Ask the Expert

Askthe Expert

Dementia

EDITORIAL BY DR. SEBASTIAN F. KOGA, NEUROSURGEON We are accustomed to terms such as “senile dementia” and assume that memory decline is a normal part in old age. Although mild decline in memory skills may be normal with age, dementia is not part of normal aging and should be investigated. Screening is easily done and can be ordered by your primary care doctor or a neurologist.

WHAT CAUSES DEMENTIA?

Dementia describes a group of symptoms which can arise from multiple causes. Alzheimer’s dementia is the most common type. Its exact causes are unknown; but it has a genetic link and is manifested by the reduction and death of neurons, leading to memory failure, personality changes, and problems with daily activities.

Vascular dementia is caused by compromised blood flow to the brain. Other dementia syndromes can be caused by exposure to toxins, defective genes, and excess of cerebrospinal fluid. Often the causes are remote and cannot be reversed at time of diagnosis. However, it’s important to understand the difference between age-related memory issues and dementia.

DO I HAVE ALZHEIMER’S DEMENTIA?

Although Alzheimer’s dementia probably represents over 60 percent of cases, there are several other types of dementia manifesting in different ways. Parkinson’s dementia, fronto-temporal dementia, Lewybody dementia, Huntington’s disease, and Normal Pressure Hydrocephalus (NPH) are other types which arise from various causes and require different treatments.

Accurate diagnosis requires brain imaging with modern MRI protocols, clinical examination (including cognitive and physical tests), and cerebrospinal fluid tests. The latter means getting a lumbar puncture, but the test is harmless and very useful. Numerous diseases can be diagnosed by blood tests, but the blood–brain barrier restricts the passage of solutes into the blood, so these tests on cerebrospinal fluid are more accurate for brain disorders. Certain proteins in the spinal fluid act as a biomarkers of disease and can help diagnose and even predict future decline.

IS THERE ANY TREATMENT?

Yes. Although there are no perfect cures, a specialist will be able to help. There are new drugs which delay the progression of Alzheimer’s, and for other dementias there are surgical techniques to increase blood flow to the brain or divert excess cerebrospinal fluid from the brain.

As a neurosurgeon, I often treat patients with Normal Pressure Hydrocephalus (NPH). The procedure is relatively simple and can make a big difference in quality of life. It is not a cure, but it can delay or postpone symptoms for several years. I encourage all older patients with memory issues to see a specialist with training in neurology or neurosurgery.

CAN I DO ANYTHING FOR PREVENTION?

Besides genetic factors, dementia syndromes have been linked to depression, head injuries, and hypertension. Maintaining normal blood pressure is important, as well as maintaining normal blood sugars which affect circulation in the capillary blood vessels that supply sensitive areas of the brain such as the temporal lobe and the retina.

Social withdrawal is a risk factor, so keeping an active and social lifestyle is also important, as is maintaining intellectual activity at all ages. Retirees especially need to continue reading, engaging intellectually with an area of interest, having a hobby, and seeing friends. The brain is stimulated by complex tasks.

LAST WORDS

Dementia is not part of normal aging. If you or your family are concerned about memory lapses and diminished cognitive abilities, seek an evaluation. Screening is easy, and there is a growing arsenal of treatments which work better with early intervention. Knowledge is power.

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Dr. Sebastian Koga is a board-certified neurosurgeon specialized in brain tumors and complex spine. He is a graduate of Tulane Medical School and completed his neurosurgery residency at the University of Virginia.