Alzheimer’s disease. Dementia. We have all heard or read about these illnesses, know people who have lived with them, and we may be caring for a loved one living with them. Although these terms are related and oftentimes used interchangeably, there is a difference. “[D]ementia describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type” (https://www.alz.org/what-is-dementia.asp). Dementia with Lewy bodies (DLB) is the third most common form of dementia, and other types include mixed dementia, Parkinson’s dementia, frontotemporal dementia, Creutzfeldt-Jakob disease, normal pressure hydrocephalus, Huntington’s disease, and Wernicke-Korsakoff Syndrome, however other types exist such as alcohol-related dementia (can occur after long-term alcohol use), traumatic brain injury (TBI), or dementia-like symptoms related to a particular health condition (https://www.alz.org/dementia/types-of-dementia.asp, American Psychiatric Association, 2013). These different types of dementias have different causes, symptoms, progression, and treatment.
Because Alzheimer’s disease accounts for the vast majority of dementia cases, this article will provide an overview of this disease, what we know about its causes, risk factors for developing it, what has been found to possibly help slow the development or progression of its symptoms, and how participation in community-based programs and activities can help toward this end. Information on the other types of dementia may be found in online articles (i.e., websites include the Alzheimer’s Association, National Institute on Aging, Mayo Clinic, etc.) and videos (i.e., TED Talks, reputable scientific sources on YouTube) and in journal articles (e.g., American Medical Association, Aging, Gerontology, Journal of Aging and Health, etc.) and books.
According to the Alzheimer’s Association, 5.7 million Americans live with Alzheimer’s disease and by the year 2050 this number is projected to increase to 14 million. Alzheimer’s disease is the sixth leading cause of death in the United States, behind heart disease, cancer, chronic lower respiratory disease, accidents, stroke, and followed by diabetes, influenza and pneumonia, nephritis/nephrotic syndrome/nephrosis, and intentional self-harm (suicide) (https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm). An estimated one in three American seniors die with Alzheimer’s disease or another type of dementia. The greatest risk factor for developing Alzheimer’s disease is increasing age. “After 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly 50 percent” (https://www.alz.org/research/science/alzheimers_disease_causes.asp).
Alzheimer’s disease is a progressive, degenerative brain disease for which a cure has yet been found. The best causal explanation that the scientific community provides us is that the disease involves certain abnormalities present in the brain, plaques and tangles, which over years increasingly rob the individual of their memory, cognitive abilities, and functioning, leading to death. Plaques are “abnormal clusters of protein fragments, build up between nerve cells,” and tangles are “dead and dying nerve cells … which are made up of twisted strands of another protein” (https://www.alz.org/braintour/plaques_tangles.asp).
The Alzheimer’s Association identifies the 10 warning signs of Alzheimer’s disease and other dementia types, and what might be considered typical, normal age-related cognitive changes for each (https://www.alz.org/national/documents/tenwarnsigns.pdf):
- Memory Loss That Disrupts Daily Life: One of the most common signs of Alzheimer’s disease, especially in the early stage, is forgetting recently learned information. Others include forgetting important dates or events, asking for the same information over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What’s a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.
- Challenges in Planning Or Solving Problems: Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What’s a typical age-related change? Making occasional errors when balancing a checkbook.
- Difficulty Completing Familiar Tasks at Home, At Work Or At Leisure: People with Alzheimer’s disease often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What’s a typical age-related change? Occasionally needing help to use the settings on a microwave or to record a television show.
- Confusion with Time Or Place: People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What’s a typical age-related change? Getting confused about the day of the week, but figuring it out later.
- Trouble Understanding Visual Images and Spatial Relationships: For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving. What’s a typical age-related change? Vision changes related to cataracts.
- New Problems with Words in Speaking or Writing: People with Alzheimer’s disease may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”). What’s a typical age-related change? Sometimes having trouble finding the right word.
- Misplacing Things and Losing the Ability to Retrace Steps: A person with Alzheimer’s may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes they may accuse others of stealing. This may occur more frequently over time. What’s a typical age-related change? Misplacing things from time to time and retracing steps to find them.
- Decreased or Poor Judgment: People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What’s a typical age-related change? Making a bad decision once in a while.
- Withdrawal from Work or Social Activities: A person with Alzheimer’s disease may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite team or hobby. They may also avoid being social because of the changes they have experienced. What’s a typical age-related change? Sometimes feeling weary of work, family and social obligations.
- Changes in Mood and Personality: The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. What’s a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.
