by Julia Dima
It can start with forgetting where you parked your car at the shopping mall. Then it progresses to forgetting where you are, or what a shopping mall is. Dementia is an aggressive disease, and has no cure.
In 2012, 4,124 new cases were diagnosed in Saskatchewan, according to the Alzheimer’s Society of Saskatchewan. In 25 years, the number of new cases is expected to double. While the disease is on the rise globally, up 17 per cent from 2009, according to Alzheimer’s Disease International, Saskatchewan is seeing a significant rise because of a large senior population. In the 2011 Saskatchewan census, citizens 65 and older made up 15 per cent of the total population, a growth rate of 3 per cent since the 2006 census.
Trina Hodgson, the provincial coordinator for the Alzheimer’s Society says that is the main reason the disease affects so many.
“We are still researching why these numbers are increasing. It can be because we are living longer than we have before, and it can be the rise of the senior population,” Hodgson says. “We do have a higher senior population in Saskatchewan than in other parts of Canada, and while dementia is not a normal part of aging, your risk increases as you age.”
In a survey conducted by the University of Saskatchewan in 2012, 44 per cent of participants indicated that dementia is an issue in their immediate family. Despite this, the disease is still shrouded in misconceptions, Hodgson says. One of the main misconceptions is a misunderstanding of what dementia is, and how it varies from Alzheimer’s disease.
“Dementia is the grouped disorder, and Alzheimer’s is a form of dementia. There are many kinds of dementia,” says Hodgson. “Dementia overall is characterized by a loss of intellectual ability, including memory impairment, judgment, and abstract thinking, as well as changes in personality. Alzheimer’s disease is just the most common form of dementia, making up about 65 per cent of cases.”
Rather than being a specific disease, as some people understand dementia, it is the larger group of symptoms that categorize the many types of dementia, including Alzheimer’s disease, frontotemporal dementia, vascular dementia, and Lewy Body dementia – all of which have some similar symptoms. Those symptoms include memory loss, difficulty with communication and language, and loss of reasoning and logic. But the different types of dementia can have other symptoms, like strokes, visual hallucinations, and even loss of vision. Alzheimer’s is specifically categorized by memory loss, difficulty with problem solving, forgetting how to perform familiar tasks, forgetting time and place, having difficulty speaking, and personality and mood changes.
In the early stages, Alzheimer’s can be tough to diagnose, and cannot yet be physically seen in CT scans – rather relying on cognitive function tests and physicals. Therefore it often is not recognized until brain deterioration is severe, according to Hodgson. She says this is because many of the early signs beyond memory loss aren’t recognized as symptoms of dementia.
“When we talk about memory loss, it’s about changes in day to day ability or difficulty performing familiar tasks. The warning signs that people tend to disregard or not notice could include changes in mood and behaviour. What could look like depression can in actual fact be early dementia.”
Often, the physical signs of Alzheimer’s can be seen when the disease is severe. Dr. Darrell Mousseau is the research chair for the Alzheimer’s Society of Saskatchewan. He says that when the disease is progressed, it can be physically seen.
“Alzheimer’s disease is usually the loss of brain function associated with the loss of a sticky protein in the brain called beta-amyloid,” he says. “Another feature of the Alzheimer’s brain is the disconnection between brain cells – they can no longer communicate effectively. And, when you look at an Alzheimer’s brain, it looks significantly shrunken compared to a non-Alzheimer’s brain of someone of the same age and sex. There’s certain areas of the brain, particularly the hippocampus – tied into higher brain function – that is significantly smaller, and the cortex of the brain looks shrunken and misshapen.”
Mousseau says that the primary focus in battling dementia is in prevention.
“Alzheimer’s cannot be cured, but it can be prevented. The preventions that are commonly talked about are lifestyle changes – exercise, changes in diet, avoiding unhealthy food. If you get just under three hours of exercise minimum a week, you diminish your chances of developing Alzheimer’s later on by almost 40 per cent. So, this prevention method is significant.”
Last year, the provincial government invested $400,000 into dementia research, and the Alzheimer’s Society of Saskatchewan is currently sponsoring research into links between depression and Alzheimer’s later in life.
Mousseau is heading that research. His work could change the way risk for the disease is managed.
“If you suffer depression, the risk for Alzheimer’s tends to double or triple over the general population. It’s not like you go from zero risk to 100 per cent risk, but it does effect the risk substantially,” he says, “I’m hoping that at some point, we can identify people in pre-dementia stages, well before any symptoms appear, and if we can, maybe we can start them on a treatment that will delay or block the onset of Alzheimer’s. I’m hoping that is what my contribution ends up being.”
While there is no cure for Alzheimer’s, medication exists to help delay the onset of dementia, called cholinesterase inhibitors. However, at late stages, the drug may not be effective. Hodgson says the pros may not outweigh the cons of using the drug, and it cannot cure dementia – only delay the symptoms.
“The idea behind those drugs is that they slow the progression of the disease, but they are not a cure. For a third of the people that take these drugs, they work, for a third, they don’t work, and for the last third, they have too many side effects to know if they are working. They are also very costly drugs, and people can apply for exceptional status through the drug plan to get coverage for them but coverage isn’t guaranteed.”
Hodgson says the biggest challenge facing those with dementia in Saskatchewan right now is stigma.
“If we can become as a society more aware of how we can support people with Alzheimer’s disease, and make them feel like they are in a safe environment as they progress through their disease process, we can reduce stigma,” Hodgson says. “We’ve come a long way in understanding many other disease processes, we still have a long way to go in terms of understanding and being compassionate to people with Alzheimer’s disease.”
