"By 2020, there will be 29 million
demented people worldwide." That startling prediction
comes from Dr Guy Proulx, a neuropsychologist at Toronto's
Baycrest Centre for Geriatric Care. Stats such as those
— gleaned from the World Health Organization (WHO)
— are striking terror in the hearts of aging baby
boomers everywhere. 'I forgot my Botox appointment twice
in a row — is that normal? Am I on the fast track
to Alzheimer's?'
Neurologists like Dr Morris Freedman
— a colleague of Dr Proulx's and the head of neurology
as well as director of Baycrest's Memory clinic —
are seeing a noticeable increase in concerns like these
from people in their 50s and early 60s. "The baby boomers
are becoming older and there are more people in that
age group at risk for dementia," he says.
WHAT'S
NORMAL?
With an aging population reaching record highs, research
into normal versus abnormal memory loss is at fever
pitch and you can't turn over a rock without finding
a new study. Mild cognitive impairment (MCI) is the
new buzzword making the rounds in neurological circles
and garnering much research attention.
In general terms, MCI is a subtle
but measurable memory disorder. But it's very different
from dementia. People with MCI show no signs of impaired
judgment or reasoning, unlike those with dementia. Dr
Freedman concedes there is controversy about an exact
definition for MCI. To qualify for the dubious distinction,
the amnestic form of the disorder must be tested for
and documented and the person must otherwise be able
to function in the community. "In order to have that
[MCI] label, there isn't a dementia," Dr Freedman explains,
adding that not everyone with MCI will necessarily develop
Alzheimer's disease.
But, says Dr Proulx, more than
50% will. The MCI-afflicted aren't even included in
the WHO's dementia projections. Which is why following
people in those critical few years between MCI confirmation
and conversion to full-blown dementia is a crucial aspect
of current research.
SEEING
THE SIGNS
"What's important for a family doctor who sees a person
complaining of memory loss, is to make an assessment
of whether there is or isn't a significant memory impairment,"
says Dr Freedman. He says the GP's role in early detection
is extremely important, and notes an increasing emphasis
on education programs for physicians focusing on dementia
and assessment techniques.
Dr Proulx agrees and adds that
GPs are clamouring for more information. "They are desperately
asking, for sure," he says, adding, "GPs are also finding
that you could have dementias with vascular etiologies.
Not only do Alzheimer's and vascular disease tend to
co-occur, they might even interact. We're hearing a
lot about that." Chronic diseases with known vascular
risk factors include type II diabetes and hypertension;
high cholesterol, obesity and smoking are also seen
as emerging risk factors for Alzheimer's type dementias.
Many boomers are well-informed
about vascular risks and lifestyle modifications. This
is encouraging, Dr Proulx says, as early intervention
for heart disease could also benefit dementia onset.
"What's good for the heart might also be good for the
brain and if you don't intervene earlier on, time lost
could be brain lost," he adds.
CAUSE
FOR CONCERN
The fastest growing segment of the Canadian population
is the over 85s. Currently, 35% of those folks are diagnosed
with dementia, says Dr Proulx. In 10 years that number
will grow by 40%. "That's a hell of a big number."
Big enough to worry those baby
boomers already experiencing some functional impairment,
but also those others who Dr Proulx dubs 'the worried
well.' "If you've been to Loblaws and you forgot something,
that's normal," says Dr Proulx, "but if you forgot you've
been to Loblaws about an hour ago, your family would
be worried wouldn't they?" He recommends listening to
the families. MCI, by definition, needs to be corroborated
by a family member. Why? "Because it's pretty hard to
remember you can't remember... right?"
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