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Alzheimer's Awareness Week Is In July

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Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office

July 2007 - July 1-7 marks world Alzheimer's Awareness Week, an annual health campaign organized by the Alzheimer's Society in the United Kingdom.

Alzheimer's disease (AD) is a brain disorder that gradually destroys a person's memory and ability to communicate and carry out daily activities. As Alzheimer's progresses, a person may experience changes in personality and behavior, including anxiety, agitation, delusions or hallucinations. Alzheimer's is the most common form of dementia, a group of conditions that gradually destroy brain cells and lead to decline in mental function. Alzheimer's disease is not a normal part of aging.

More than 5 million people in the United States are living with Alzheimer's disease. This number includes 4.9 million people over the age of 65 and between 200,000 and 500,000 people under age 65 with early-onset Alzheimer's disease and other dementias. On average, AD patients live 8 to 10 years after they are diagnosed, although the disease can last for up to 20 years. Scientists are not sure what causes Alzheimer's disease, and there is no cure, although new treatments are on the horizon. Research has also shown that effective care and support can improve the quality of life for individuals with AD and their caregivers.

The other most common form of dementia is "multi-infarct" or "vascular" dementia, which is caused by a series of small strokes or changes in the brain's blood supply, resulting in the death of brain tissue. Vascular dementia accounts for 10-20% of all cases of progressive, or gradually worsening, dementia. It usually affects people between the ages of 60-75, and is more likely to occur in men than women. Symptoms that begin suddenly may be a sign of this kind of dementia. People with multi-infarct dementia are likely to show signs of improvement or remain stable for long periods of time, then quickly develop new symptoms if more strokes occur. In many people with vascular dementia, high blood pressure is the cause.

Risk Factors
1. Age. Alzheimer's disease usually begins after age 60, and risk goes up with age. Most individuals with the disease are age 65 or older. The likelihood of developing Alzheimer's doubles about every five years after age 65. About 5 percent of people ages 65 to 74 have AD, while almost half of those age 85 and older have it.

2. Family history. Research has shown that those who have a parent, sibling, or child with Alzheimer's are more likely to develop the disease. The risk increases if more than one family member has the illness. Early-onset familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, is inherited.

3. Injury. There appears to be a strong link between serious head injury and future risk of Alzheimer's.

4. Health. Several health risk factors are associated with Alzheimer's and other forms of dementia, including heart disease, high blood pressure, and diabetes. One study found borderline diabetes increases dementia risk almost 70 percent. Another concluded that among Type 2 diabetics, those with the poorest blood sugar control have the greatest dementia risk. (Source: Alzheimer's Association www.alz.org Exit Disclaimer – You Are Leaving www.ihs.gov) High blood pressure, diabetes, high cholesterol, and heart disease are the main causes of strokes, which can lead to vascular dementia. The most significant risk factor for vascular dementia is high blood pressure.

Although many American Indians and Alaska Natives do not have a strong genetic (hereditary) disposition toward AD and dementia, AI and AN people have some of the highest rates of heart disease, high blood pressure, and diabetes, as well as high rates of injuries. Unlike hereditary risk factors, these health risk factors for AD and other forms of dementia can be offset by healthier lifestyles.

Evidence suggests that behaviors that keep you healthy in general may offer some protection against developing Alzheimer's and other dementias. Have your blood pressure checked regularly, and keep it within a healthy range to lower the risk of stroke. Keep your weight within recommended guidelines, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and your mind. Crossword puzzles, reading, and other mental exercises can help keep your brain healthy and appear to have a protective effect against AD. Also, always protect your head from serious injury by using seat belts and wearing your helmet when participating in sports.

Warning Signs
At first, the only symptom of AD may be mild forgetfulness, which can be confused with age-related memory change among elders. Most elders with mild forgetfulness do not have AD. In the early stage of AD, people may have trouble remembering recent events, activities, or the names of familiar people or things.

Warning signs of Alzheimer's disease include:

1. Asking the same question over and over again.
2. Repeating the same story, word for word, again and again.
3. Forgetting how to do routine activities like cooking. People with dementia often find it hard to plan or complete everyday tasks.
4. Losing the ability to pay bills or balance a checkbook.
5. Getting lost in familiar surroundings, or misplacing household objects. People with Alzheimer's disease can become lost in their own neighborhood.
6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

Other warning signs of Alzheimer's include problems with language and abstract thinking, sharp changes in mood or behavior, and loss of initiative. If someone has several or even most of these symptoms, it does not mean they definitely have the disease. It does mean they should be thoroughly examined by a medical specialist trained in evaluating memory disorders.

