Dementia, Alzheimer’s, Parkinson’s: How Aging Affects Your Brain

The number of people with Alzheimer’s is expected to triple – to 16 million – by 2050, and women are at the center of the “tsunami,” both as patients and caregivers, according to a new report released yesterday by Maria Shriver: The Shriver Report: A Woman’s Nation Takes on Alzheimer’s. Learn more about this and other degenerative brain diseases…

As people age, it is normal to experience minor declines in memory and the ability to learn new and complex information. Major changes are not normal, however, and are often the sign of a degenerative condition that needs immediate medical attention.

Because women generally live longer than men, degenerative brain disorders – which typically strike later in life – are a serious concern to them.

A recent major study, part of the Women’s Health Initiative (WHI) and reported in the Journal of the American Medical Association in 2003, showed that women age 65 and older taking combination-hormone therapy (estrogen plus progestin) had twice the rate of dementia than women who did not take the medication.

An estrogen-only phase of the WHI was stopped in June 2004 when data showed that women on estrogen-only therapy also had a slightly greater dementia risk.

The WHI results indicate that combination-hormone therapy could cause an additional 23 cases of dementia per 10,000 women per year, while estrogen-only hormone therapy could trigger an additional 12 cases.

The increase of dementia cases by estrogen-only therapy was not statistically significant, but even a small increase is cause for concern when evaluating a treatment being used to prevent disease in otherwise healthy individuals.

Also, a European study has shown that women who are obese throughout life are more likely to lose brain tissue, which is one of the first indications that a person will develop dementia.

For these reasons, women should monitor their health closely and discuss any concerns with their health-care providers.
What Is Dementia?
Dementia is used to describe a decline in brain function. Changes in memory, personality or behavior are frequent signs of dementia.

Dementia makes it hard for a person to perform routine, daily tasks. A person with dementia may ask the same questions or get lost in familiar places. This person often cannot follow directions; is disoriented about time, people or places; and may neglect personal safety, hygiene or nutrition.

Dementia is not a normal part of aging, and some forms of dementia can be improved with treatment. Some treatable conditions can cause dementia, including high fever, dehydration, vitamin deficiency, poor nutrition, bad reactions to medicines, thyroid problems, or a minor head injury.

These conditions are serious and should be treated by a doctor as soon as possible. Sometimes dementia gets worse and cannot be cured.

Several disorders, including Huntington’s disease and Parkinson’s disease, are linked to dementia. The two most common causes of dementia are discussed below. Any persistent changes in memory, personality or behavior should be checked out by a physician.

What Is Alzheimer’s Disease?
Alzheimer’s disease is the most common cause of dementia. There is currently no cure. Nearly half of all people over age 85 are estimated to have Alzheimer’s disease, and 10% over 65 have it.

It is the eighth leading cause of death for women in the United States, and several studies have shown that women are at higher risk for developing the disease than men.

Forgetfulness is a common first sign of Alzheimer’s. As the disease progresses, language, reasoning and comprehension are affected, eventually to the point where people cannot take care of themselves. Individuals live an average of eight years after the onset of symptoms, but some live as long as 20 years or more.

The cause of Alzheimer’s is unknown, but the disease involves the development of plaques and tangles in the brain’s gray matter that interrupt the transmission of information within the brain.
As a result, nerve cells in the brain eventually die, triggering the loss of functionality. The damage to the brain from Alzheimer’s appears to be more severe in women.

However, men with the disease have a higher risk of mortality related to the disease itself, such as the severity of dementia and episodes of delirium. Death among women with Alzheimer’s is often connected to malnutrition and the inability to perform the tasks of daily living.

Diagnosis
Right now, Alzheimer’s can only be diagnosed definitively by examining the brain after death. Doctors can make a probable diagnosis of the disease, however, that is roughly 90% accurate, according to the National Institute on Aging.

Treatment
There are some drugs available to improve the brain’s functioning, but there is no evidence that they can slow the underlying progression of the disease. No prevention for the disease exists, but the Alzheimer’s Association recommends that people stay as physically and mentally active as possible.

Developing new treatments for Alzheimer’s disease is an active area of research, according to the National Institutes of Health. Scientists are testing a number of drugs to see if they prevent Alzheimer’s disease, slow the disease or help reduce behavioral symptoms.

