Aging Brain

Compilation from: Dr. Lam

Introduction
Less than 30 years ago, the prevailing medical wisdom declared that "senility" was the
result of either normal aging or hardening of the arteries. Today we are getting closer
to truly understanding the causes of the major neurological disease of old age, the
aging brain, for which one of the many symptoms is failing memory. As the brain ages,
mental and physical functions are impaired. The most extreme form of this process
can lead to death.
While the rest of our body reaches its prime around age 30, starting its natural
progression of declining health soon thereafter, our brain does not start loosing its
major functions until our 60s. The indicator of an aging brain is loss of brain tissue
with men losing brain tissue almost three times faster than women, according to a
study conducted at the University of Pennsylvania in 1999.
Four million Americans suffer from dementia, the hallmark of Alzheimer's Disease
(AD). This number is expected to swell fourfold by the year 2040. 12% of people aged
60 and above, and 50% of those over 80 years of age, suffer from dementia, and the
main cause is AD. Dementia is the fourth leading cause of death in those over 60. AD
alone kills 100,000 people per year in the U.S.A. Onset of symptoms can start as
young as 40 and continue for about 20 years before severe symptoms - such as loss of
memory, inability to carry out normal work and being irritable and suspicious - show.

Pathophysiology of Dementia and Alzheimer's Disease (AD)

AD is a degenerative disease characterized by progressive mental
deterioration, memory loss, and dementia. Memory and abstract thought
processes are impaired. Symptoms include depression, disorientation of space
and time, inability to concentrate and communicate, loss of bladder and bowel
control, memory loss, personality change, and severe mood swings. Death
usually occurs within 5 to10 years as the individual becomes totally
incapacitated. Nerve fibers surrounding the hippocampus, the brain's memory
headquarters, become tangled and shrunken. Information cannot be properly
transmitted, new memory cannot be formed, and old memories cannot be
retrieved. Characteristic plaques of beta-amyloid protein build up and damage
nerve cells.

Diagnosis
There are no reliable and accurate markers , in the form of blood tests, of
dementia and AD. A brain scan is helpful in marking the progression of the
disease by indicating the brain's glucose metabolism rate. A test measuring
electrical activity in the brain can be helpful, but not definitive. The
measurement of the amount of beta-amyloid found in spinal fluid is not a
definitive diagnostic tool either. Diagnosis of AD is not straightforward

and rests largely on a combination of clinical findings, confirmed by a

specific set of physiological changes in the brain.

What Are Your Chances of Dementia and AD?

While the average age of an AD patient is in the 70s, the disease begins to
make its appearance years earlier (in the 40s, 50s, or 60s) as mental
problems such as chronic forgetfulness and difficulty in handling routine
chores.
During this borderline state, called mild cognitive impairment (MCI), people are not
demented but they do perform worse than their peers on memory tests. Family
members are the first to notice this impairment. People who meet the criteria for MCI
will degenerate into clinical AD at the rate of 10-15% percent a year, according to
Ronald Peterson, director of the Mayo Alzheimer's Disease Center. By contrast, normal
elderly people deteriorate at the rate of 1-2% per year.
If you have relatives with AD, your chance of developing AD is higher than
the general population. 49% of relatives of AD patients develop the disease
by age 87.
It is important not to over-diagnose AD. There is a group of normal, aging adults
who feel forgetful but perform well on cognitive tests. This "worried well" group
develops AD at the rate of 3% per year. Forgetting where you put your keys is
not AD. Not knowing what you should do with your keys can be a form of
dementia.