Dementia: Alzheimer's Disease
Alzheimer's is the most common form of degenerative dementia in older adults and ranks among the most disabling conditions. It is marked clinically by progressive deterioration of cognitive ability and the emergence—sometimes early—of behavioral disturbances. It typically begins with memory loss, but may also include language problems, spatial and temporal disorientation, personality change, and depression.
The disease unfolds insidiously and gradually, moving through distinct stages. Its progression and duration vary from person to person.
In the early stage, patients lose memory of recent events, struggle to find the right words, and have difficulty forming abstract thoughts. Autobiographical memory remains largely intact.
In the middle stage, patients become disoriented in time and space, cannot learn new information, and need help with basic daily activities.
In the terminal stage, patients are bedbound, their limbs in a flexed position due to loss of cortical and subcortical control. They are completely incontinent and dependent, ultimately succumbing to wasting or infection.
Diagnosis relies on standardized criteria, clinical examination, and neuropsychological testing. Blood work rules out organic causes—particularly thyroid disease and vitamin deficiencies—that may contribute to cognitive decline. Heredity can play a role, especially in sporadic and familial forms.
Treatment consists of medications that slow the disease's progression. These drugs work in only some patients, but when effective, they can preserve enough independence to allow home care for several years. Additional medications may help manage depression, sleep disturbances, delirium, hallucinations, agitation, and aggression.
Vascular dementia arises from brain damage due to vascular causes—either ischemic or hemorrhagic. In Western countries, it is the second most common form of dementia after Alzheimer's.
Multiple risk factors contribute to its development: diabetes, high blood pressure, and high cholesterol.
The symptoms of vascular dementia depend heavily on where the vascular damage occurred and vary widely. Cognitive decline is patchy—some functions severely impaired while others remain relatively intact.
Current treatment focuses on controlling risk factors for cerebrovascular disease.
Osteoporosis
This is by far the most common disabling condition in older age, affecting more than 50 percent of those over sixty-five—predominantly women. The hips and knees suffer most. The impact on disability is severe, touching 20 percent of patients, and the social costs are high. Osteoporosis predisposes people to fractures, most commonly hip fracture, which affects 60 percent of women over seventy-five.
Stroke
Stroke is the third leading cause of death and the leading cause of permanent disability. One year after a stroke, 33 percent of patients are completely disabled. Stroke is the acute complication of high blood pressure. The resulting brain damage produces severely and progressively disabling conditions.
Parkinson's Disease
See the article dedicated to this condition in issue 93
Deafness
Hearing loss takes a toll on emotional, psychological, and cognitive well-being. It often accompanies vertigo, imbalance, and increased risk of falls.
Depression
Depression is among the most common risk factors for suicide in older adults, lurking especially when serious illness or bereavement strikes. Patients respond to both medication and psychotherapy.
The Geriatrician's Task
These interlocking conditions progressively rob older patients of independence and the ability to manage basic daily tasks. The burden falls not only on the patient but also on family and caregivers—emotionally, physically, and financially.
In the twenty-first century, the geriatrician's role should be to guide and support both patient and family, ensuring they never feel alone or abandoned as they navigate the care of someone no longer able to fend for themselves.
Dr. Cristina Lo Iacono, 2006
Department of Aging Sciences, Policlinico Umberto I, Rome
