Many years ago, Dr. Alzheimer described a patient who was around 50 years old who had  progressive deterioration of mental function and passed away at a young age.  The person’s course was over several years, mental function deteriorated and the person was finally completely unable to care for themself.  Dr. Alzheimer was catapulted to fame with his name applied to a condition otherwise known as presenile dementia.  Known in Dr. Alzheimer’s time was a condition called senile dementia where elderly individuals frequently had difficulty with caring for themselves as they aged.  Their loss of function was really indistinguishable from Dr. Alzheimer’s case who suffered that problem in her 50’s.  Somehow the term Alzheimer’s disease became corrupted and was applied to anybody who had difficulty with mentation resulting in end-stage dementia.  In the strictest sense of the word, Alzheimer’s disease applies to individuals who progress to end-stage mental function with dementia at an early age in their 50’s.

     Today our Nursing Homes are populated primarily by elderly individuals more than 70 years of age whose mental function has deteriorated to the point where they are not able to care for themselves.  To refer to them as having Alzheimer’s disease is inappropriate.  In fact most of  these individuals have lost their mental capacities secondary to degenerative diseases that affect the brain’s function.  Most of these conditions are avoidable and under appreciated.

     The question might be asked, “What are these avoidable conditions”.  They primarily revolve around conditions that either poison the brain or decrease the blood supple to the brain leaving it with inadequate nutrients and oxygen to function.  By far the most common toxic substance in our society is alcohol.  I have had the opportunity to care for patients in several of  our veteran facilities where alcohol related dementia is a very common problem.  These veterans who were our finest in their hour in the military are frequent “hard drinking” men who somehow succumbed to alcoholism in their later years.  As time passes, their capability for original thought and to learn new tasks is lost.  Eventually, they are unable to button their shirts or get a spoon in their mouth.  Because of the alcoholism, many of them have been abandoned by their families and they wind up in our veteran hospital system.  I have always felt that this was an incalculable tragedy that those who served us so well and so long should eventuate to such a fate.  But the brutal truth is that this is continuous self administration of a toxic substance that eventually destroys the person’s ability to think.

     At the opposite end of the spectrum, from the alcoholic who contributes to his own deterioration is the person who is hypertensive, either not knowing or not believing that high blood pressure is detrimental to the person’s mental function.  In the Cleveland Clinic Journal of Medicine, in September of 2002, was a presentation on the detrimental effects of high blood pressure on a person’s ability to think.  Since 1995, there have been no fewer than 7 publications demonstrating a deterioration in a person’s mental capability in proportion to high blood  pressure.  It is a national mandate at this time, that blood pressures should be controlled in everyone and blood pressures below 135/85 are desirable for the general.  Blood pressures below 130/80 are prescribed for anyone with a chronic illness such as diabetes or heart disease.  These recommendations are based not just on the quantity of life and the ability to demonstrate longevity.  Rather the recommendations are also based on the quality of life with the preservation of the individual’s mental function when blood pressures are adequately controlled.

     Another chronic degenerative disease in which mental function is measurably decreased is diabetes.  Studies have been done showing that as blood sugars are better controlled, the person’s ability to perform complex mental tasks are calculations is markedly improved as compared to when blood sugars are very abnormal.  It has recently been shown that there are insulin receptors in the brain even though the brain derives it sugar without the use of insulin.  It is now recognized that insulin enhances mental function and the deficiency of same is associated with slow progressive deterioration of mental function.

     Finally, there is the recent recognition that multiple small infarcts (dead areas) are seen in the brains of elderly individuals when MRI (magnetic resonance imaging) studies are done on individuals for various other reasons.  These multiple small infarcts appear to be a marker for vascular degeneration and therefore decreased blood supply to various parts of the brain.  They are thought to develop a response to small blood clots that develop locally or to small blood clots that develop in other parts of the body and then flow to the brain where they clog up blood vessels depriving the brain tissue of necessary blood supply.  There is a well known condition called multi infarct dementia that represents the extreme of this but there is a school of thought that these small infarcts contribute to slow progressive deterioration of mental function even on the “normal individuals”.  These infarcts seem to be much less prominent in individuals who use an aspirin per day, in individuals whose blood pressures are well controlled and in individuals who hearts stay strong and able to provide adequate blood supply to the brain.

     Lastly, Dr. Ken Bartholomew has written a book that is yet to be published in which he discusses at great length the importance of maintaining “mental conditioning”.  Just as your muscles become weak with inactivity, he makes the point that the brain behaves in the same manner.  Challenging yourself mentally with reading, or puzzles, or artistic efforts maintains a person’s mental capacity because it is being used.  Watching that idiot box that we call a television set does not qualify in this way.

     Just as an automobile requires maintenance and judicious use, so does the human brain. Allowing slow degenerative changes to take place because of high blood pressure, diabetes, heart disease or toxic substance abuse such as alcohol leads to changes so slow that they are often not recognized for what is really happening.  To really muddy the water at this point, there are now studies showing that estrogen replacement therapy is associated with substantial in decrease of dementia in women.  With all of the recent controversy  regarding hormone replacement therapy, a final word on this point is still awaited but it is very provocative that the studies done thus far have all shown a decreased development of dementia in women who use estrogen replacement therapy.

     The important time to protect the vascular supply for the brain is in the 30-60 year age group during which the degenerative changes are occurring that eventuate in dementia in people over age 70.  Get your loved ones and yourself adequate medical care and avoidance of high blood pressure and diabetes, so you can still think when you are 70 years old and older.  Dementia occurring with age is not an inevitability.  It can be prevented.