We’ve all seen it. What a tragedy when a loved one or a friend begins to fail. Once it was called senility because failing mental faculties were associated with the aged. However, the most common cause of cognitive decline (dementia) is Alzheimer’s Disease and can occur in younger people like Coach Pat Summitt. How ironic that the original 1906 description of this terrible disease by Dr. Alois Alzheimer occurred in a group of young adults and was labeled “presenile dementia” – as if it were natural for old folks to become demented.
The most common cause of dementia is Alzheimer’s Disease, though it can’t be definitively diagnosed without a pathological analysis of brain tissue showing beta amyloid plaques and neurofibrillary tangles. This is arcane medical-ease, and this column is not the place for me to pontificate on pathological descriptions of amyloid plaques, Lewy body deposits or mechanistic tau protein dysregulation. However, perhaps this is a place to describe the basic characteristics of the major dementing diseases.
All of us age, and our mental quickness begins to decline after our twenties. Interestingly, many innovative scientific discoveries are made earlier in life rather than later. Fortunately, accumulated life experiences more than compensate for our loss of abstract thinking. I may have once been sharper, but now I’m wiser. Doctors sometimes use the term age related cognitive decline. Primarily this manifests as simple lapses in memory and doesn’t affect the ability to function. Another medical term is mild cognitive impairment which can be measured with careful psychometric analysis, but, again, there’s no loss of daily functioning. And though some people with memory loss develop dementia, many do not.
Since we don’t confirm the suspicion of Alzheimer’s Disease with brain biopsies, it’s best to describe the most common of the neurodegenerative brain diseases as dementia of Alzheimer’s type or DAT. Since this degenerative disease preferentially affects the temporal and parietal lobes of the brain, short term memory problems and visual-spatial defects are early signs. Events of long ago are easily recalled whereas remembering the contents of breakfast cannot. Also, recalling three items on a memory screening test is problematic because of damage to the hippocampus, an area of the brain which helps consolidate new memories. Parietal lobe dysfunction is demonstrated by difficulty drawing a clock face, orienting the numbers and correctly placing the hour and minute hands. Only later do emotional issues, keeping appointments, planning, traveling, shopping and cooking occur. People eventually become apathetic, begin to wander and become unable to do activities of daily living such as dressing and bathing.
Strokes can cause vascular dementia, though the principle feature is paresis. Recurrent strokes can result in memory loss, difficulty naming objects and the loss of executive functions such as planning, shopping, etc. In evaluating dementia doctors should consider vitamin B12 deficiency, hypothyroidism and depression which can masquerade as cognitive decline. Also, drugs like alcohol and even Benadryl can cause confusion by interfering with brain chemistry. Lastly, brain trauma (dementia pugilistica), HIV or prion infection, obstructions of brain spinal fluid flow and genetic diseases like Huntington’s Disease can cause dementia.
Less common than DAT is Lewy Body dementia. This condition often begins with symptoms like Parkinson’s Disease, but without the characteristic tremor. Dementia can occur late in Parkinson’s Disease or in a rarer group of patients with “Parkinson’s Plus” syndromes. Lewy Body dementia often causes psychiatric symptoms including hallucinations and delusions. Lastly, an entity called frontotemporal dementia preferentially affects the frontal lobes of the brain and presents with language problems and difficulties in social and personal function rather than memory issues or visuospatial dysfunction so common in DAT.
As a doctor I’ve always used the term demented in a medical context. However, in the process of becoming a writer I’ve become more interested in words, the tools we use to communicate. Recently, I learned that Mr. Webster gives a second definition of demented as someone “not able to think clearly or to understand what is real.” The Trump derangement syndrome seems to fit the unhinged reaction of snowflake collegiates, protesters who march, block streets and destroy property, the people on the airline who booed a family hurrying to catch a plane for their soldier son’s funeral and the audience who booed Vice President elect Mike Prince at a performance of Hamilton. A southerner with class would never invite someone into their house, single them out and then insult them as did the cast of the play who lectured Mr. Pence. We now learn that none of the cast voted; yet they deign to insult a gentleman like Mr. Pence and We The People.
It is obvious where eight years of community agitation has taken us. We are at each other’s throats like no time since the Civil War. Some years ago I wrote that we are engaged in a “barely civil war.” And over the last ten years it has become much worse. Threats are now being made against members of the Electoral College, sanctuary cities promise to defy Federal law, California is talking about succeeding and Democrat/leftists vow to continue ruling the country despite being a minority. The Democrat brand has been decimated by Obama and his policies which were rejected in 2010, 2014 and 2016. Republicans have the Presidency, the Congress and the vast number of State Legislatures and Governorships.
As Obama once told Eric Cantor and Republicans, “Elections have consequences.” Yes, they do, and it’s time to get over it and get to work fixing the mess that’s been created. I’m sorry that I have to keep speaking out against Obama, Democrats and leftists. But, unfortunately, they never quit in their quest to send those who disagree with them to the back of the bus. The Democrat Party has become the party of the east and west coasts, and their only plurality is in large cities rife with crime. The people have decided it’s time for a change. The Democrats need to become the “loyal opposition” as were the Republicans over the previous eight years. I challenge Democrats to look up the definition of loyal opposition and help to make America Great Again.
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