What is dementia? What are the causes?
Alzheimer’s is one of many types of brain diseases which have in common progressive difficulties in brain functioning: memory, judgment, planning. While we can describe dementia under the microscope, how it actually occurs is largely unknown.
Scientists study how accelerated aging in dementia is associated with substances (such as amyloid plaques and Tau protein tangles) accumulating within the brain over time. This is not unlike grit building up in engine oil.
Healthy brain cells are like live wires that connect to each other indirectly across a gap. Chemical messengers become depleted in dementia making it more difficult to bridge signals between nerve cells.
In other cases of dementia there can be damage to blood vessels that carry oxygen and other fuels to the brain, as is the case with multiple strokes (clots and/or bleeding). A history of trauma to the brain with multiple concussions is known to accelerate age-related dementia. Parkinson’s disease can progress from movement problems and tremors to dementia. Alcohol-related dementia is another cause and having more than one factor can be important.
How does the brain change in Dementia?
If you look inside the brain using scanners there are 2 types of structures which are associated with memory. In the deep centre we find side-by-side almonds (the amygdala, which function in emotional memory). Above them are a pair of seahorses (hippocampi, which function in factual memory). Folks find it reassuring to understand how many of the structures in the brain are preserved while only some are altered in memory difficulties.
Usually mild Dementia occurs alongside normal aging – especially with difficulties with short term memory. One model for conceptualizing recent factual memory involves books being stored on the top shelf of a book case.
Recent facts that are placed on the highest shelf can become difficult to reach. This process is happening in the paired seahorses, deep in the brain. On the other hand long held memories, such as stories from childhood, are easier to find as they are on the lower shelves where they can be readily grasped, opened and read.
In addition to preserved memories of old times, there is another gift that we can count on. Emotional memories also remain intact. We can trust that our emotional truths continue to be within our reach, stored safely in other structures – the paired almonds deep in the brain.
Emotional memories can also be likened to collections of books on shelves. Factual memory is like a series of shelves stacked in time, one on the other. In emotional memory, each shelf contains memories of a particular emotional flavour. For example, the memories of loving women are clustered on a unique shelf. Another dusty shelf may hold memories of critical teachers and demanding supervisors.
My grandmother whose soul flourished in dementia would mix up names of the women near her heart; (Sister, daughter, granddaughter, niece). By recognizing the clustering of these emotional memories as evidence of her pride, gratitude and love, we were able to understand who was important to her. We were all in the same boat on the same shelf and there was never a need to correct her about what name she had found on the golden shelf.
My grandmother’s values were safely stored in the faithful almonds. On her very last night in the ER she worried about the sleep I was losing and her great grand daughters’ education, though she might not have been able to tell you the date or the president of the US of A or the prime minister of Canada or current events in the newspaper. She was well and every bit herself as Matriarch of the family.
What stands out for you in terms of what the future looks like, for Healthcare Providers, for those diagnosed, for families? Do you have any helpful hints about how to move forward after a diagnosis of dementia?
There are now more options for testing early on: genes, blood, and spinal fluid tests; high tech scans like SPEC and PET. Some people prefer to plan their lives knowing there is a strong likelihood of an early diagnosis in the future. Others prefer to wait until the diagnosis is certain.
A few considerations that may mimic dementia:
- Low thyroid, anemia and other medical conditions may appear like dementia so a thorough checkup with blood tests is important to rule out treatable causes of poor memory.
- Delirium, which presents with sudden confusion and agitation, is treatable. Often the cause is an infection, effects of medication, or change in blood chemistry.
Here is a list of common sense things scientists say we can do for our brain health:
- Exercise 20 mins/day
- Treating mental health issues
- Getting ample sleep
- Using less or no alcohol
- Keeping an interest in learning (crossword puzzles, reading, strategy games)
30 years ago support groups were begun for people with serious illness such as cancer and it was a surprise to find those who settled in groups had improvement in their quality and quantity of life over those not in groups. Support groups are recognized over the world as a resource for family and folk living with dementia. Community is so important for brain health as it naturally fosters nourishing connection.
I have a story about a friend with early dementia who once ran a production company with no paper or pens, only her memory. Every phone number, name and date was immediately stored in her brain where she could retrieve the fact in an instant. Now she is a mere mortal and has had to learn how to use a calendar, address book and reminders on her phone.
Since I have been involved in Alzheimer Cafes, I am less afraid of my next birthday and find myself safely as one of “all in the same boat”.
Further Questions for the audience:
- What was getting a diagnosis like for you?
- Did anyone have a good experience getting their diagnosis and support?
- Was anyone expecting it?
- Was anyone relieved to know?
- What are our options in responding to being diagnosed with dementia?
Sending love to All.