Defying Dementia: Understanding and Preventing Alzheimer's and Related Disorders

235 Pages·2006·3.19 MB·English

by  Robert Levine

DEFYING DEMENTIA
Understanding and Preventing
Alzheimer’s and Related
Disorders
Robert Levine, MD
LibraryofCongressCataloging-in-PublicationData
Levine,Robert,1939–
Defyingdementia:understandingandpreventingAlzheimer’sand
relateddisorders/RobertLevine.
p.cm.
Includesbibliographicalreferencesandindex.
ISBN0–275–98970–4(alk.paper)
1.Dementia.I.Title.
RC521.L48 2006
616.8’3—dc22 2006008236
BritishLibraryCataloguinginPublicationDataisavailable.
Copyrightª2006byRobertA.Levine,MD
Allrightsreserved.Noportionofthisbookmaybe
reproduced,byanyprocessortechnique,withoutthe
expresswrittenconsentofthepublisher.
LibraryofCongressCatalogCardNumber:2006008236
ISBN:0–275–98970–4
Firstpublishedin2006
PraegerPublishers,88PostRoadWest,Westport,CT06881
AnimprintofGreenwoodPublishingGroup,Inc.
www.praeger.com
PrintedintheUnitedStatesofAmerica
Thepaperusedinthisbookcomplieswiththe
PermanentPaperStandardissuedbytheNational
InformationStandardsOrganization(Z39.48–1984).
10 9 8 7 6 5 4 3 2 1
To my mother Dorothy
who was always so alive and now lingers with dementia,
And to my patients with dementia and their families,
from whom I have learned so much.

CONTENTS
Preface ix
Acknowledgements xi
I. UNDERSTANDING DEMENTIA 1
1. Introduction 3
2. Confounders of Dementia: Normal Aging, Mild Cognitive
Impairment and Pseudo-dementia 21
3. Alzheimer’s Disease 37
4. Fronto-Temporal Dementia—Pick’s Disease 67
5. Dementia with Lewy Bodies and Parkinson’s Disease
Dementia 79
6. Vascular Dementia and Mixed Dementia 101
7. Less Common Forms of Dementia 111
II. LOWERING THE RISK OF DEMENTIA AND
MAXIMIZING COGNITIVE FUNCTION 127
8. Accelerated Aging, Cognitive Reserve and What
We Can’t Control 129
viii CONTENTS
9. The Importance of Physical Activity and Exercise 141
10. The Need for Cognitive Stimulation and Socialization 157
11. Diet and Substances That May Reduce the Risk of Dementia 173
Afterword 191
Notes 193
Glossary 209
Index 213

PREFACE
If I had known
That old age would call,
I’d have shut my gate,
Replied ‘Not at home!’
And refused to meet him.
Anonymous Poem from Kokinshu1
‘‘A physician cannot improve on an asymptomatic patient!’’ This was a
favoriteaphorismofaprofessorofmineduringmytraininginneurology
decades ago. He was trying to convey the idea to his resident physicians
that when people feel well, you don’t make them feel better by treating
them.Andsincetheywon’tseeanybenefitsfromyourtreatment,itwon’t
makethemhappier.Infact,theymaybeunhappierbecauseofrestrictions
you try to impose, or medications you want them to take.
Myprofessor’sadmonitionisasignificantpartofthedilemmaweface
indealingwithdementia.Howdoweinducepeopletoaddressapotential
problemonthedistanthorizonwhentheycurrentlyfeelwell?Howdowe
motivate individuals to take action, or change behavior, in response to a
possiblethreatthathasnotyetmaterialized?Itisanissueofconsiderable
importance because the earlier the campaign is initiated to defeat this
unseenfoe,thegreaterthechancesthecombatantwillemergevictorious.
This dilemma is a challenge for physicians who specialize in cognitive
problems.Strategiesforpreventingdementiaaremosteffectiveiftheyare