Dementia affects a significant portion of American elderly although dementia is not a routine part of aging. It is caused by one of several specific diseases. The most common cause of dementia is senile dementia of the Alzheimer's type (SDAT).

Multi-infarct dementia (MID) a condition which results from several small strokes in the brain, is the second most common cause of dementia. The remaining individuals with dementia have a host of other causes (e.g. - Parkinson's disease, metabolic disorders, degenerative disorders. etc.). One-half of the patients in skill nursing facilities are affected with dementia, and it is the most common reason for long-term admissions to nursing homes. Despite a wide range of causes, the principles of care are the same for all forms of dementia.

It often seems that each generation of mankind develops a communal fright over some symbolic disease. Centuries ago there was the dread of leprosy. The black death devastated continents during the Middle Ages, quickly followed by small pox. Today each modern generation trembles before the possibility of a different disease: AIDS and young adults, cancer to the middle aged, and Alzheimer's for the elderly. At a meeting of the West German Society of Alienists (doctors interested in patients with mental problems), Alois Alzheimer, a 42 year old pathologist presented his findings. His case concerned a 51 year old woman who had first experienced memory loss and disorientation, followed by depression, hallucinations, dementia and death, all within 5 years.

The autopsied brain contained areas of abnormal tissues clumped into what looked like tangled nets (now called neurofibrillary tangles or senile plaques). His audience was bored. No one asked a question. His presentation appeared only as a title in a journal in 1906, and not until a year later was a full report published. Like many important scientific discoveries, Alzheimer's description of a disease, which today is the fourth leading cause of death in the elderly, passed over the heads of his colleagues.

The Cause

The cause of Alzheimer's disease is unknown. Since the prevalence of the disease has been recognized only in the last 15 years, a great deal of time, money and effort have been devoted to research into its cause. Several hopeful avenues have been encountered, but none have led to an answer. The disease affects individuals throughout the world, and there is no association with nutrition, infections or other enviornmental factors. All people with Down's syndrome (a genetic condition in which there is an extra copy of chromosome 21) will develop changes in their brains similar to Alzheimer's.

Diagnosis

Alzheimer's is made through a diagnosis of exclusion, which means that other causes of dementia have be ruled out first. A definite diagnosis can only be established at the time autopsy and an examination of the brain.

Symptoms

Alzheimer's disease progresses through several distinct stages, although timing varies widely. There may be an early or late onset, and a slow or rapid progression. Identical twins, each of whom is affected, may experience quite different forms of the disease. Yet, in all people it is terminal. Survival for more than 10 years after diagnosis is possible.

In the early stage there is memory loss that is difficult to distinguish from forgetfulness. You could not pick out an early stage Alzheimer's person at a cocktail party. At this point, they are affected by generalized loss (e.g., forget where things are placed, get lost easily and have trouble remembering appointments) which may seem related to fatigue or ill health. The early stage is often so nebulous that individuals with strong skills are able to hide it from their closest friends and family members although retrospectively it is clearly recognizable.

The mid-phase of the disease is characterized by a progression of symptoms. Forgetfulness increases and long-term memory can may be affected. Short-memory loss becomes more pronounced. Persons may have difficulty adjusting to their surroundings. Confusion is now apparent. At some point during the mid-phase, a realization phase is entered. Both the person and family members realize that something is wrong. The person is now at risk for depression. One in four Alzheimer's patients will also have depression.

When memory loss and confusion become so pronounced that the individual cannot function without assistance, the confusional phase has been entered. Family members and friends are not recognized. Hallucinations are common. There is a particular hallucination which may be unique to Alzheimer's patients. They perceive the image on the television as real. They join in conversation with the ''TV people", or run screaming out of the room yelling "fire" while watching a newscast of an eight alarm blaze. Agitation can mount and immobility and incontinence develop. Eventually all recognized characteristics of the person's personality are lost, and the person becomes aphasic (the inability to talk), apraxic (the loss of purposeful movement) and agnosic (the inability to recognize people or things).

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