Joyce had always been at the top of her class, from middle school through college. As a young woman in the 1950s, she was defiant toward the belief that women were second-class citizens, only good for staying at home with the kids. Due to her determination, she attended the best law school in the country, started her own practice and became a star attorney in her field. At the age of 68, she was active, going to the gym at least twice a week. Her diet was full of vegetables, fruits, fish, and other healthy foods. Her doctors always told her that she had no risk factors for heart disease or dementia. Her only medical issue seemed to be low thyroid tests that the endocrinologist said he would watch and treat if necessary.
However, one month after Joyce’s 68th birthday, her secretary of 20 years was surprised to find errors in Joyce’s typically perfect briefs. Joyce had been hiding the fact that thorny legal issues, which had always been easy for her, were becoming increasingly difficult. She once had prided herself on remembering every case, from the most obscure to the most quoted, but now she found herself misplacing her keys or her pocketbook. Walking in the city she was born in, she became confused and went south instead of north, winding up in strange neighborhoods. She was concerned, but tried to push the problem aside, rationalizing it as part of the normal aging process.
Her internist believed it was more serious. He recommended a neurologist to test her cognitive functioning. Joyce went the following week. She was shocked when she couldn’t remember the date, or the three objects that the neurologist asked her to recall after 10 minutes. When the doctor asked about her family history, she had to admit that both her father and mother had suffered from dementia. Her father had been in his 70s when he was diagnosed with Lewy body dementia, and her mother reached 90 before getting a diagnosis of Alzheimer’s.
Joyce eagerly started two medicines that the doctor prescribed. One was Namenda, 10 mg per day. The other was Aricept, 10 mg, that she had to take at bedtime. Even though she took them as conscientiously as she could for six months, the medicines didn’t help very much, and she didn’t always remember to take them. She just got worse. After three years she had to be admitted to a nursing home, because she’d become incontinent and she couldn’t feed or dress herself. Her friends and family couldn’t believe the change they saw in her.
Joyce had Alzheimer’s, which is the most common and well known of the dementias. In Alzheimer’s dementia, people have multiple cognitive deficits, such as aphasia, i.e., difficulty talking, and apraxia, i.e., trouble doing things for themselves. They fail to recognize objects (agnosia) and they can’t abstract, plan or organize their thoughts. Memory impairment is the primary problem. They can’t learn new information or recall previously learned information. Today, there are many medications available, but none of them seem to help very much. Joyce tried the two most popular anti-dementia medications with little relief of her symptoms.
It is clear that we need to find better treatments. In Alzheimer’s patients, plaques and tangles form in the brain and block neurotransmission. A vaccine that stops the formation of brain plaques was tried out on mice with dementia, where it seemed to work. However, when it was tested on humans, some patients died, so testing had to be stopped.
Both men and women suffer from dementia. Some studies have shown women are more susceptible to dementia than men, while some experts believe that women only appear more likely to develop these disorders because they live longer. Dementia tends to strike later in life and devastate the individual and the family. Between 2 and 4 percent of the population over 65 years is believed to have dementia of the Alzheimer’s type.
There are many forms of dementia. Most people are familiar with Alzheimer’s, but there is also vascular dementia (formerly called multi-infarct dementia). In this dementia, CT scans show multiple vascular lesions in the brain. Dementia is found in Parkinson’s, Lewy body dementia, dementia from HIV, Huntington’s, Pick’s, and other conditions. In all of these disorders, patients have decreased memory and poor functioning.
As the baby boomers age and reach 65 and older, we will have an epidemic of Alzheimer’s and other dementias. Regular cardiovascular exercise has been proven to reduce incidence of dementia by up to 50 percent. Increasing the brain’s cognitive reserves through new challenges such as language learning and social interaction can also reduce symptoms. But, as in Joyce’s example, a genetic predisposition towards dementia can be difficult to overcome. Holistic practices like brain education might be an effective alternative treatment, if it can be started in the early stages of Alzheimer’s. The time to explore new therapies is now, so brilliant women like Joyce will be able to maintain their mental functioning well into old age.
Dr. Carol W. Berman is a psychiatrist and clinical instructor in psychiatry at New York University Medical Center. She is in private practice in New York City and has written two books, “One Hundred Questions and Answers About Panic Disorder” and “Personality Disorder: A Practical Guide.”