THE MANY FACES OF DEMENTIA
In honor of National Alzheimer’s and Brain Awareness Month, let’s take a look at another debilitating cognitve affliction – dementia. Here’s a breakdown of the dangerous neurocognitive disorder, according to alz.org:
Physicians often refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) to guide them in determining if an individual has dementia and, if so, the condition causing dementia. The latest edition of the manual, DSM-5, classifies dementia as a neurocognitive disorder.
Dementia may be either a major or a mild neurocognitive disorder. An individual must have evidence of significant cognitive decline, and the decline must interfere with independence in everyday activities (for example, assistance may be needed with complex activities such as paying bills or managing medications).
Furthermore, an individual must have evidence of modest cognitive decline, but the decline does not interfere with everyday activities (individuals can still perform complex activities such as paying bills or managing medications, but the activities require greater mental effort). When an individual has these or other symptoms of dementia, a physician must conduct tests to identify the cause.
Different causes of dementia are associated with distinct symptom patterns and brain abnormalities.
Increasing evidence from long-term observational and autopsy studies indicates that many people with dementia, especially those in the older age groups, have brain abnormalities associated with more than one cause of dementia, otherwise known as mixed dementia.
In some cases, individuals do not have dementia, but instead have a condition whose symptoms mimic those of dementia. Common causes of dementia-like symptoms are depression, delirium, side effects from medications, thyroid problems, certain vitamin deficiencies and excessive use of alcohol.
Unlike dementia, these conditions often may be reversed with treatment. One meta-analysis, a method of analysis in which results of multiple studies are examined, reported that 9 percent of people with dementia-like symptoms did not in fact have dementia, but had other conditions that were potentially reversible.
DIFFERENCES BETWEEN WOMEN AND MEN IN THE PREVALENCE OF ALZHEIMER’S DISEASE AND OTHER DEMENTIAS
More women than men have Alzheimer’s disease and other dementias. Almost two-thirds of Americans with Alzheimer’s are women. Of the 5.1 million people age 65 and older with Alzheimer’s in the United States, 3.2 million are women and 1.9 million are men.
There are a number of potential reasons why more women than men have Alzheimer’s disease and other dementias. The prevailing view has been that this discrepancy is due to the fact that women live longer than men on average, and older age is the greatest risk factor for Alzheimer’s.
Many studies of incidence (which indicates risk of developing disease) of have found no significant difference between men and women in the proportion who develop Alzheimer’s or other dementias at any given age.
However, limited new research suggests that risk could be higher for women, potentially due to biological or genetic variations or even different life experiences. Data from the Framingham Study suggests that because men have a higher rate of death from cardiovascular disease than women in middle age, men who survive beyond age 65 may have a healthier cardiovascular risk profile and thus a lower risk for dementia than women of the same age, though more research is needed to support this finding.
RACIAL AND ETHNIC DIFFERENCES
Although there are more non-Hispanic whites living with Alzheimer’s and other dementias than people of any other racial or ethnic group in the United States, older African-Americans and Hispanics are more likely than older whites to have Alzheimer’s disease and other dementias.
A review of many studies by an expert panel concluded that older African-Americans are about twice as likely to have Alzheimer’s and other dementias as older whites, and Hispanics are about one and one-half times as likely to have Alzheimer’s and other dementias as older whites.
Variations in health, lifestyle and socioeconomic risk factors across racial groups likely account for most of the differences in risk of Alzheimer’s disease and other dementias by race. Despite some evidence that the influence of genetic risk factors on Alzheimer’s and other dementias may differ by race, genetic factors do not appear to account for the large prevalence differences among racial groups.
Instead, health conditions such as cardiovascular disease and diabetes, which increase risk for Alzheimer’s disease and other dementias, are believed to account for these differences as they are more prevalent in African-American and Hispanic people.
Lower levels of education and other socioeconomic characteristics in these communities may also increase risk. Based on data for Medicare beneficiaries age 65 and older, Alzheimer’s disease or another dementia had been diagnosed in 8 percent of white older adults, 11 percent of African-Americans and 12 percent of Hispanics.
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