Causes of Alzheimer Disease

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Information on Causes of Alzheimer Disease

While exact statistics are hard to come by, it is generally estimated that about 80% of all dementia in persons over age 65 is caused by two irreversible disorders. Alzheimer's disease, by far the most common, is a disease of unknown cause associated with progressive dementia leading to death within 5 to 10 years. At autopsy, the brain shows characteristic microscopic abnormalities in the cerebrum, the largest "intellectual" part of the human brain. Though many tantalizing research leads are under exploration, there is as yet no treatment for this condition proven to be effective. The other major cause of irreversible dementia among the elderly is a phenomenon usually known as multi-infarct dementia, meaning many small strokes that destroy small areas of brain tissue. Theoretically, the treatment of existing high blood pressure might help in preventing further "mini-strokes", but the treatment of hypertension in the elderly can be very tricky since "over-treatment" can also lead to brain damage due to insufficient blood flow. That is the bad news. The relatively good news is that approximately 10 to 20% of persons over 65 years of age with mental deterioration have underlying causes that may be partially or completely reversed, including the following:

- Inappropriate drug ingestion: This "cause" is put at the top of the list to emphasize the increasing recognition of the phenomenon of excessive and inappropriate drug use by the elderly. Some of this use stems from the problems of dementia itself (forgetfulness as to when the last dose was taken, confusion about how long medication should be taken) or a tendency to try something suggested by a friend. However, much of the blame must be laid at the doorstep of physicians who too readily prescribe drugs without careful checking as to what the person is already taking, or who spend too little time to consider (and explain) the special problems that many common drugs might cause older people. Indeed, one of the first steps in evaluating the development of dementia in anyone is to review all drug use carefully, including non-prescription drugs. In some cases it may be necessary to check the medicine cabinet at home rather than rely on the verbal report given. The discontinuation of drugs should be done under the supervision of a knowledgeable physician, since serious withdrawal problems can occur.

- Unrecognized depression: As with persons of any age, serious underlying depression may be missed in the midst of intellectual deterioration. But there is a special danger of this happening to an elderly person, given the easy explanation of "senility" for such deterioration and the erroneous assumption that elderly persons are not likely to become depressed. Indeed, during depression they are more likely to deny mood changes and instead focus on bodily complaints. But depression is being increasingly identified as the basis for impaired mental function in elderly people, and proper treatment can lead to striking improvement.

- Underlying physical disease: This category is all-inclusive and runs the gamut from alcoholism to infection to low thyroid function to an unrecognized blood clot next to the brain.


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