Navigating Health and Aging: A healthy brain starts with prevention techniques

An ounce of prevention is worth a pound of cure.

How many of us have heard this saying? In the world of dementia care this may be the only advice that offers hope to those worried about developing the deadly and dreaded disease states that cause memory loss and dementia.

Alzheimer's disease and related dementias may have different pathologies or processes happening in the brain, but all add up to deficits and cognitive decline. In the case of Alzheimer's disease, plagues and tangles of tau proteins form in the brain causing disconnection of neurons, basically causing the wiring of the brain to malfunction. The brain atrophies or shrinks, resulting in less brain matter. In the case of vascular dementia - caused by high blood pressure, stroke or small mini-strokes - small clots cause disruption in the brain. Another type of dementia, Lewy body dementia, results in the degeneration of neurons.

The brain is complex and is composed of different lobes, with different functions associated with each one. The temporal lobe is primarily associated with memory; the frontal lobe with executive functioning, reasoning, expressive language and personality; the parietal lobes with processing sensory information; and the occipital lobe controls the ability to recognize things around us.

No two people affected by dementia will behave in the same way or exhibit the same symptoms. This is directly related to the areas of the brain that are affected.

If we think of the brain working in three parts, we can better understand the experience of those affected by dementia.

The first part is the gadget or hardware that takes in all the information - the sights, smells, sounds, tastes and tactile information from the outside world and processes it.

The second part places the information in temporary storage - the chalkboard.

The third part sends the information to be kept long-term to the file cabinet.

The gadget is the brain structure that allows all the processing and storing. The short-term memory is the chalkboard and the long-term memory is the file cabinet. The first thing to happen when the hardware or brain begins to fail is the ability to remember what was written on the chalkboard, and then to move it to the file cabinet. The file cabinet full of long-filed information is intact for much longer than the chalkboard.

People can remember events from long ago and recite their address of 30 or 40 years ago, because it is safely stored in the file cabinet, at least for a while. It is often frustrating to loved ones interacting with someone affected with dementia to understand why some things seem to be working and others are not. Those affected may be very aware of their deficits, but in many cases because of the disease process, some have no insight or awareness of what is happening to them.

The appearance of symptoms is generally subtle and occurs over years. It is normal as we age to be forgetful or occasionally have problems with finding a word. However, when forgetting becomes life altering and interferes with daily living, then it is much more than the normal aging process.

How do we know if forgetfulness is related to aging, dementia or some other health problem?

Researchers have made progress in the identification of dementias through MRI and PET scans, the use of biomarkers and cognitive testing, but unfortunately nothing has been offered in the way of cure.

That seems to be where hope comes in to play. When facing the diagnosis of a disease process such as Alzheimer's disease or vascular dementia, we all hope that something is out there to cure the disease. Unfortunately, despite many studies and many drugs going through the rigorous FDA approval process, few options are available.

Medications to help compensate for memory loss have been on the market since 1993 with the last one being FDA approved in 2003.Tacrine or Cognex was approved in 1993 and is no longer in use, due to side effects and ineffectiveness. Aricept or Donepizil has been out since 1996 and is still widely used, despite side effects and lack of long-term efficacy. Studies have not proven benefits past 24 months of use. While some short-term compensatory benefits have been proven, there seems to be little hope when it comes to preventing progression of the disease process. The Exelon Patch was approved in 2000, Razadyne in 2001, and the most recent was Namenda in 2003.

Unfortunately, these medications only work temporarily and some may be inefficient in delaying the effects of the disease at all. Side effects can cause people to feel so bad that they discontinue use. For others, the side effects cause worsening symptoms, and as a result, increased behavior problems can cause loved ones to request that the medication be discontinued.

So what is there left to do?

The process leading to dementia may sometimes start as early as in person's 20s. While little has been found in reversing the process, suggestions for prevention may apply to those already affected. Research recommends that a brain healthy regimen may decrease the risk for developing cognitive impairment, and could help to improve the lives of those affected.

In the book "The Alzheimer's Prevention Program" by Gary Small and Gigi Vorgan, a regimen of healthy diet, exercise (walking), strengthening memory skills, reducing stress and mental workouts can decrease the odds of developing symptoms of Alzheimer's disease by a significant degree.

Unfortunately while treatment or cure for the reversal of the effects of dementia caused by Alzheimer's disease, vascular dementia and Lewy Body dementia has yet to be found, there can be hope in prevention found in lifestyle changes.