Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
The year was 1983. Ronald Reagan was at the height of his
presidency, and during a speech to the press, he made a minor
mistake. He then quipped, "You know what the best thing about
Alzheimer's disease is: You make new friends everyday." It
was a tasteless joke. Little did president Reagan know that
within ten years he would be unable to tie his own shoelaces,
a victims of the very same disease he joked about.
Senility is what the public calls dementia and Alzheimer's is
just one form of it. Repeated mini strokes and Parkinson's
disease are other common causes. While the prevalence of
senility is only 5-7% by age 80, by age 95, 50% of people are
senile. In the U.S.A., about 5 million people have this
problem.
Typically, the disease starts gradually, with short term
memory impairment (long term memory is usually intact to
begin with). Long term memory includes birth date, address,
recognizing family members yet there can be language problems
and errors in judgment, such as losing one's way on the way
home or forgetting why one is in specific store. Depression
is common at this point as most people recognize what is
happening. Later problems in walking and with using the
bathroom occur, as well as failure to eat and perhaps
aggressive behavior. Many then progress on to an inability to
eat and speak. To see a person reduced to this is a difficult
thing for a doctor and family.
The biggest risk for dementia is age, but family history is
important as well -- there may be a genetic element to the
disease. Other risk factors include head injuries,
depression, low level of education, deprived nutrition during
pregnancy or early brain development as an infant, and
repeated exposure to fumes of industrial cleaners.
While many tests can be done including CAT scans of the head
and MRIs, they aren't terribly useful. There is a
standardized questionnaire that is most helpful and a
baseline mental and memory exam will also aid in
diagnosis.
While in the past the prognosis was dismal, now there is some
hope for delaying full-blown development of the disease. The
newest breakthrough is a drug called Aricpet, which in a
small amount of patients, can lead to improved functioning
and ability to recognize things. It also seems to slow the
rate of decline of the patients but the results are not
dramatic. But at least this is a start and we are looking
forward to more hopeful information from drug therapy.
Less proven therapies which may help include high dose
Vitamin E, selegiline (a drug used in Parkinson's disease),
and the extract from the nut of the Ginkgo tree. Again, the
results are not miraculous and they do not cure the
disease.
On the other hand, I must remind my readers that occasional
forgetfulness is not a negative sign. We all forget,
especially when "our mind is elsewhere." Only when it is
sustained and getting gradually worse is it time to be
concerned.
Many of these patients are institutionalized, but if you
decide to take care of an elderly parent at home, and I think
it is a praiseworthy thing, be aware of the difficulties and
make sure you are well read on the subject and have a strong
support group. Write me in care of the Yated.
While the evidence for the reliability and safety of the
chicken pox vaccine is excellent, it still hasn't been
approved for usage in Israel. Consequently, many children get
the chicken pox and their doctors are not aware there is a
treatment to lessen the disease's course. Zovirax, and a
newer drug Valtrex, both treat chicken pox as powerful
antivirals. They also are first line treatment for shingles
in the elderly and Zovirax cream works well against cold
sores. Ask your doctor about Zovirax and Valtrex.
