Friday, November 21, 2014

The Science Behind The Other Place

When Dragon started work on The Other Place, I wanted to learn more about the science presented in the play. I wasn't clear on the difference between dementia and Alzheimer's, which seems to get the most press, and wondered what the latest statistics on memory related disease was in America. Like cancer, in my experience, it seems to be a disease that hits every family in some way.

According to the national Alzheimer's Association:
"Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia.   
Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.  
Dementia is often incorrectly referred to as "senility" or "senile dementia," which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging."
 The Mayo Clinic further says:
"Memory loss generally occurs in dementia. However, memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost driving.  
Dementia can make you confused and unable to remember people and names. You also may experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible."

I know that I'd heard that you can't officially diagnose Alzheimer's, and in the play they reference the fact that they can't officially diagnose Juliana's illness while she was still alive, which made me wonder about the diagnosis process and the truth of that statement.

According to the Mayo Clinic, some common symptoms of dementia include:

  • Memory loss
  • Difficulty communicating
  • Difficulty with complex tasks
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Problems with disorientation, such as getting lost
  • Personality changes
  • Inability to reason
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations
Further, the National Institute of Health's Institute on Aging says this about Alzheimer's: 

"Alzheimer’s disease can be definitively diagnosed only after death, by linking clinical measures with an examination of brain tissue and pathology in an autopsy. But doctors now have several methods and tools to help them determine fairly accurately whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause) or “probable Alzheimer’s dementia” (no other cause for dementia can be found). 
To diagnose Alzheimer’s, doctors may:
  • Ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
  • Conduct tests of memory, problem solving, attention, counting, and language
  • Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
  • Perform brain scans, such as computed tomography (CT) or magnetic resonance imaging (MRI), to distinguish Alzheimer’s from other possible causes for symptoms, like stroke or tumor
These tests may be repeated to give doctors information about how the person’s memory is changing over time. 
Early, accurate diagnosis is beneficial for several reasons. It can tell people whether their symptoms are from Alzheimer’s or another cause, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medications, or other conditions that may be treatable and possibly reversible."
Since Alzheimer's is by far the largest subset of dementia, I wondered how prevalent the disease is. The Alzheimer's Association reports that around 5 million Americans are currently living with Alzheimer's disease. Almost two-thirds of those Alzheimer's patients are women. In her 60s, a woman's estimated lifetime risk for developing Alzheimer's is 1 in 6. For breast cancer it is 1 in 11. Alzheimer's disease is the 6th leading cause of death among Americans. In 2013, 15.5 million caregivers provided an estimated 17.7 billion hours of unpaid care valued at more than $220 billion. 

Not only does it take a severe emotional toll, it takes a massive financial toll on America as Alzheimer's disease is the most expensive condition in the nation. In 2014, the direct costs to American society of caring for those with Alzheimer's will total an estimated $214 billion, including $150 billion in costs to Medicare and Medicaid. 

Nearly one in every five dollars spent by Medicare is on people with Alzheimer's or another dementia. The average per-person Medicare spending for those with Alzheimer's and other dementias is three times higher than for those without these conditions. The average per-person Medicaid spending for seniors with Alzheimer's and other dementias is 19 times higher than average per-person Medicaid spending for all other seniors.

There is currently no cure for Alzheimer's but there a whole lot of research being directed in the area. Some traction has recently been made on helping to delay the inevitable progression and there are a number of clinical trials open to patients to help test new solutions. 

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