“The journey into dementia has its disappointments to be endured as well as its triumphs to be cherished.  In all of the ambiguities and confusion there may also be signs of hope, for this is a journey with intersecting signposts; reminders of the past and pointers to the future.  There are always fresh opportunities for a new walk on a new day.” – Rosalie Hudson

In Part 1 of this two-part series the reader was presented with an overview of dementia, including its signs and symptoms, and introduced to the more common progressive (worsening over time) forms of this all too often devastating disease.  In Part 2 of this two-part series I will discuss the reversible forms of dementia, along with the risk factors, complications, prevention, treatment and resources available.

To briefly review, dementia is the loss of mental functioning (thinking, reasoning, memory) that is of such severity as to interfere with daily functioning.  It is not, itself, a specific disease, but rather a collection of signs and symptoms which may include alterations in behavior, mood and personality.  Dementia arises when areas of the brain involved in learning, decision-making, judgment, language and memory are affected by one or more of a vast array of infections or diseases.  Dementia can cause confusion, difficulty remembering people’s names, and changes in social behavior and personality.  Although memory loss often occurs in dementia, memory loss alone does not form the basis of such a diagnosis.  Most types of dementia are degenerative, non-reversible; meaning the changes in the brain that are causing the dementia cannot be stopped or turned back.  Alzheimer’s disease is by far the most common cause of progressive dementia, causing 50-60% of all dementias.

Dementia most often occurs in older aged individuals, and the risk of dementia increases with age.  It is estimated that approximately one-in-five cases of dementia are treatable, in that they can be either partially treated, dramatically lessening the signs and symptoms of the disease, or actually cured.  Some of these are dementias caused by hormone and/or vitamin imbalances, drug reactions and interactions, and illicit drug use and alcohol.  Severe depression, and other significant psychiatric disorders, can produce symptoms that appear to be dementia (known as pseudo- or false dementia), and is also highly treatable.  This is why it is absolutely critical that your physician be extremely thorough when making the diagnosis so as not to miss a potentially treatable cause. 

Certain types of hormonal and metabolic problems, including thyroid disorders, hypoglycemia (low blood sugar level), vitamin B-12, B-1 (thiamin), B-6 and folic acid deficiencies, and too much or too little sodium or calcium in the blood stream, can all lead to signs and symptoms of a treatable and reversible dementia.   

Other treatable and reversible types of dementia include reactions to medications, infections, brain injuries and tumors, lack of oxygen to the brain (anoxia), and certain illnesses and types of poisoning.  Transient episodes of dementia can occur as a result of an adverse reaction to medication(s) or as a result of a toxic interaction between medications.  It can also be demonstrated as a result of extreme fever or from the effects of your body fighting off severe infections.  Some of the more common brain infections causing treatable dementia are encephalitis and meningitis.  Lyme disease, and disorders that create a severely compromised immune system such as leukemia, can also create many of the signs and symptoms of dementia.  Brain tumors, although thankfully rare, can cause a dementia process as can subdural hematomas (bleeding between the surface of the brain and its protective out covering).  Your brain simply cannot survive very long without oxygen.  Lack of oxygen (anoxia) to the brain can be caused by a number of factors including a heart attack, carbon monoxide poisoning, severe asthma episode, chronic lung problems, exposure to prolonged high altitude, certain kidney and liver disorders, and others.  No matter what the cause, anoxia can produce notable signs of dementia.  If this anoxia is short lived the dementia should be fully reversible.  However, prolonged exposure to a lack of oxygen can lead to brain damage, and only partial reversal of the symptoms.  Exposure to heavy metals, lead and manganese for example, certain pesticides and other poisons can lead to reversible dementia, as well as both acute and chronic recreational drug and alcohol abuse. 

Although dementia is a brain disorder, its effects can negatively impact a number of other systems of the body.  Dementia can alter personality and behaviors.  Some of these changes are as a result of reactions to the emotional challenges of having to deal with ever deteriorating functioning, and others likely the result of the actual brain changes themselves.  Dementia often leads to confusion, anxiety, a lack of inhibition, depression and disorientation.  Insomnia, sleep apnea, and restless leg syndrome are also somewhat common complications of dementia, along with disruption in the normal sleep-wake cycle whereby the individual sleeps during the day and is awake at night.  Further complicating this disorder is the fact that almost all dementia sufferers will ultimately severely reduce or completely stop eating and drinking altogether.  This is often the result of fact that in advanced phases of dementia sufferers actually lose the sensation of hunger, and thus the desire to eat, as well as causing a loss of control of the muscles used in chewing and swallowing, putting them at significant risk of choking.  In advanced stages of dementia one can often lose the ability with activities of daily living (ADL’s).  These would include challenges with toileting, bathing, dressing and other basic self-help skills.  As the disorder progresses the ability to recall the names of familiar people and things diminishes.  This of course leads to severe difficulties in social communication which can further make the individual feel more depressed and isolated. And, as a result of diminished problem-solving and decision-making abilities dementia can place it’s sufferers in situations where their personal safety is at risk such as driving, cooking, and navigating unfamiliar areas.  These complications, sadly, lead to a shorter lifespan and highly stressed caregivers.

