Driving and Dementia

A new study from Rhode Island Hospital and Brown University show that adults who have Alzheimer's disease are involved in more traffic accidents and perform more poorly on driving tests than their peers who do not have any cognitive impairment.

Researchers studied 128 older drivers. Eighty-four were in the early stages of Alzheimer's and 44 were age-matched controls with no cognitive impairment.  The goal was to understand driving impairments in adults with very mild to mild dementia.

In addition to an increase in traffic accidents and a decrease in performance on driving tests, adults with Alzheimer's showed significant and steady decrease in their driving abilities over time.  Although some individuals with very mild dementia can continue to drive safely for a period of time, regular driving assessments are necessary to avoid accidents.

So how do you know when you or your loved one should stop driving?  Some people naturally understand the risks involved in driving with a cognitive impairment and stop by themselves.  Others lack the ability to judge their skills and may insist they are able to continue to drive even when it becomes obvious to others they cannot.

Driving is privilege, not a right and adults who have been diagnosed with very mild or mild dementia have an obligation to have their driving skills evaluated.  Individuals with moderate to severe dementia should not drive at all.

Independent driving evaluations are often available through driver rehabilitation programs or your state DMV.  Googling "driver evaluation" and your state should get you several names in your geographic area who offer this service. 

Your physician may be required to report a diagnosis of dementia to the DMV, resulting in the automatic suspension of a driver's license.  However, reporting laws are different in each state.  When a driver is reported to the DMV, they may be required to take a new behind-the-wheel driving test.

If you or other family members are driving with a person with dementia, it is your obligation to monitor their driving skills.  Signs of potential trouble include drivers who stop in traffic for no apparent reason or fail to stop at stop signs or red lights; getting lost in familiar areas or not being able to remember the way home; traffic violations, fender benders or near-misses; or driving too slowly.

High Blood Pressure and Dementia

Health advocates stress the importance of "knowing your numbers."  These important numbers include your weight, body fat, cholesterol, blood sugar, and blood pressure.  Overall physical health is important to maintain a healthy brain.  Uncontrolled high blood pressure leads to more cognitive problems as we age.  Blood pressure naturally increases with age and hypertension, sometimes referred to as "the silent killer," affects approximately 60% of adults over the age of 60.

Multi-infarct dementia, one of the most common causes of dementia in older adults, is caused by a series of strokes that destroy nerve tissue in the brain.  The most common risk factor for this type of dementia is high blood pressure.

If you don't know your numbers, you should see your doctor and have your blood pressure tested.  In the meantime, The Mayo Clinic has an online quiz to check your risk of high blood pressure.  It only takes a few minutes and it just might save your life!

B12 Helps Maintain a Healthy Brain

A new study in the American Journal of Clinical Nutrition (November 2007) suggests that deficiencies of vitamin B12 can cause cognitive impairment in adults.  The study tracked 1648 men and women over the age of 65 over the course of 10 years.  

Vitamin B12, also called cobalamin, helps to keep nerve cells and red blood cells healthy.  It is also used in making DNA.  It is found in many foods that come from animals, including fish, meat, poultry, eggs, milk and milk products.

Symptoms of a B12 deficiency include: anemia, fatigue, weakness, constipation, numbness and tingling in the hands and feet, depression, confusion, disorientation, dementia, and soreness in the mouth.  Many of these symptoms mimic the signs of Alzheimer's but are reversible with the proper treatment.  

According to the National Institutes on Health, " Vitamin B12 is bound to the protein in food. Hydrochloric acid in the stomach releases vitamin B12 from proteins in foods during digestion.  Once release, vitamin B12 combines with a substance called intrinsic factor (IF).  This complex can then be absorbed by the intestinal tract."  Because of this process, adults with GI problems who use some antacids that slow the release of hydrochloric acid into the stomach, may not be able to effectively absorb B12.  Examples of these medications include Prilosec, Prevacid, Tagament, Pepsid, and Zantac.

Metaformin, a drug used to treat diabetes, may interfere with the absorption of calcium which then leads to difficulty in the absorption of B12.  Researchers found that using calcium carbonate supplements helped to minimize the effect of Metaformin on the malabsorption of B12.

If you take any of these medications and are experiencing cognitive difficulties (problems with your memory, concentration, attention, thinking) talk to your doctor.  He or she may order blood tests and/or suggest supplements.  It is important that you do not stop taking anything that has been prescribed by your physician without medical advice.

For more information on Vitamin B12, including a list of foods high in B12 and a list of medications that may interfere with the absorption of B12, see the factsheet from the National Institutes on Health at http://dietary-supplements.info.nih.gov/factsheets/vitaminb12.asp

Normal Aging and Dementia

Do you know the difference between normal aging and dementia?  If not, the Alzheimer's Association publishes the following list:  10 Warning Signs of Dementia.  If you are concerned about your ability to think, to remember, or to concentrate, ask yourself the following questions:

1.  Memory Loss:  Forgetting recently learned information is one of the most common early warning signs of Alzheimer's disease.  Do you forget things more often or find yourself unable to recall information later?  Do your friends or family tell you that you keep repeating the same question over and over again?

2.  Difficulty Performing Familiar Tasks:  Do you have difficulty planning or completing everyday tasks?  Do you lose track of the steps involved in preparing a meal, placing a telephone call, or playing a game?

3.  Problems with Language:  Do you often forget simple familiar words or substitute unusual words?  Do you mimic actions when you can't remember the words to describe them?  People with dementia may be unable to think of the word "toothbrush" for instance and instead ask for "that thing in my mouth" or mimic the action of brushing their teeth.

4.  Disorientation to Time and Place:  Do you ever get lost in your own neighborhood, forgetting where you are or how you got there?  Have you ever been unable to find your way home?

5.  Poor or Decreased Judgment:  Has anyone told you lately that you dress inappropriately, wearing several layers on a warm day or little clothing in the cold?  Do you ever show poor judgment, like giving away large sums of money or engaging with telemarketers who tell you you've won a sweepstakes?

6.  Problems with Abstract Thinking:  Do you ever have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used?

7.  Misplacing Things:  Do you ever put things in unusual place, such as your watch in the sugar bowl or your keys in the freezer?

8.  Changes in Mood or Behavior:  Do you experience rapid mood swings, from calm to anger or tears, for no reason?

9.  Changes in Personality:  The personalities of people with dementia can change dramatically.  Have you become extremely confused, suspicious, fearful or dependent on family members?

10.  Loss of Initiative:  Have you become very passive, sitting in front of the TV for hours, sleeping more than usual?  Have you lost interest in your usual activities?

To find out more about the 10 Warning Signs of Dementia, visit the Alzheimer's Association website at www.alz.org

Most Older Adults Have Brain Disease

A study from The Rush Memory and Aging Project at Rush University Medical Center in Chicago suggests that most older adults have significant brain disease when they die even if they don't have any signs or symptoms of dementia.

Researchers in the study evaluated the brains of 141 subjects, both with and without any clinical signs of dementia.  Only 20 were free of any physical signs of brain disease.  And many of the subjects with clinically diagnosed dementia had several different types of pathology causing their cognitive impairment.  The most common combination was Alzheimer's along with signs of stroke damage; the second was Alzheimer's with Lewy Body disease, which has symptoms similar to Parkinson's disease.

The take away message from this research is that, although the prevention of Alzheimer's is important, it is also necessary to prevent other types of pathologies such as stroke by managing high blood pressure, high cholesterol, diabetes, obesity, and smoking.

For more information or to participate in the Memory and Aging Project, go to

www.rush.edu.rumc/page-1099611542239.html