Coping with Dementia

Next to Alzheimer's disease, the second most common form of primary dementia is multi-infarct dementia (MID) or vascular-type dementia. This is usually found in Asians with an estimated incidence of 15 to 20 percent of all dementia cases.

MID is triggered by a series of multiple strokes that interrupt blood supply to the brain. Each stroke corresponds to a decrease in mental function. It also leads to the formation of dead brain tissue or infarcts and the loss of function of parts of the body affected by the damaged area.

The symptoms of MID are almost similar to Alzheimer's disease except for partial paralysis of one side of the body which is common in strokes. There is gradual loss of memory and personality changes with increasing depression. Involuntary laughing or crying may also be present.

However, MID's main difference from Alzheimer's disease is that the accompanying mental deterioration happens step by step: periods of decreasing brain function alternate with a temporary improvement of the condition. Also, MID tends to occur mainly in the 55 to 65 age group. On the other hand, Alzheimer's disease generally favors older patients.

Sometimes a person may have both diseases. This is called mixed-type dementia and can be seen in about 20 percent of patients.

"In the early stages, before too much damage has occur¬red, the affected person often is aware of impaired ability, and frustration tends to increase the characteristic depression," said Dr. David E. Larson, editor-in-chief of the Mayo Clinic Family Health Book.

What causes MID? Careful evaluation by a doctor will often reveal an underlying disorder. These include atherosclerosis (the buildup of fatty deposits in the artery walls) and coronary heart disease. Other possible causes are hypertension and diabetes.

Is there a way to prevent or treat dementia? That depends on your specific condition. For the reversible forms of the disease or secondary dementia, treatment is aimed at correcting any underlying disorder such as diabetes, low thyroid function, nutritional deficiencies, and brain tumors.

The use of sleeping pills, anxiety preparations, and other sedatives should be minimized or stopped and excessive alcohol consumption should be controlled. Avoidance of exposure to carbon monoxide, organic solvents and other toxic substances may help. In MID, control of risk factors like heart failure, high blood pressure, and diabetes is essential.

"Prevention of stroke is the only potentially effective treatment for this dementia. If you have high blood pressure or transient ischemic attacks or have had a stroke, you will need continuing treatment for these diseases to minimize their recurrence and avoid MID," Larson said.

The picture remains hazy for Alzheimer's disease. At the moment, medical science does not know how to prevent or treat this disease. The best that the physician can do in this case is to make the patient as comfortable as possible.

When caring for a patient with Alzheimer’s disease, encourage that person to continue normal activities and social interactions as much as possible. The doctor may recommend certain exercises as well as memory aids to help the patient accomplish daily chores. Avoid moving to a new location since this may disorient people with Alzheimer's. Don't let the patient operate dangerous equipment or machines but he or she may be allowed to drive under careful supervision.

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