A. Mark Clarfield
Several years ago at a public ceremony, a member of Europe's royalty forgot where she had put her reading glasses. Her husband may have thought that his regal spouse was showing signs of early Alzheimer's disease. However, Her Royal Highness clearly remembered that she wore glasses. In this distinction lies the difference between normal aging and dementia.
However, when the family doctor is concerned that a patient is suffering from one of the dementias--an insidious loss of higher cerebral functions including memory, judgment, affect, orientation, behaviour and language skills--further differentiation must be made. Most demented patients suffer from Alzheimer's disease or from brain damage resulting from multiple strokes. Unfortunately, in either of these situations there are few available treatments that can either reverse or limit the ongoing brain damage. For a fortunate few with a reversible cause for the dementia, early treatment can actually result in a significant improvement in the cognitive dysfunction.
Only a decade ago, the highest medical authorities held that anywhere from 20-40% of dementias were reversible. However, meta-analyses of the data indicated that reversibility occurred in no more than 11% of cases.1,2 Even more recent community-based studies indicate that, unfortunately, most dementias are incurable (although certainly not unmanageable); probably less than 1% fall into the reversible category.