| A. Overview | | | | those with suspected dementia, performance on |
| From time to time, we all forget where we left | | | | neuropsychological tests offers a distinct profile. |
| our keys, walked into a room not knowing why | | | | To diagnose dementia, a complete medical and |
| we went there in the first place, or have trouble | | | | neuropsychological evaluation is recommended and |
| recalling what we ate last night. If we are elderly, | | | | a complete patient history is very important. It is |
| our first thought or fear is "Am I getting | | | | of vital importance that the physician understands |
| Alzheimer's?" Not necessarily. There are 100 | | | | the differences between depression and dementia. |
| conditions which mimic dementia (memory and | | | | C. What is Alzheimer's disease? |
| thinking problems) that are actually reversible and | | | | Alzheimer's disease is a degenerative and |
| treatable. These are sometimes called | | | | progressive brain disorder characterized by |
| "pseudodementia" "pseudo" meaning "not genuine | | | | memory loss and problems with language, planning |
| or false". In other words, disorders or conditions | | | | and organization, reasoning and judgment, spatial |
| that mimic dementia like symptoms. For example, | | | | abilities, and changes in personality and behavior. It |
| reactions to medications (geriatric patients are | | | | occurs most often in individuals over the age of |
| major consumers of prescription and | | | | 65 years. A person's chance of developing the |
| over-the-counter drugs, and studies have | | | | disease increases with age. Individuals 85 years of |
| revealed that a host of these medications | | | | age and older have the highest rates of the |
| produce effects symptomatic c of cognitive | | | | disease. While there are several types of |
| decline), emotional distress (i.e., depression), vision | | | | dementia, Dementia of Alzheimer's Type (DAT) is |
| and hearing (undetected problems of vision or | | | | the most common form seen in the elderly and |
| hearing may result in inappropriate responses, | | | | may be the single greatest source of dysfunction |
| which may be misinterpreted as dementia), | | | | in people older than 85 years. Researchers have |
| nutritional deficiency (i.e., folate, niacin, thiamine, | | | | estimated that approximately 360,000 new cases |
| vitamin B-12), endocrine abnormalities | | | | of DAT will occur each year. More than 4 million |
| (hypothyrodism can cause confusion that mimics | | | | Americans have DAT, and this number is |
| dementia), infections (older people can develop | | | | expected to triple over the next 20 years with |
| infections that produce a sudden onset of | | | | increasing life expectancies and the aging of the |
| confusion), subdural hematoma (blood clot on the | | | | "baby boomers" generation. Women are more |
| surface of the brain), normal pressure | | | | likely than men to develop DAT, partly due to |
| hydrocephalus (increased pressure in the brain due | | | | their longer life expectancy. Although there is no |
| to interruption of the flow of the spinal fluid), brain | | | | cure for DAT, effective medical and behavioral |
| tumors (tumors in the brain can cause mental | | | | treatments are available. These treatments may |
| deterioration), or stroke (build up plaques can be | | | | help to slow the progression of the disease. Early |
| surgically removed or medially treated to prevent | | | | diagnosis is important for managing the effects of |
| stroke). The reason an elderly person's memory | | | | the disease. The average time between the |
| is not as sharp as when he/she was younger | | | | diagnosis of DAY and death is 8-10 years, but this |
| could also be subsequent to normal aging process | | | | can vary from person to person. Therefore, legal |
| of the brain. As the body ages, so does the brain. | | | | and financial arrangements should be made |
| As the body ages, it becomes physically more | | | | regarding the individual's estate and ongoing care. |
| difficult to perform so does the brain; it becomes | | | | D. What Happens to the Brain When It Ages? |
| slower and loses its ability to think efficiently. | | | | With advancing age every organ of the body |
| | | | undergoes alterations in one way or another. The |
| The objective of this article is to elucidate the | | | | brain is no exception. Effects of aging on the brain |
| relationship between a most debilitating disease | | | | are well documented. The brain's volume is at its |
| (Dementia of Alzheimer's Type), depression, and | | | | peak until the age of 30 and declines gradually |
| normal memory decline due to aging (the brain | | | | over the next decades. Some structures are |
| starts shrinking after the age of 30 resulting in | | | | affected more than others. Cortical atrophy |
| changes in thinking and behavior). Memory decline | | | | (shrinkage associated with decrease in number |
| is one of the areas more sensitive to the aging | | | | and size of nerve cells) first shows up in the 40s, |
| processes and more prevalent in people over the | | | | followed by dilation of ventricular size in 40s for |
| age of 65. | | | | men, bur not until 50s in women. Studies have |
| B. How to Differentiate Between Dementia and | | | | shown modest age related changes particularly in |
| Depression? | | | | areas responsible for storage and retrieval of |
| It is important to know that "dementia" is a | | | | memory (i.e., temporal lobe, hippocampus, and |
| syndrome consisting of disturbances in distinct | | | | basilar-subcortical regions). For every decade after |
| cognitive functions. The main symptom in | | | | 40s, the hippocampus loses 5% of its cells. This is |
| dementia is memory loss, but other functions are | | | | very important as the ability to learn new |
| also affected, such as orientation, reasoning, | | | | information, retain and recall at a later time is |
| problem solving, judgment, visual-spatial | | | | processed by the cells in the hippocampus. Other |
| performance, language, and change in personality | | | | brain changes seen in nondemented "normal" |
| and emotions. Dementia is an acquired disorder | | | | elderly persons include the presence of senile |
| with evidence of decline in cognitive functions | | | | plaques and neurofibrilary tangles, abnormalities |
| from a previous level of function, as | | | | associated with Alzheimer's disease. However, |
| demonstrated by history and cognitive testing. As | | | | there is a distinction between normal aging and |
| a result, social, occupational, and functional abilities | | | | Alzheimer's disease based on the distribution and |
| can deteriorate. The most common | | | | extent of those features. Major cognitive changes |
| pseudodementia and the most easily misdiagnosed | | | | with aging has shown to be in the areas of |
| is that associated with depression. General | | | | nonverbal learning and memory, retention of |
| internists and family practitioners fail to recognize | | | | verbal material, reaction time, visuospatial |
| major depression in up to 20% of their | | | | processing speed, and concentration. However, |
| outpatients with the disorder, either as depression | | | | these cognitive changes do not necessarily have |
| misdiagnosed as dementia or vice versa. The | | | | to mean impairment affecting daily living or quality |
| ability of primary-care physicians to recognize and | | | | of life. Even healthy elderly people show |
| correctly treat depression is important since only | | | | age-related decline in some cognitive functions. |
| approximately 20% of people with depression are | | | | Research has shown the regular aerobic exercise |
| treated by mental health professionals. This is | | | | may slow the rate of cognitive decline and even |
| especially crucial since both disorders especially | | | | reverse it. Increase blood flow during exercise |
| depression, are treatable and misdiagnosis may | | | | provides for better oxygenation of the brain. |
| cause an individual with potential full cognitive | | | | Even playing video games may be good mental |
| function to be unnecessarily confined in long-term | | | | exercise for older person as it can speed up |
| care faculties (Yesavage, 1993). While cognitive | | | | reaction time. Evidently, exercise and healthy |
| and behavioral difficulties (e.g., forgetfulness, sad | | | | lifestyle are not only good for general physical |
| mood, slowed thinking) in depression are similar to | | | | health, but also helps the brain work efficiently. |