Alzheimer’s and Cognitive Disorders

"Cognition" is a fancy word that mental health professionals use to describe the wide range of brain-based behaviors that we rely on every day. Cognition encompasses lots of different skills, including perception (taking in information from our sensory organs), memory, learning, judgment, abstract reasoning (thinking about things that aren't directly in front of us), problem solving, using language, and planning.

We take many of these cognitive skills for granted as we go about our routine activities. For instance, eating breakfast in the morning is a relatively complex task that involves multiple steps. First, we need to be aware of (health care professionals call this "oriented to") the time, and realize that it is appropriate to have an early meal. Next, we need to decide what to eat, which involves generating different meal choices and making a selection. Then, we need to follow the correct steps in order to prepare the meal. Even something simple like a bowl of oatmeal can be ruined if the preparation steps are not followed in the correct order (e.g., if you forget to add the water to instant oatmeal before heating it up in the microwave). Finally, we need to remember how to use utensils and swallow in order to eat.

Damage to any part of the brain can cause a cognitive disorder, which is a "catch all" term used to describe impairment in any one (or all) of the thinking skills that we described above. Cognitive disorders used to be called "organic mental syndromes" or "organic mental disorders" to indicate that these disorders had a brain or biological basis. However, the term "organic" is no longer used because it implies that all other mental disorders (not categorized as organic) do not have a biological basis. Most mental health professionals now believe that the majority of mental disorders are caused or influenced by brain chemistry or another medical issue that affects how the brain functions.

Many people mistakenly use dementia as a synonym for Alzheimer's Disease. This use of the word is inaccurate; "dementia" is an umbrella-like term that refers to any brain syndrome that causes multiple cognitive deficits. In other words, saying someone has "dementia" is similar to saying that someone has a fever; you are not specifying the exact cause of the symptoms.

A person with dementia can experience all sorts of problems, including:

• Impaired Memory (especially the ability to remember recent events and newly learned facts)
• Impaired Language Skills (decreased ability to communicate to others and understand what is being communicated)
• Impaired Orientation (not knowing who one is, where one is, and/or what time it is)
• Impaired Judgment (impaired ability to make decisions regarding personal, interpersonal, financial, and/or medical affairs)
• Impaired Executive Functioning (impaired ability to plan and carry out daily tasks and make decisions).

Dementia can be caused by one medical condition or by multiple medical problems. Most dementias are caused by one of the following:

• Alzheimer's Disease, which accounts for 50-70% of all dementia cases
• Vascular Disease, which accounts for 15-20% of all dementia cases and includes strokes (disruptions in the blood supply to the brain) and transient ischemic attacks (TIAs, or mini strokes)
• Lewy Body Disease, which accounts for up to 20% of all dementia cases

Alzheimer's Disease (AD) is the most frequent cause of dementia. For many decades, people thought that "senility" was a natural part of getting older; consequently, AD did not receive much attention as a real medical disorder. It is now considered a major public health problem that is causing serious issues for families and society. According to the National Institutes on Aging, the cost of caring for all of the people in the US with AD is about $100 billion every year.

Alzheimer's Disease is not a normal part of aging or "just what happens when we get old." If AD was part of the natural aging process, we'd have a very large group of people (every person over 65) walking around today with this disorder! As we age, we do experience minor changes in memory and thinking. But, these changes do not seriously impair our daily functioning or our ability to live independently and take care of ourselves. There are several differences between normal aging and Alzheimer's Disease:

• Forgetfulness - People aging normally might forget part of an experience (I can't remember what I had for breakfast yesterday). People with Alzheimer's Disease will forget the entire experience (I can't remember yesterday morning at all).
• Remembering - People aging normally may forget something (such as a movie recommendation for a friend), but they will eventually recall the desired information (e.g., later in the evening or the next day). People with Alzheimer's will not recall the information at a later time.
• Comprehension - People aging normally can usually follow verbal or written instructions with no problem (e.g., filling out a sweepstakes entry or following a recipe). People with Alzheimer's Disease become less and less able to follow instructions (or multiple step directions) as the disease progresses.
• Memory Aids - People aging normally will usually benefit from using notes and other reminders (e.g., a grocery list). People with Alzheimer's gradually become less able to benefit from memory aids (e.g., they will forget that they have a list, or forget how to use the list).
• Self-Care - People aging normally may be stiff or have some aches and pains, but they can still complete personal care tasks (e.g., bathing, dressing, styling hair, going to the bathroom, etc.). People with Alzheimer's lose the ability to perform these kinds of tasks because they cannot remember the steps involved, and eventually, they won't remember when these tasks are appropriate.

There are different terms that health care professionals use to further specify different types of Alzheimer's Disease. "Familial AD" runs in families (i.e., is passed on from generation to generation). Individuals who develop AD before age 65 are said to have "early-onset Alzheimer's Disease." Early-onset familial Alzheimer's Disease is the most aggressive form of AD; those affected by it suffer a swifter cognitive decline than individuals with late-onset Alzheimer's Disease (occurring after age 65).