Medicines already used to help reduce the risk of heart disease may help lower the chances of developing Alzheimer’s disease as well, or may slow its progression. Clinical trials of drugs known as statins, which lower cholesterol, have begun to determine if they might help slow down the progression of Alzheimer’s.

In other studies, scientists are tracking the health of Alzheimer’s patients to see if they exhibit any signs or conditions distinct from the general population that may give clues to the origins and progression of the disease.

For example, research has shown that people with Alzheimer’s often have higher levels of the amino acid homocysteine in their blood. Folic acid and vitamins B6 and B12 can reduce levels of homocysteine in the blood, and scientists are looking to see whether these substances can also slow rates of mental decline.
What Is Vascular Dementia?
Vascular dementia, the second most common type of dementia after Alzheimer’s, occurs when the arteries that supply blood to the brain narrow or become blocked.

Symptoms can strike quickly, often following a stroke, but they also can develop gradually. These symptoms are similar to those of other forms of dementia, described above, making them hard to distinguish from signs of Alzheimer’s.

Risk factors for vascular dementia center on:

Advanced age (over age 65)

High blood pressure (hypertension)

Heart disease

Diabetes

Smoking, being overweight, having elevated cholesterol levels, and having a family history of heart problems can also increase your risk for stroke, which is a primary trigger of vascular dementia.

Small or mini strokes, which often go undetected, are a frequent cause of vascular dementia. The effect of these small strokes can be very slight, but they can worsen over time.

As more blood vessels in the brain are blocked, the mental decline associated with dementia can increase. Temporary loss of vision, speech or strength or brief episodes of numbness are warning signs of small strokes and should be taken seriously.

Vascular dementia can affect an individual’s thinking, language, walking, bladder control and vision. It commonly begins between ages 60 and 75 and affects men more often than women.

Because they live longer, however, women need to be aware of the warning signs of vascular dementia as they age; some aspects of dementia can be prevented with appropriate medical treatment, such as reducing high blood pressure.
What Is Parkinson’s Disease?
Parkinson’s disease is the second most common degenerative brain disease behind Alzheimer’s. Parkinson’s is a chronic, progressive disease that results from the death or injury of nerve cells (substantia nigra) in the midbrain. These cells allow the brain to communicate with itself and coordinate the body’s movement; without them, the body’s movement becomes somewhat unregulated.

As with other degenerative diseases, its symptoms can often be mistaken as common signs of aging. There are four key symptoms of Parkinson’s:

Tremors (the shaking of a leg or arm when it is at rest)

Slowed physical movement

Stiffness or rigidity in the arms, legs or trunk

Poor balance

When two of these symptoms are present at the same time, especially if they occur more prominently on one side of the body than the other, Parkinson’s is the likely diagnosis. Initial symptoms are usually mild and begin on one side of the body and can spread to the other side of the body over time.

Risk Factors
There is a family history of Parkinson’s disease in 5%-10% of patients. At any age, men are 1.5 times more likely than women to get Parkinson’s disease. It is not clear why men are affected more often, but some researchers believe men are exposed to environmental toxins more frequently that can trigger the disease.

Treatment and Management
The progression of the disease varies from patient to patient. As symptoms worsen, patients often have trouble with routine tasks because of tremors and reduced mobility. As symptoms progress, it is important for patients to talk with their physicians, so that optimal treatment can be established.
According to the National Parkinson’s Foundation, “the goal of treatment is not to abolish symptoms, but rather to help the patient manage symptoms, function independently, and make the appropriate adjustments to a chronic illness. The illness will not go away, but management of its symptoms can be successful in reducing disability or other handicap.”

Although Parkinson's affects more men, the gender gap may close in the future. Environmental exposures, such as exposure to pesticides, have been linked to Parkinson’s. Women now work in a wider variety of professions than ever – military service, for example – and their environmental exposure more closely parallels men’s exposure than it has in the past.

Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research.

To learn more about the Society for Women’s Health Research, visit their website.

Will You See Your 80th Birthday?
Can you rely on good genetics to keep you thriving through the years, or do you need to do more to raise your odds of living longer?