Note: Mood changes with age may also be a sign of another condition. Consult a doctor if you observe changes in yourself or others” or experience any of these 10 warning signs. (https://www.alz.org/national/documents/tenwarnsigns.pdf)
There are two types of Alzheimer’s disease: early-onset and late-onset. Early-onset Alzheimer’s disease occurs in individuals under the age of 65 years and can occur as early as in their 30s. It is the rarer form of the disease, affecting between five and 10 percent of Americans, and research suggests a strong genetic component. “Some cases are caused by an inherited change in one of three genes, resulting in a type known as early-onset familial Alzheimer’s disease, or FAD. For other cases of early-onset Alzheimer’s, research suggest there may be a genetic component related to factors other than these three genes. A child whose biological mother or father carries a genetic mutation for early-onset FAD has a 50/50 chance of inheriting that mutation. If the mutation is in fact inherited, the child has a very strong probability of developing early-onset FAD” (https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet).
Most Alzheimer’s cases are the late-onset type, occurring in people in their mid-60s and later. “Researchers have not found a specific gene that directly causes the late-onset form of the disease. However, one genetic risk factor – having one form of the apolipoprotein E (APOE) gene on chromosome 19 – does increase a person’s risk” (https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet). The Apolipoprotein E (APOE) gene is located on chromosome 19 and is involved in making a protein that helps carry cholesterol and other types of fat in the bloodstream (https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet#apoe).
Although the cause or causes of late-onset Alzheimer’s disease are less well understood than the early-onset type, scientists believe it is related to a combination of factors, including genetics, environmental and lifestyle factors and may increase an individual’s risk for developing the disease. We have no control over our genetics, some control over our environment, and we can definitely exercise control over our lifestyle, which should provide comfort.
“Research shows that people who are regularly engaged in social interaction maintain their brain vitality. But again, the combination of physical and mental activity with social engagement — and a brain-healthy diet — is more effective than any of these factors alone. One study reported that leisure activities that combine physical, mental and social activity are the most likely to prevent dementia. In the study of 800 men and women aged 75 and older, those who were more physically active, more mentally active or more socially engaged had a lower risk for developing dementia. And those who combined these activities did even better. Other research found that sports, cultural activities, emotional support and close personal relationships together appear to have a protective effect against dementia” (https://www.alz.org/we_can_help_remain_socially_active.asp).
The Alzheimer’s Association (https://www.alz.org/brain-health/adopt_healthy_diet.asp) identifies two brain-healthy diets that can benefit body and brain and help reduce both the risk for heart disease and reduce the risk for dementia: the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. The DASH diet is designed to lower blood pressure and includes foods low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low-fast dairy. The Mediterranean diet focuses on fruits, vegetables, and grains and emphasizes limiting the consumption of red meats, and eating fish and poultry at least twice a week.
Additionally, in a review of the literature on the association between physical activity and the risk of Alzheimer’s disease, 18 studies found that physical activity was inversely associated with the risk of Alzheimer’s disease; that is, an increase in physical activity was associated with a decreased risk for the disease. This review also found that leisure-time physical activity was particularly protective against Alzheimer’s disease, but not work-related physical activity (Stephen, Hongisto, Solomon & Lönnroose, 2017).
The above studies lend support to the benefits that seniors centers can provide participating members through an array of programs and activities that promote physical and mental activity, social interaction, brain-friendly diet, cultural activities, emotional support and personal relationships. The South Pasadena Senior Center opened in 1982 as a “one stop shopping center” for services and activities. “The Center’s mission is to offer a place in which older adults and persons with disabilities can meet with one another to fulfill their social, physical, emotional and intellectual needs. Center programs and activities are designed to enhance and support senior citizen independence and encourage involvement in and with the community.” Located adjacent to the public library, close to Mission Street, the Gold Line station and local bus lines, and may also be accessed via Dial-A-Ride, Access Services (Eastern Region), taxi, or other forms of transportation such as Uber and Lyft services.
The South Pasadena Senior Center’s programs and activities help promote seniors’ physical health (flu vaccinations, blood pressure and glucose testing, medication review, podiatry clinic, Functional Fitness class ballroom dancing, line dancing, yoga, chair yoga, and walking group), mental and emotional health (mindfulness meditation, memory training, language classes, book club discussions, bridge group, creative writing group, gymnasium for the mind, Mah Jong, tours to places of interest such as the Queen Mary, San Antonio Winery, Holyland Exhibition and the Americana), and support services to help seniors remain independent, healthy, and safe (such as information and referral service, convalescent care planning by an attorney, and care management services to help seniors access needed services and programs).
The South Pasadena Senior Center is located at 1102 Oxley Street in South Pasadena, is open Monday through Friday from 8:00 A.M. to 5:00 P.M. (closed on holidays), and can be reached at (626) 403-7360. We hope that you, a family member, or senior you know who can benefit from the Center’s programs and services will come for a visit and speak to a staff member about your interests and needs.
Herb Shon, Ph.D., LCSW South Pasadena Senior Citizen Commissioner
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Stephen, Ruth, Hongisto, Kristina, Solomon, Alina, Lönnroos, Eija (2017). Physical Activity and Alzheimer’s Disease: A Systematic Review. The Journals of Gerontology, 72(6), 733-739.