There is some confusion in the lay use of medical terms applied to elderly persons suffering from a loss in their mental abilities. The medical term that describes a person who have troubles in thinking, specially in remembering recent events, is dementia. This latin-derived word was coined by the Romans and literally means “out of his/her mind”, because many patients misbehave themselves. Dementia became gradually used by doctors as a broad term for insanity and in society a demented person was equated as madness.
In the 19th Century the causes -the medical term is etiologies- of dementia were classified by the age of onset. Common causes diagnosed as “early or presenile dementias” were syphilis, an infectious disorder that was a pandemic in the Late Modern Period of Europe and its colonies, chronic alcoholism and starvation. In late 19th Century, a dementing illness starting in the youth was first described and termed as “dementia praecox” (very early dementia). Later, this form of dementia -of madness- was renamed to schizophrenia.
The etiology of late dementias was shorter and more straightforward, either caused by vascular diseases of the brain -strokes- (vascular dementia) or by aging (senile dementia). So senile dementia was the medical term used when gradual loss of thinking in an old person occurred. It was considered as a normal part of the aging process, that everyone if lives enough, will suffer. This medical thinking sounded well, and lay people understood it plainly.
Alzheimer’s description in 1903 of peculiar brain lesions in a fifty-three years-old demented woman was initially regarded as a rare form of presenile dementia. Almost sixty years later of the initial description, the medical community realized that the same lesions were found in the brains of older people diagnosed of senile dementia. Aging was not the cause of madness!
In short, dementia is the term used for the clinical description of a disturbance of the mind, aging does not cause dementia by itself, and Alzheimer’s disease is the commonest disease that causes dementia in the elderly, and also in every age frame. The vast majority of elders are not affected by Alzheimer’s disease. The occurrence of Alzheimer’s disease in the population -the medical term is incidence- ranges from 3% in the age range 65-70 years-old, to less than 50% of the people aged 90 or more. No doubt that age is associated with Alzheimer’s disease, but a direct cause seems to be unlikely.
The process of human aging is complex and yet not well understood. Our body changes with age and our brain too. There are some cognitive modifications experienced by all persons, mainly slowness of the speed of processing information, less attention span, difficulties in multi-tasking and naming. These modifications do not cause a major impact in every day activities and are stable for years. It is true that these changes are similar to those produced by Alzheimer’s disease at the very beginning, and in occasions only repeated evaluations can tell if a person is in the aging or in the Alzheimer’s disease route. In this phase of mild troubles in everyday thinking (what psychologists call cognitive abilities -memory, orientation in places and time, planification, speech, among others-) the medical term of mild cognitive impairment had emerged to lump these people that merits medical attention and should be evaluated periodically.
We now know that Alzheimer’s disease does not start the day a patient is demented. It begins almost fifteen years before, silently without any symptom for years and then cause mild cognitive impairment and restlessly impairs our ability to cope with everyday duties and no longer can live alone, thus being designated as having dementia. There is lot of research in trying to diagnose the early brain changes that produce Alzheimer’s disease and to confidently diagnose the disease sooner. There are some biological markers -biomarkers- that can be detected in human fluids like blood or spinal liquid that correlate with the presence of Alzheimer’s disease even when the person has no or mild cognitive impairment. In the next decade, this testing would be widely available so hopefully we can fight against Alzheimer sooner when symptoms are still very mild.
People with mild cognitive impairment might benefit from measures that may slow down the symptoms progression in case that they have Alzheimer’s disease as etiology. Some measures with some positive results are control or medical treatment of vascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking), engaging in regular exercise and maintaining social relationships -a solitary life leads to sedentarism, social isolation and unhealthy feeding-, and also everyday reading or writing small pieces of sheets. These healthy measures probably in combination with an adequate nutrition and preventive remedies of neurodegenerative or vascular deterioration, would help to reduce the incidence of Alzheimer’s disease in the next generation of our elderly people.