Dementia

   According to world rankings, the United States citizenry does not do well regarding physical health.  What are the cognitive health statistics ?  Centenarians are the best super agers cognitively.  This country has about 60,000 centenarians. Not surprisingly, the United States, as far as the number of centenarians(age 100) , does not fare well. For instance, Japan has 3.4 3 out of 10,000 people,  France, about 2.70 out of 10,000, Sweden about 1.9 2 out of 10,000, United Kingdom 1.9 5 out of 10,000 and  the United States about 1.7 3 out of 10,000.  This disquisition pertains to mild cognitive impairment( MCI) , dementia, hydrocephalus dementia and Traumatic Brain Injury.. Dementia is not a specific disease.It’s a term for a group of symptoms caused by different disorders that affect the brain.

Briefly, numerous studies show that much of the causes found in being able to reach 100 or a super age are related to lifestyle choices. These behaviors include 1.  Regular exercise ,at least 150 minutes per week 2.  Sleeping approximately seven hours per night. 3.  Eating a variety of fruits, vegetables , lean protein and whole grains 4.  Quitting smoking or non-smoking 5.  Handling stress well 6.  Having a strong social network with lots of mental activities.

Unfortunately, MCI is an imprecise term that describes the stage between age associated memory impairment and dementia.  One study suggests that people with MCI have difficulty remembering important family events ; have trouble remembering what was just said and read; have problems with essential paperwork like taxes;forget to take medications; use a memory list and have some problems doing complex tasks like some meal preparation but can still prepare and eat meals.

 Importantly, individuals with MCI can still perform activities of daily living like getting dressed by themselves, preparing meals without assistance, eating meals and going on walks without getting lost. The incidence of MCI's is increasing to about 4% annually.However, iIt is found in 10 to 20% of Americans aged 65 and older. Many with MCI do not progress to dementia . Older men are about 50% more likely than older women to develop MCI.  One study found that the rate of mild MCI was 1.5 times higher in men than women and women  transition from normal cognition directly to dementia at a later age than men.

Some of the risks  well-known for MCI are behavioral choices:  1.  Five year study with MCI found that those that had  vascular risk factors like hypertension and high LDL cholesterol were twice as likely to progress from MCI  to dementia.  2.  Having three or more of: excessive weight, high blood pressure, high triglycerides, low HDL cholesterol and high blood sugar markedly raised the risk of mild cognitive impairment. 3. People with prediabetes, diabetes,  have three times the risk of developing cognitive decline in the form of mild cognitive impairment.  4.  Those that had sleep-disordered breathing and sleep apnea were twice as likely to develop MCI or dementia than women without these conditions.  The study showed that the risk for MCI would be lowered significantly if people would a.  Stop smoking  b.avoid alcohol/sedating drugs c . Use nasal spray to open passages.  d.  Control weight and blood pressure. e.know apnea symptoms and seek a medical evaluation regarding apnea. 5.  Regular  vigorous exercise for 45 to 60 minutes a day four days a week improved cognitive functions.  Another study found that those who did moderate physical exercise like brisk walking, swimming, yoga, aerobics and strength training in midlife were 39% less likely to develop MCI.  Those engaged in exercise later in life were 32% less likely to develop MCI. 7. Several studies have shown that low carb ,low calorie diets with lots of fruits and veggies ,getting regular restful sleep and keeping the brain active with new learning will lower the risk of developing MCI and improve functioning of those diagnosed with MCI.

There is not  an exact or precise definition of dementia,  it’s not a specific disease. There are many signs and symptoms and  some dementias  can be treated and reversed.  Factually, 1. Age is the biggest risk factor because of increasing human life expectancy.2. Dementias are becoming more common and currently found in 14% of Americans age 71 and older. 3. Lifestyle and genetic expression  affect the risk of developing dementia.4. Individuals with dementia usually experience problems  that interfere with their ability to carry on normal activities of life.5.  Memory loss is a common symptom of dementia. But, memory loss, by itself, is not dementia.

Significant symptoms of dementia include  A . Disorientation to time and place. Difficulty reading a watch with hands and reading a digital clock with month ,date and year. B. Difficulty in concentrating with loss of initiative and tiredness, C.  Trouble with the executive functions like planning, setting goals, organizing , and abstract thinking,D.Language disturbances as an aphasia.  There is some difficulty in finding words, especially nouns .E. Impaired motor performances F. Problems in spatial reasoning.  G.  Failure to recognize common objects- agnosia. Difficulty in identifying an elephant, a rake in a drawing or some road sign and calling a TV remote a camera.  H.Ppersonality and mood changes like depression,low energy and discouragement . I.Neglecting  personal hygiene and safety.

