When I first started writing about aging issues in 1991, I had to define Alzheimer's disease with each reference. "Alzheimer's leads to progressive memory loss," I would write.
People liked to associate the disease with age. We're seeing more of it, people would say, because everyone lives longer.
Then I spent 12 years following John Folcarelli, who was in his mid-50s when he was diagnosed. "It's not my fault I have the Alzheimer's," he told me the first time we met. By the time he died, he could no longer put words together sensibly.
Little wonder we panic at any thought of memory loss or dementia. We know 42 percent of people over 80 have some form of dementia.
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But is it Alzheimer's or just forgetfulness?
"We can't really tell until we follow someone over a long period of time," says Dr. Mary Harward of Orange, Calif., who specializes in internal medicine but is also a geriatrician.
Q: What causes dementia?
A: Well, there are different types, from Alzheimer's to vascular. People with high blood pressure can have blockage of the arteries that causes a form of dementia, for example.
There is also familial dementia and the early onset of Alzheimer's.
And there are secondary causes, like pseudo dementia, for example. Someone in deep depression may appear to have dementia but, once treated, that will go away.
Q: Is there anything we can do to prevent dementia?
A: What we can all start, even in our younger years, is keeping our brains active. If this doesn't prevent dementia, it will at least give you more of a brain reserve to draw upon.
Q: How long can your brain stay active?
A: People can maintain an active brain for a long period of time, even with formalized interventions. Computer games still are not proven, but structured learning programs may be helpful in maintaining brain health.
Q: Just keep the brain active?
A: There's more. Have a balanced life. Exercise, eat a healthy diet. There is no magic supplement, however. You need to accept you may still develop dementia.
Q: What about new medications for Alzheimer's?
A: There are interventions, like Aricept, that may slow the progress. It is not a dramatic slowdown, but can keep one out of the nursing home a little bit longer.
Q: What can family members do to help someone with dementia?
A: Keep them engaged. Don't ignore them. Even a patient with moderate dementia has an active brain.
Q: Should someone be tested if memory changes?
A: There is a brain assessment that can be done. These tests can be important. It's helpful to pick up normal memory loss from significant problems.
Q: What about people who are just forgetful?
A: Mild cognitive impairment doesn't necessarily affect daily life. It's not dementia.
Q: Has any research focused on who seems to get Alzheimer's?
A: Well, a lot of people. I don't know what other illness has a prevalence of 42 percent of the population. We are finding that people who have been to college, who keep their brains active by reading, going to classes, constantly challenging themselves, seem to have a lower risk for dementia.