A previous essay dealt with dementia. It included signs of dementia and guidelines for normal aging contrasted with dementia. Lifestyle factors were addressed along with some of the non-reversible dementias that included Alzheimer’s. There’s an estimated 6.2 million Americans 65 and older living with Alzheimer’s dementia in 2021 of which 72% are aged 75 or older. One in nine people age 65 and older or 11.3% have Alzheimer’s dementia. Almost ⅔ of Americans with Alzheimer’s are women. According to the Alzheimer’s Association, “Someone in the United States develops Alzheimer’s dementia every 66 seconds.” The state with the highest rate of Alzheimer’s is Alaska. Although California ranks second among highest rates of life expectancy, it also ranks fifth In Alzheimer’s disease mortality per CDC.This essay deals with mild cognitive impairment and Alzheimer’s Disease with a suggestion for a more comprehensive treatment model.
Briefly, the progressive disease of Alzheimer’s was first identified by Alois Alzheimer In 1907.He identified, with an autopsy, the proliferation of plaques and tangles in the brain. It is believed that the pathology of Alzheimer’s begins over 20 years before the symptoms are noticed. Result , the disease has been progressing for years.Even people in their 30s and 40s are affected in areas of memory, and thinking. In essence,, baby boomers are the fastest-growing segment in our population
Unfortunately , even today,there is not 100% accuracy with the diagnosis. Despite that fact, researchers have identified areas of Impaired cognitive functioning in different brain areas. Deficits include: progressive memory impairment; time and spatial disorientation; receptive language impairment; anomia or poor object reasoning; decreased word finding; vague statements with impaired abstract thinking; acalculia or impaired arithmetic calculation;agnosias or Impaired object and facial recognition; apraxia or difficulty performing purposeful movements;apractagnosia orInability to use objects correctly; personality changes; progressive decreased emotional expression;sleep disturbance; delusions, hallucinations, depression and /or anxiety .
Alzheimer’s disease affects up to 50% of the people aged 85 and older.. There’s an increased frequency from age 50 onward. Not only that ,,Alzheimer’s pathology is found in 65 to 85% of all dementias. This is an irreversible progressive disorder in which brain cells or neurons deteriorate resulting in the loss of cognitive functioning with major effects in the cerebral centers and to the hippocampus specifically. ‘
Dementia is a complicated diagnosis. For example,there are more than 50 kinds of neurodegenerative dementias including the most common which is Alzheimer’s. A study of 1400 older men and women showed that 45% had plaques and tangles of Alzheimer’s disease. Further, many people had a combination of two or more pathologies or dementias. Autopsies showed that most of the older people who get dementia, 65-85% have plaques and tangles of Alzheimer’s in their brains. However only 30% of these people had Alzheimer’s disease. The rest have evidence of Alzheimer’s pathology plus vascular dementia or stroke. Having more than one type of dementia appears to accelerate deficits and speed of decline.
The progressive disease of Alzheimer’s has been characterized by stages: 1. Mild confusional state 2-7 years 2. Mild-to-moderate impairment-2 years 3.Moderate impairment–18 months 4. Severe impairment-21/2 years 5. Very severe impairment–1 to 2 !/2 years. In essence, the progression of this disease begins with procedural memory impairment such as recent facts and proceeds until the person requires 24 hour maximum assistance.
There are many risk factors for Alzheimer’s disease dementia which of course are related to genetics and lifestyle choices. The following are a few: :increasing age; more women than men ;cardiovascular disease; insulin resistance; traumatic brain injury;chronic inflammation ;high blood pressure; estrogen deficiency; non stimulating mental lifestyle; low level of education;low socioeconomic status ;low level physical activity; job with low learning challenges , obesity; high cholesterol; smoking drug and alcohol abuse ;chronic gum disease;diet low in fruits and vegetables; long-term stress; anxiety and depression. Incidentally, those that don’t get Alzheimer’s disease are independent living centenarians.
One can undergo a mental status examination; a neurocognitive evaluation; neuropsychological testing; various physical protocols such as evaluating cerebral spinal fluid, Pittsburgh Compound B; PET scan, laser test for accumulation of beta amyloid and several blood tests measuring levels of certain proteins altered by Alzheimer’s disease .Even at death the brain autopsy, can be misleading. So these techniques and measurements still do not give a 100% certainty as far as an Alzheimer’s diagnosis.Yes they point to the likelihood of an Alzheimer’s diagnosis.
Unfortunately ,at this point in time, there is no one comprehensive approach or program to treat mild cognitive decline or mild cognitive impairment due to Alzheimer’s. We have controversial doctors like Dale Bredesen; functional medicine and nutrient treatment; aging programs in medical hospitals, Alzheimer's Associations, outpatient neurologists and neuropsychological testing.
Why not incorporate a program to address many of the symptoms experienced by those with mild cognitive impairment. We know that these individuals experience visual motor and perceptual difficulties; perceptual distortion; spatial visualization and orientation problems. We also know that some individuals , because of the difficulty with words, learn better either employing auditory or visual techniques. We also know that these individuals experience declarative memory; decreased word finding; and acalculia difficulties.
With the above being said, it makes sense to create a post school learning environment. A school setting makes sense because of the availability and training of elementary school teachers that can teach reading, grammar,writing, spelling, arithmetic and PE. Further, resources include the availability of teaching music, art, board games,computer skills with the importance of interpersonal interaction . Moreover, a team of a school nurse, reading disability teacher, speech pathologist and school psychologist are also important. In other words,teaching, learning and memory are skills first taught in elementary schools.I would also add a nutritionist to provide breakfast and lunch employing a Mediterranean style diet.
Schools can evaluate and learn to provide service with special consultation. Involve Medical Centers, state health departments, federal government agencies and monies,Medicare and insurance companies to fund a pilot program with a built in evaluation. This program addresses mental stimulation, exercise, diet with the importance of interpersonal interaction. Individuuals would still have their primary care physicians and neurologists to rely on for their physical health.
Reference
Institute For Natural Resources, Understanding Dementia.
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