However, it is also important to remember that some memory loss and changes in ability can be normal signs of aging. People's personalities do change somewhat with age. Occasionally forgetting names or appointments, the day of the week, why you came into a room or what you planned to say is a normal effect of aging. Misplacing objects from time to time is also normal, as is finding it challenging to balance a checkbook or making a questionable decision from time to time. If you are concerned about any significant changes in your behavior or memory, or in that of a loved one, consult a physician.

Doctors use several tools to diagnose AD, including: questions about the person's general health, past medical problems, and ability to carry out daily activities; memory, language, and problem solving tests; medical tests of blood, urine, or spinal fluid; and brain scans. Sometimes these test results help the doctor find other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel problems in the brain can cause similar symptoms.

If the symptoms do point to AD, an early, accurate diagnosis helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease.

For patients exhibiting signs of vascular dementia, doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. They will counsel patients about good health habits such as exercising, avoiding smoking and drinking alcohol, and eating a low-fat diet. To reduce symptoms of dementia, doctors may change or stop medications that can cause confusion, such as sedatives, antihistamines, strong painkillers, and other medications. Some patients also may have to be treated for additional medical conditions that can increase confusion, such as heart failure, thyroid disorders, anemia, or infections.

Doctors sometimes prescribe aspirin, warfarin, or other drugs to prevent clots from forming in small blood vessels. Medications also can be prescribed to relieve restlessness or depression or to help patients sleep better.

To improve blood flow or remove blockages in blood vessels, doctors may recommend surgical procedures. Studies are under way to see how well these treatments work for patients with multi-infarct dementia.

Although no treatment can stop AD completely, for some people in the early and middle stages of the disease, the drugs tacrine (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®, formerly known as Reminyl®) may help prevent some symptoms from becoming worse for a limited time in some patients. Another drug, memantine (Namenda®), has been approved to treat moderate to severe AD, although it also is limited in its effects. And the FDA recently approved the use of donepezil to treat moderate to severe AD.

Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.

For more information, including resources for caregivers

ADEAR (Alzheimer's Disease Education and Referral) Center
The ADEAR Center is a service of the National Institute on Aging, funded by the Federal Government. It offers information and publications on diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to AD and dementia. Staff will answer telephone and written requests and make referrals to local and national resources.
P.O. Box 8250
Silver Spring, MD 20907-8250
http://www.nia.nih.gov/Alzheimers/ Exit Disclaimer – You Are Leaving www.ihs.gov

Alzheimer's Association (offers a free information packet about multi-infarct dementia and information about support groups for families)
225 North Michigan Avenue
Suite 1700
Chicago, Illinois 60601
www.alz.org Exit Disclaimer – You Are Leaving www.ihs.gov

American Stroke Association (a division of the American Heart Association) Information about stroke and recovery, as well as related research, programs, and events is available from:
7272 Greenville Avenue
Dallas, TX 75231
1-888-4-STROKE (478-7653)
www.strokeassociation.org Exit Disclaimer – You Are Leaving www.ihs.gov

National Institute of Neurological Disorders and Stroke
Information about stroke and current research on stroke-related conditions is available from:
P.O. Box 5801
Bethesda, MD 20824
www.ninds.nih.gov Exit Disclaimer – You Are Leaving www.ihs.gov

National Stroke Association
Information about stroke and support for stroke survivors and their families is available from:
9707 E. Easter Lane
Englewood, CO 80112
1-800-STROKES (787-6537)
www.stroke.org Exit Disclaimer – You Are Leaving www.ihs.gov

National Heart, Lung, and Blood Health Information Center
Information about preventing stroke, including information about risk factors such as high blood pressure, high cholesterol, heart disease, and smoking, is available from:
P.O. Box 30105
Bethesda, MD 20824-0105
www.nhlbi.nih.gov Exit Disclaimer – You Are Leaving www.ihs.gov

Eldercare Locator
Information about services and resources in your area, such as adult day care programs, transportation, and meal services, is available from:
www.eldercare.gov Exit Disclaimer – You Are Leaving www.ihs.gov
e-mail: eldercare_locator@aoa.gov

Alzheimer's Society (UK)
http://www.challengedementia.org.uk/ Exit Disclaimer – You Are Leaving www.ihs.gov

IHS Elder Care webpage

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