  One significant or common sign of dementia is asking the same questions repeatedly. The question could again be asked 15 minutes later etc. within the same day. The individual is unable to retain that information.  Also, areas and locations that were once familiar become unfamiliar or unrecognizable.  Another sign is forgetting names of familiar people or even forgetting that there was a  previous history with individuals. With conversation, the details of that conversation are either forgotten or recalled incorrectly.

Declarative memory is a memory of facts, events, dates, telephone numbers  of which some  become impossible to retain. These are long-term memories.  An Episodic Declarative memory is a personally experienced event such as to what you ate for dinner last night or what happened on your 21st birthday party.  Remembering a string of time-based life events is an Autobiographical memory and this also becomes disrupted with dementia.  A Semantic Declarative memory is memory for facts that are not tied to one particular time.  These memories would be the car you drive, words of language, numbers, arithmetic operations, addition,and  multiplication tables.This is the general fund of knowledge and also impaired.

 Procedural memory is the retention of the ability to engage in  motor activities such as making coffee, driving the car, tying shoe strings, and playing a sport.  These are  athletic routines and with repeated practice  is called muscle memory.Procedural memories become habits and can be practiced. In other words, depending upon what memories that are lost, can significantly impair normal everyday functioning. If so, that individual requires assistance in doing day-to-day activities. It's like an adult who has regressed to a much earlier stage of development with minimal retention in some areas.

Normal pressure hydrocephalus is a dementia that can be treated.  Essentially it's the inability to reabsorb cerebrospinal fluid back into the vascular system.  This results in a buildup of fluid on or in the brain that  increases intracranial pressure . The treatment is placing a shunt inside the head to drain fluid from the brain.  Nowadays, the cerebral spinal fluid can be regulated with the shunt.  In the not so distant past, the neurosurgeon could insert a shunt but was unable to regulate the CSF flow .Symptoms of  hydrocephalus dementia are mental status changes, urinary incontinence and gait disturbance. 

 This hydrocephalus dementia  injury is caused by a trauma to the head and called TBI.  It's a major public health problem, especially for young Americans. TBI can be caused from car and motorcycle accidents, equestrian activities as well as from sport participation especially football.  These TBI's can cause dementia, but the symptoms usually stabilize or improve over time.  Even if the symptoms improve, many TBI survivors will still have impaired mental functioning that can interfere significantly with activities of living.  Sometimes the symptoms will improve to a level where dementia is not present and technically be a reversible dementia.  However, moderate to severe TBI injury dementia symptoms typically do not return to pre-entry levels of functioning after recovery.

Symptoms for TBI depend upon the degree of impact to the brain.  Symptoms are also highly variable from person to person, moderate to severe.  TBI typically results in dementia with major problems in attention, concentration, memory, problem solving, judgment, lack of empathy , impulse and emotional control, social interactions, depression and anxiety  .Improvement in recovery from dementia level symptoms depends upon the nature and extent of treatment, rehabilitation interventions and family support. It's not a surprise that some  parents are not thrilled with their children's participation in playing football, riding a motorcycle or horse.  My  oral surgeon cousin almost had a coronary when he learned that I took his Stanford graduate son ,on my Harley Davidson, to Alice's restaurant and Half Moon Bay.

Statistically we are not exceptional when it comes to cognitive  health. However,  Musk,Bezos, Gates  and Buffett are exceptional at accumulating money.  Both physical and cognitive health are about 70% related to behavioral choices .Are Musk, Bazos, Gates and Buffett exceptionally healthy?  What is the correlation between being exceptionally wealthy and having exceptional cognitive and physical health?  By the same token, a study correlating the wealth of the top 1% with their physical  and cognitive health would be revealing as well. Unfortunately,Ponce de Leon could not find youth In hot humid Florida. However, that does not stop today’s old on their search.Capitalism provides its own unique mythology while paying old, overweight people to testify the benefits received from a memory supplement. Just take a supplement?

Reference

Understanding Dementia.Institute For Natural Resources.