Over the years medical researchers have identified several potential risk factors in the development of dementia.  For some of the risk factors there is nothing anyone can do about altering them, but many of the factors can be affected by each and every one of us, thereby reducing the risk.  Some risk factors that cannot be altered include family history and age.  Although dementia is not a normal part of the aging process, the risk of Alzheimer’s, vascular, and many other forms of dementia dramatically increases with age.  Additionally, people with a history of dementia in their family are also at increased risk of developing dementia.  That being said, there are many people with a family history that never develop dementia and of course many without a history in the family that do.

Now for the potential risk factors that you can do something about and thereby reduce your chances of developing dementia.  If you drink too much alcohol, you need to really cut it down.  Yes, we have all heard about the studies that moderate consumption of alcohol, especially red wine, can indeed have some beneficial effects primarily on heart disease.  However, the long term abuse of alcohol clearly puts individuals at greater risk of developing dementia.  Elevated levels of what is known as “bad” or low-density lipoprotein (LDL), cholesterol can dramatically increase the risk of vascular dementia, and possibly an increased risk of developing Alzheimer’s disease.  Diet and exercise, along with the use of cholesterol lowering medications can help limit this risk.  Elevated blood pressure and Type II diabetes both increase your risk of vascular dementia and Alzheimer’s disease.  So, please make certain you and your doctor effectively address these issues.  As a result of diminished blood flow to the brain another important risk factor for vascular dementia is the build-up plaques on the wall of the arteries (atherosclerosis), which can also lead to stroke.  Finally, smoking can increase the risk of dementia by directly increasing the risk of a range of vascular diseases.       

In order to do all you can to reduce your risk of dementia later in life, quit smoking, only consume alcohol in moderation, control your blood pressure and effectively manage your diabetes.  Be certain to exercise regularly and try eating a low-fat diet.  Since the vast majority of dementias are irreversible, prevention is the answer. 

Obviously, the treatment of dementia will depend on the type and what conditions are causing it.  Oftentimes short-term hospitalization is required to accurately diagnose the type of dementia and its underlying causes.  Once determined, aggressively and effectively treating the underlying cause(s) of a reversible dementia can oftentimes lead to complete, or almost complete, resolution of the signs and symptoms.  For those dementias that are not able to be reversed, medications may be needed to control the problematic behaviors caused by the impulsivity, confusion and lack of judgment.  Commonly used classes of medications used include:  antipsychotics, mood stabilizers, and stimulants.  Yet other medications may be utilized that may actually slow the rate of symptom progression.  This includes relatively new medications such as Aricept, Exelon, Namenda and Razadyne.  However, the benefits these medications provide are frequently quite limited, and often not obvious to the patient or their family. 

Dementia sufferers will, ultimately, need support in the home as the disease progresses.  Caregivers and family members can solicit the assistance of the patient’s physician in helping manage behavior and sleep problems and keeping them calm.  Some ways to help reduce confusion are to:

• Maintain a simple, routine and consistent schedule
• Keep lights on at night
• Surround the patient with familiar objects
• Use Post-It notes and written lists to help direct routine tasks and activities.

Additionally, calming music can help ease anxiety, improve sleep, and reduce restlessness and wandering.

Locally, we are blessed to have an abundance of service providers who support patients who suffer from dementia and their caregivers.  Just some of these wonderful services providers are:

Alzheimer’s Association – California Central Coast Chapter, provides an array of services including Alzheimer’s and dementia caregivers support groups in both Santa Barbara and Ventura counties.

Santa Barbara County
1528 Chapala Street, Suite 204
Santa Barbara, CA 93101
(805) 892-4259

Santa Barbara North County
528 South Broadway
Santa Maria, CA 93454
(800) 272-3900

Ventura County
80 North Wood Road, Suite 302
Camarillo, CA 93010
(805) 484-6028

Senior Planning Services
1811 State Street
Santa Barbara, CA  93101
(805) 966-3312

Center for Successful Aging

1528 Chapala Street, Suite 205

Santa Barbara, CA  93101

(805) 963-8080

csasb.org

Santa Barbara Home Instead Senior Care

3 West Carrillo Street, Suite 208
Santa Barbara, CA  93101

(805) 560-6995

Alexander Court Memory Care

325 W. Islay Street

Santa Barbara, CA  93101

(805) 898-2650

Merrill Gardens at Santa Maria

1220 Suey Road

Santa Maria, CA  93454

(805) 310-4102