Dementia 101

Contributed by: Dennis Fortier, President, Medical Care Corporation

Based on the various interpretations I read in the press, there seems to be some confusion about the term dementia. The DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, American Psychiatric Association) provides the most commonly used criteria and defines dementia in this way:

Dementia is a clinical state characterized by loss of function in multiple cognitive domains. Diagnostic features include : memory impairment and at least one of the following: aphasia, apraxia, agnosia, disturbances in executive functioning. In addition, the cognitive impairments must be severe enough to cause impairment in social and occupational functioning.

So, in even simpler terms, being demented means that one's mental faculties are impaired to a degree that interferes with their social and occupational function. For the purpose of most discussions, it really is as simple as that.

The confusion begins when people talk about "being diagnosed with dementia" or "treating dementia". In a world of clarity, those same people would speak instead about "being diagnosed with Parkinson's Disease or with Alzheimer's Disease" which may have led to a clinical state of dementia. No one would "treat dementia", they would treat the underlying medical condition causing the impairment that we describe as dementia. It is a simple concept but I hear it confused (or read about it being confused) on a daily basis.

We don't need to detect dementia, we need to detect medical conditions that lead to dementia. We cannot treat dementia, we must treat medical conditions that cause dementia. The word dementia merely describes the extent of some person's cognitive impairment.

A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

What Causes Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

This is a common question that all too many people answer incorrectly. The comprehensive answer is that there are many causes of memory loss, most of which are completely treatable, and all of which are manageable to some degree. Many, however, assume that all recall deficits are due to Alzheimer's Disease and therefore, such symptoms must indicate a dire medical condition. While it is true that Alzheimer's Disease is one of the leading contributors to memory loss, there are many other, more benign conditions such as depression, thyroid disease, and anxiety to name just a few, that commonly impair memory and can be easily treated by a physician.

There is a good summary of medical conditions that cause memory loss and their respective treatments at (which is an educational website, supported by Medical Care Corporation).

AD Treatment Perspective #1

Contributed by: Dennis Fortier, President, Medical Care Corporation

Current treatments do not cure AD but they can slow disease progression. This is an important difference. If you are expecting treatment to help the patient regain their former cognitive abilities, you will almost surely be disappointed. If you are expecting some stabilization or slowing of their decline, you may well be satisfied.

Remember: Slowing the advance of the disease can add precious months or even years to a patient’s independence and should not be marginalized as meaningless simply because a cure would be better.

5 Truths and 5 Myths about Alzheimer's and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

Sometimes the truth can be very misleading. This is often the case with complex topics when an “expert” makes a narrow but accurate statement that is subsequently generalized by the lay public. This is a common phenomenon in the fields of Alzheimer’s and dementia.

Here are five examples of true statements that have been so commonly misinterpreted that they have spawned five harmful yet well-entrenched myths.

Narrow Truth: There is no cure for AD.
General Myth: Because there is no cure, nothing can be done for patients diagnosed with this disease.

Like diabetes and hypertension, we cannot yet cure Alzheimer’s disease. However, physicians can intervene and manage the symptoms with more success than most headlines would indicate. In fact, with a timely diagnosis, a physician can prescribe a treatment plan including pharmaceutical therapy, improved diet, physical exercise, mental and social activity, and certain OTC supplements. When this approach is combined with an educated caregiver, disease progression can be commonly slowed for some meaningful period of time.

Narrow Truth: The only certain method for diagnosing Alzheimer’s disease is to inspect a sample of brain tissue during autopsy.
General Myth: Alzheimer’s disease cannot be accurately diagnosed until death.

If “certain” means 100% accuracy, then there is no certain diagnostic method for many well known diseases (Lou Gehrigs disease springs immediately to mind). However, physicians following published diagnostic guidelines can get a highly accurate diagnosis of Alzheimer’s disease (90%-95), even at a fairly early stage of the disease. This diagnostic accuracy is on par with commonly accepted clinical practice.

Narrow Truth: Current treatments do not stop the progression of AD.
General Myth: Since the disease will continue to progress, there is no need to bother with treatment.

There is no doubt that reversing all memory loss would be the best treatment result and halting further memory loss would be better than ongoing decline. However, this does not mean that slowing the pace of further decline is not a worthy pursuit. We all want better treatment options in the future but until they arrive, preserving quality of life during a patient’s final years is definitely a worthwhile and attainable goal.

Narrow Truth: Cognitive decline is a part of normal aging.
General Myth: Pronounced cognitive deficits just need to be expected and tolerated

As we age, all of our organic functions tend to slow. Our ability to think, make calculations, use judgment, and store and retrieve information is not immune to this process. However, a pronounced loss of cognitive capacity severe enough to impact a person’s ability to lead an independent life is not normal. When such decline occurs, there is some underlying pathological explanation that can be identified and treated by a physician. Accepting significant loss of mental function as a normal artifact of aging is a tragedy.

Narrow Truth: It’s best not to know if you have Alzheimer’s disease
General Myth: It’s best if the problem stays undiagnosed

This final “truth” is a stretch to begin with. I can imagine that, if it were possible, an Alzheimer’s patient might enjoy life more if they could receive the highest standards of care without ever knowing they had a terrible disease. However, this does not make the case that the problem should be ignored. The published evidence in favor of managing the symptoms and prolonging a higher quality of life outweighs the presumed benefits of bliss. Additionally, patients need to know about their condition if they are to participate meaningfully in their own care and end of life decisions.

I hear and read these narrow “truths” in the media everyday. I also see first hand how the public mischaracterizes them and takes away a broader and more harmful message than is intended.

Education remains a major barrier between our current ability to care for AD patients and the higher standards that are within our immediate grasp. I hope we can begin to divorce ourselves from these sound bites of misleading truth and begin to see the Alzheimer’s picture with more clarity.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.