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ever gracious hostess, Marta has never reproached me for spending an hour on the phone with the animal hospital in Washington and for missing the first two courses of her delicious and lovingly prepared meal. It is easy to guess what I wish for when I stand between the two Martas. I wish that the friendship endures. And as time goes by, I think this wish thing really works. Fashions have come and gone, jobs, boyfriends and husbands have come and gone, ambassadors and even presidents have come and gone, but The Three Martas are here to stay! ALZHEIMER1 S DISEASE/DEMENTIA by Ihor Magun, M.D. Dementia is a syndrome in which our higher- reasoning ability decreases to the point that it interferes with even simple activities of daily living. There are two major causes of dementia in older individuals: Alzheimer's disease and vascular dementia. People as young as forty can get Alzheimer's, but it usually affects people over the age of seventy-five. As a greater number of individuals are living longer, there is more public awareness of problems occurring with changes in intellectual ability as people age. Individuals with Alzheimer's disease have a progressive decline in mental abilities accompanied by behavioral changes. The disease begins with diffuse injury to the brain with the formation of fibrotic areas called neurofibrillary tangles. These can only be confirmed with a biopsy, which is rarely performed except post-mortem. The etiology (cause) of this disease remains elusive, but there has been significant progress in the biochemical and genetic research on the disease. Vascular dementia, which accounts for about fifteen per cent of dementia cases, is caused by strokes and can be due to problems with small blood vessels. Individuals afflicted with vascular dementia probably have other medical problems, including hypertension, diabetes, and elevated cholesterol. Special imaging techniques such as CAT scans and MRI scans can appear deceptively normal. There are specific criteria used to diagnose dementia, but anyone who seems to be exhibiting symptoms of dementia should be evaluated to exclude any condition which appears to be dementia but is a correctable medical condition. The greatest problem with dementia is usually the behavioral problem which can be extremely difficult to deal with, especially for caregivers. To reduce problems, one needs to simplify the patient's environment and to focus on factors which provoke disruptive behavior and minimize them. For end-stages dementia, in the individual with few or no verbal abilities, the quality of life is very poor. The main problem for caregivers is not knowing the specific wishes of the individual. All families should have what is known as an advanced directive. This should be addressed during the early stages of dementia where specific individual preferences about the desire for cardiopulmonary resuscitation, tube feeding and antibiotics can be determined. Certain studies have shown that there are several medical therapies which slow the progression of dementia. One is estrogen replacement in women. Aspirin and ibuprofin and Vitamin E supplementation are other agents suggested. These should be considered only recommendations; they have not been proven to be the standard treatment regimen. For vascular dementia, control of the underlying problem is as important as the use of aspirin or Vitamin E. Two medications with variable results are currently available, Cognex and Aricept. Other medications are in the final stages of development and may prove to be of greater value. With improved medical research and the use of computer technology, the overall management of dementia will be easier. The future appears promising. The National Alzheimer's Association in the Untied States of America is veiy supportive and is a wonderful source of helpful information. They may be reached at 1-800-272-3900 or via Internet at www.alz.org. 22 “НАШЕ ЖИТТЯ”, БЕРЕЗЕНЬ 1999 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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