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Lecture: assessments, medication among tools to combat dementia
Carolina Meadows

The aged King Lear, with Sheakespeare’s help, said, “I fear I am not in my perfect mind.” Five hundred years after Shakespeare, brain function as people reach advanced age is at risk for cognitive impairment and dementia.

Dr. Debra Bynum, an associate professor in the Division of Geriatric Medicine at the University of North Carolina at Chapel Hill, recently gave an excellent talk about troubles in thinking as well as memory loss in the elderly. Her talk was part of the Medical Update lecture series at Carolina Meadows.

She emphasized mild cognitive impairment. Remembering names or “where did we put things?” affects everyone, including this reporter. Memory changes without significant impact on daily activities doesn’t necessarily mean a person is on the way to dementia. In 10 percent of those with failing memory, however, it does when accompanied by at least one of the following: – Loss of understanding or being able to speak (aphasia) – Impaired ability to move parts of the body (apraxia) – Failure to identify objects (agnosia) – Difficulty in planning or organizing daily activities

A decline in previous levels of socialization or occupational activities can become part of the spectrum of dementia.

There are mental assessment tools such as the three-item recall test; hearing the names of three objects and then recalling them a short time later. Another is, “can a person draw where the hands of a clock are when told the time?” A person may not do well with these mental assessments but not have dementia. Doing well, however, does not exclude various types of dementia. The major two are Alzheimer’s disease and vascular dementia. The two may overlap.

Focal shrinkage of the temporal lobe of the brain in patients with Alzheimer’s disease can be seen with MRI. Similar changes can be recognized with frontal-temporal lobe dementia. Thirty percent of patients with Parkinson’s disease will develop dementia. Alcoholism, infection such as HIV, neurosyphilis (Al Capone had it) and Mad Cow disease can lead to dementia. Other risk factors include long-standing hypertension, diabetes and smoking. Of recent interest is dementia possibly related to remote concussions in contact sports.

Delirium and depression can be seen in patients with dementia. Delirium can be acute when elderly patients are hospitalized and should not be mistaken for dementia.

Dr. Bynum pointed out that no current treatment makes dementia better in the long term. A psychotropic medication such as resperidal can for a short term, but the medication can produce major side effects. Some medications like cholinesterease inhilutas, memantine, or donepezil may slow it a little but never reverse cognitive impairment. They all have side effects and can be costly. Vitamin E, Ginko biloba, fish oil, estrogen and NSAIDs don’t appear to help at all.

Dr. Bynum gave a thorough, memorable presentation about minds becoming imperfect.

A medical update from resident Public Relations Committee member Dr. Jim Scatliff:

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