's patients almost always become childlike in their behavior, regressing backward mainly because they are accessing old information.
"Whatever mom and dad were, you're going to get more of it," he said. "If mom was real quiet she'll get quiet, if she was real sweet she'll get sugary sweet. If mom or dad was stubborn or hardheaded, they're going to be more of that."
Alzheimer's affects the prefrontal cortex, which controls personality. The social filter disappears and whatever the Alzheimer's patient is thinking or feeling will become immediately apparent. Those with cerebral dementia will have a lot of agitation and are often argumentative.
During a patient visit, Aylor devotes more than half of his time with the family.
"That's something we do best, we have the ability to take a little time," he said. "It's not that hard to diagnose dementia and what we can do is sit down with the family and share with them information they'll need to make informed decisions. The time to make those important decisions is not when it's become an emergency situation."
Consults have to include the family, he said, with discussion including family observations and information about the disease. Then talks turn to advance directives and wills, who's going to take care of mom or dad, what assisted living has to offer. Many times the family has not looked at the big picture.
"That's usually the biggest shock - where this is going, not what it is now," Aylor said. "Right now mom is just confused, later mom may become a different person."
Looking at all of the options is stressed.
"You don't want to look back and realize you didn't consider everything that's available."
Treatments limited
Two-thirds of the therapy used in treating Alzheimer's is medication, but cognitive exercises - dominoes, crossword puzzles, word finding games, board games - are an important component in treatments.
The activities are neuroprotective, Aylor said, and someone who develops those behaviors can help protect their brain from further decline or stabilize the decline.
"What we don't know is what games are better," he said.
Patients who do the medication and games fare better compared to those who just take the medication.
"There's both a social component and a neurological component at work," Aylor said.
Now that a diagnosis happens earlier in the disease process, an Alzheimer's patient can expect a near to normal life expectancy. Early intervention protects independence, so that window where a supervised environment is required is put off many years.
More education also translates to more protection against dementia.
Aylor used the analogy of a spider web to explain the benefit education plays in the disease process.
Those with webs that are ornate and detailed have developed pathways that go everywhere and it's likely a deficit in the brain can be worked around. If part of a simple web is pulled away, the web will collapse.
The lower the education, the less chance there will be auxiliary pathways.
