Page 11 - Boca Club News - February '22

Boca Club News, Page 11
Medical Matters:

Dementia Revisited (Part One)

By Richard Nagler, M.D., a member people we know, but can’t remember their names. Also which are responsible for the transmission of information
of Broken Sound Club and retired leaving one room to enter another and just standing there from one brain cell to another, contributing to dementia.
physician. After graduating from the wondering what you came in for...and when you are ready to There is also a deficiency of the chemical transmitter
University of Pennsylvania and New say something it just vanishes. In addition, having difficulty Acetylcholine. This is very important because it is the one
York University’s School of Medicine, finding the right word or forgetting the day of the week, or factor in Alzheimer’s for which limited treatment is currently
Dr. Nagler served his internship and even where you might be going and having a difficult time available.
residency at Baltimore City Hospital balancing a check book...or thinking that you lost your wallet, In Alzheimer’s, the earliest sign of dementia is memory
and Johns Hopkins. He followed that car keys, watch or cell phone only to have simply misplaced loss, such as forgetting recently learned information,
with a Fellowship in Gastroenterology them. Experiencing mood swings or sadness or avoiding important dates or events, repeating a question over and over,
at Yale University School of Medicine, and was then Chief some social obligations are other common normal variations. trouble with a familiar recipe, keeping track of monthly bills
of Gastroenterology at Fitzimmons General Army Hospital Alzheimer’s, FTD and Lewy body dementia are all closely and difficulty concentrating. There are problems driving a car
in Denver. He returned to the Yale Medical School for one related and referred to as neurodegenerative diseases. What to a familiar place, often getting lost in the process, managing
year as an Assistant Professor of Medicine before opening they have in common is a relentless massive destruction of a budget, losing track of dates, seasons and the passage of
his own successful private practice in Internal Medicine brain cells, resulting in a progressive decline in cognitive time, forgetting where they are or how they got there. Also,
and Gastroenterology. During that time, he also served for function and manifested by loss of memory, ability to learn problems with reading, joining or following a conversation
ten years as Chief of Medicine at Huntington Hospital in reason, make judgments, communicate and carry out normal and often stopping in the middle, constantly repeating
Huntington, N.Y. daily activities. In addition, there are changes in personality themselves and struggling to find the right word. They
Dementia has become the sixth leading cause of death in and behavior with anxiety, paranoia, agitation, delusions and often put things in unusual places, constantly lose things,
the United States, accounting for eight million known cases even hallucinations. The cause of these diseases is unknown. become fearful, anxious, easily upset, suspicious and falsely
and countless other unreported cases that are either in the In this column I will limit the discussion to Alzheimer’s, accuse others of stealing from them. They have problems
early stages of dementia or in denial. It is expected to rise to which usually begins after age 65, and women are twice with judgment, decision making, paying less attention to
one out of eight persons by 2030, and to afflict as many as as likely to be afflicted. Life expectancy averages eight grooming and keeping clean. Personality changes occur with
50% of those in their 80s and 90s. A major reason for this years, although many succumb earlier from associated wide mood swings, confusion, depression, changes in sleep
dramatic rise in dementia is that more of us are living longer. arteriosclerosis with heart attacks, congestive heart failure habits, becoming fearful, anxious and easily upset at home
The annual cost is predicted to rise to more than 300 billion and massive strokes. The entire brain is atrophied from the with friends or anyplace out of their comfort zone.
dollars annually, making it the most costly disease ever. massive loss of brain cells. Throughout the brain there are There is often a loss of inhibitions with outbursts of
Dementia is a general term for a condition that is basically plaques of an abnormal protein called amyloid, which fills the profanity, and they may have delusions and hallucinations.
caused by several diseases. Alzheimer’s and the variant void left by the dead brain cells. Whether amyloid actually Difficulty in swallowing can lead to aspiration and
frontotemporal dementia (FTD) accounts for about 75% of kills these cells or just replaces them after they die is not pneumonia. Incontinence is common. They have a loss of
all cases; Lewy Body dementia 10%, and cerebro vascular known, and there is no clear correlation between the amount balance and are prone to falling, which can result in bone
disease (namely, major strokes and multiple mini-strokes of it and the degree of dementia. fractures and serious head injuries. In the later stages of the
which cause oxygen deprivation and brain cell death) the Amyloid plaques can be detected, incidentally, in people disease, they often refuse to eat, inappropriately cry out and
remaining 15%. undergoing CTscans, MRIs and Pet scans as long as 20 years are no longer able to recognize even family faces.
It is important to distinguish dementia from minor before many of them will eventually develop Alzheimer’s Age is the biggest risk factor for Alzheimer’s. For those
cognizant declines that normally occur with ageing. At the and dementia. This poses an obvious dilemma as to whether over 65, the risk doubles every five years. One in six people
age of 25, our brains are fully mature and consist of billions of or not to reveal this information to anyone because at the over 80 have the disease. In Alzheimer’s an abnormal
viable brain cells. Thereafter, and with increasing frequency, present time we don’t know how to prevent dementia from gene, APOE4, has been identified by DNA studies. When
millions of them wear out and die naturally, which results developing. In addition, there is another abnormal protein, two copies of these genes are present, 60% of people
in a slow decline in mental acuity that we see in our ageing TAU, which invades and kills brain cells. TAU also tangles
population. The most common normal signs are meeting up the nerve fibers and corrupts the synaptic nerve networks, Medical Matters: Dementia Revisited on page 12

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