Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

28 Nissan 5760 - May 3, 2000 | Mordecai Plaut, director Published Weekly








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Home and Family
Your Medical Questions Answered!

by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

The year was 1983. Ronald Reagan was at the height of his presidency, and during a speech to the press, he made a minor mistake. He then quipped, "You know what the best thing about Alzheimer's disease is: You make new friends everyday." It was a tasteless joke. Little did president Reagan know that within ten years he would be unable to tie his own shoelaces, a victims of the very same disease he joked about.

Senility is what the public calls dementia and Alzheimer's is just one form of it. Repeated mini strokes and Parkinson's disease are other common causes. While the prevalence of senility is only 5-7% by age 80, by age 95, 50% of people are senile. In the U.S.A., about 5 million people have this problem.

Typically, the disease starts gradually, with short term memory impairment (long term memory is usually intact to begin with). Long term memory includes birth date, address, recognizing family members yet there can be language problems and errors in judgment, such as losing one's way on the way home or forgetting why one is in specific store. Depression is common at this point as most people recognize what is happening. Later problems in walking and with using the bathroom occur, as well as failure to eat and perhaps aggressive behavior. Many then progress on to an inability to eat and speak. To see a person reduced to this is a difficult thing for a doctor and family.

The biggest risk for dementia is age, but family history is important as well -- there may be a genetic element to the disease. Other risk factors include head injuries, depression, low level of education, deprived nutrition during pregnancy or early brain development as an infant, and repeated exposure to fumes of industrial cleaners.

While many tests can be done including CAT scans of the head and MRIs, they aren't terribly useful. There is a standardized questionnaire that is most helpful and a baseline mental and memory exam will also aid in diagnosis.

While in the past the prognosis was dismal, now there is some hope for delaying full-blown development of the disease. The newest breakthrough is a drug called Aricpet, which in a small amount of patients, can lead to improved functioning and ability to recognize things. It also seems to slow the rate of decline of the patients but the results are not dramatic. But at least this is a start and we are looking forward to more hopeful information from drug therapy.

Less proven therapies which may help include high dose Vitamin E, selegiline (a drug used in Parkinson's disease), and the extract from the nut of the Ginkgo tree. Again, the results are not miraculous and they do not cure the disease.

On the other hand, I must remind my readers that occasional forgetfulness is not a negative sign. We all forget, especially when "our mind is elsewhere." Only when it is sustained and getting gradually worse is it time to be concerned.

Many of these patients are institutionalized, but if you decide to take care of an elderly parent at home, and I think it is a praiseworthy thing, be aware of the difficulties and make sure you are well read on the subject and have a strong support group. Write me in care of the Yated.

While the evidence for the reliability and safety of the chicken pox vaccine is excellent, it still hasn't been approved for usage in Israel. Consequently, many children get the chicken pox and their doctors are not aware there is a treatment to lessen the disease's course. Zovirax, and a newer drug Valtrex, both treat chicken pox as powerful antivirals. They also are first line treatment for shingles in the elderly and Zovirax cream works well against cold sores. Ask your doctor about Zovirax and Valtrex.


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