Stimulation Reduces Dementia
Interviewed by Melissa Moniz
Wednesday - June 04, 2008
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Dr. Kavita Sharma
At what age should someone see a geriatrician rather than a general physician or family doctor?
A geriatrician is a family medicine or internal medicine physician who has an additional one or two years of fellowship training in geriatric medicine. We usually start seeing patients who are 65 years or older, although a lot of these patients can be managed by their internists if they don’t have any specific problems related to aging.
We are generally a consultative service, and most of our patients are referred to us by their primary physician. These are patients with significant memory problems or conditions related to getting frail. They may be on a long list of medications with related side effects or have complex social issues like abuse or neglect. At our Geriatric Department at Kaiser Permanente, we emphasize a team approach to handling these patients. We work in coordination with our nurses, social worker and psychiatrist to provide resources and support that may not be available to a primary care physician. This provides a more caring environment for our patients and their families.
What are some of the common problems that you see?
There are currently about 5 million Alzheimer’s patients in the United States. Almost half of the patients who are 85 years of age and older have some form of dementia. This is the most common problem that we see. Other problems that we see are osteoporosis, depression, weight loss and problems with gait and balance, which cause falls. Some of our patients are too frail to even get to the clinic. To provide continuity of care to these patients, we have a home visit program at Kaiser Permanente. We also take care of a lot of patients who are in hospice and provide support to the families as their loved ones go through end-of-life issues. Our nurses also spend a lot of time educating and counseling families about some of the difficult behavioral issues related to dementia.
What can be done to prevent memory loss?
Generally, if you have taken good care of yourself in your younger years - meaning participating in preventive care like Pap smears, mammograms, colon cancer screenings, exercising regularly and eating a balanced diet - this will have a positive impact on you later in life. Some of the risk factors for dementia are smoking, high blood pressure, diabetes and strokes.
Controlling these risk factors can substantially decrease your risk for dementia. Doing regular brain exercises, like crossword puzzles, has been shown to lower your risk for getting dementia.
Is there a way to prevent it from progressing if you catch it early?
Early detection helps the patients and families plan for the future and get their affairs in order - like financial planning or completing advanced directives and assigning a power of attorney - while they still have the capacity. In fact, I would urge all elderly patients to complete their paperwork and plan for the future. Looking into long-term care insurance is also a good idea. Also, controlling their underlying medical problems like high blood pressure, diabetes and heart disease tends to slow the progression. Keeping physically fit by exercising and socializing also tends to keep the brain stimulated. At Kaiser Permanente, we offer exercise classes that are open to the public through our Lifestyle Program. The current medical treatments that are available have marginal benefits.
Is memory loss genetic?
Some forms of dementia are linked to genetic mutations. These are patients who manifest memory loss fairly early in their 40s or 50s. However, most cases of Alzheimer’s disease are not clearly inherited. In most memory clinics, fewer than 5 percent of patients meet the definition for Alzheimer’s disease that is caused by genetic mutation.
Are there any problems you see that are on the rise?
The average life expectancy is about 77.8 years. As the population ages, heart disease and cancer are fairly prevalent. However, over the past decade there is more awareness about preventive medicine. Also, lifestyle changes - like eating a balanced diet, exercising regularly and quitting smoking - have all had an impact on stabilizing deaths from cardiovascular diseases, which is the No. 1 cause of mortality in the U.S.
What are the biggest changes that happen to the body as you age?
There are certain changes that occur to the body that are a normal part of aging and may not necessarily indicate disease. For instance, the need for reading glasses, hearing problems, balding, wrinkling of skin as the skin loses elasticity and the loss of the skin’s ability to adequately absorb sunlight and make vitamin D. This may affect bone and muscle strength. The kidneys may not work as effectively, hence the doses of medications may need adjustment. Changes in metabolism may affect digestion and cause constipation. There also are lower levels of hormones, which accounts for sexual dysfunction in both males and females. Forgetfulness is also a part of aging and may not always indicate dementia. Certain diseases like arthritis, cancer, diabetes, heart diseases and strokes are more prevalent as you age.
Can you talk a little about osteoporosis?
Osteoporosis is the loss of bone mineral density as you age. It’s more common in post-menopausal females because of estrogen loss. To promote bone buildup, weight-bearing exercises, increasing dairy intake and taking calcium and vitamin D supplements are recommended. Men are not as likely to have osteoporosis because of testosterone. However, men who smoke, have a history of alcohol use and/or have been on steroids seem to have a higher likelihood of getting osteoporosis. Screening for osteoporosis by a bone density scan would be a means to detect it. If you have lost height or tend to have fractures easily with minimal injury, this could be an indication of osteoporosis.
What are some problems that are more common in males than in females?
There are hormonal changes that affect men as they age, and the term “andropause” is being used more commonly now. It relates to declining testosterone levels. Unlike the changes in menopause, these changes are very gradual and variable in different people. Some men maintain normal testosterone levels well into old age, and some men have low levels but it causes no obvious symptoms. The effects may not be noticeable until the 80s. The common symptoms include infertility, reduced sexual desire, decreased energy and bone loss. In addition, erectile dys-function is another common problem faced by men as they age. Most patients with diabetes, heart diseases or peripheral vascular disease may experience this problem. You should always consult with your doctor before taking any medications for this problem.
What advice would you give the younger generation to keep healthy for years to come?
Aging is inevitable. But how well you age depends on lifestyle and health decisions that you make in your younger years. Your retirement is known as your “golden years” and it can be so. At Kaiser Permanente, we have a healthy seniors’clinic where we have seen people in their 90s who are living alone in amazingly good health.
I would recommend participating in preventive health, undergoing cancer screening like Pap smears, colorectal screens and mammograms, and maintaining an active lifestyle.
Certain brain exercises like reading and crossword puzzles tend to stimulate the brain and reduce the risk of dementia.
So my advice to the younger generation would be to stay active, mentally and physically, and take good care of your body now so that you may continue to thrive as you age.
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