Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
There are many diseases that can reduce cognitive function – your ability to think, learn, and remember. Diseases that cause significant, progressive decreases in cognitive function and significantly affect your daily functioning are called dementias. Dementias can affect many cognitive functions, including language, spatial perception, abstract thinking, and problem solving skills.
Over time, loss of cognitive function interferes with work, social interactions, and daily activities such as shopping, managing finances, dressing, bathing, and maintaining a home.
The most common type of dementia, Alzheimer’s disease, is a specific pathological condition that causes more than 75 percent of all cases. People with Alzheimer’s are often unaware that their symptoms are getting worse, or how impaired they have become.
It is possible to have mild cognitive impairment and still function normally. However, people with mild cognitive impairment have a significantly higher risk of developing dementia over time.
At present, the progression of the disease cannot be halted, although there is a lot of research underway trying to find effective treatments.
The second most common cause of dementia is vascular dementia also known as multi-infarct dementia. In this case, the dementia is caused by multiple strokes that have damaged the brain.
We may be able to prevent this form of dementia from getting worse by preventing further strokes. The use of antiplatelet agents (such as aspirin), treatment of high cholesterol and high blood pressure, and stopping smoking can all reduce the risk of future strokes.
The actual cause of Alzheimer’s is unknown. However, we know that there is a build up of an abnormal protein, called beta-amyloid, which comes from cell membrane proteins in the brain. When beta-amyloid deposits accumulate, they form a substance called plaques. The plaques damage nerve function and may lead to brain cell death. Nerve cell damage causes the progressive loss of thinking and memory skills experienced by people with Alzheimer’s. Some of the most affected nerve cells are those that release acetylcholine, a chemical that is vital for transmitting nerve impulses that support memory, judgment, and other thought processes.
Alzheimer’s can occur at any age from 45 or older, but the disease is increasingly common in older people. About 10 percent of people older than 65 have Alzheimer’s, but more strikingly, about 50 percent of people who are 85 years old have Alzheimer’s disease.
Depression is also common in elderly people without dementia. When the depression is severe, it can cause mental slowness, which can resemble dementia. Other causes of dementia can include:
Normally as we grow older, we all experience senior moments or memory lapses. For most of us, these lapses usually involve temporarily forgetting a name or something we meant to do. These incidents may be annoying, but they do not prevent us from functioning normally.
Dementia affects memory much more significantly. For example, people with dementia usually are not aware how poor their memory has become and may not even realize that they forgot something. People with normal memory loss are usually aware that they have forgotten something.
The following list highlights the differences between memory symptoms experienced during normal aging and those caused by dementia. With normal forgetfulness, you may:
With dementia, you:
Because there are many different causes of dementia, it is difficult to predict its course. Dementia has been known to progress more rapidly in some people or to last as long as 25 years in others.
As a person’s thinking becomes more impaired, they have increased difficulty in performing activities of daily living. Below is a chart that roughly graphs the progression of the disease.
|Stage of Dementia||Problems with Thinking||Problems with Daily Functioning|
Remote memory is unaffected
Language (names and paraphrases)
Difficulty performing familiar activities
If you have symptoms that you are concerned about, such as memory loss or behavior changes, talk to us about your concerns. It is helpful to bring someone to the visit who knows you well, since they can add another perspective on how well you are functioning. We will also test your cognitive function. These tests can be simple screening tests – such as answering some questions to assess your memory and reasoning abilities – or we may recommend more in- depth and complicated testing, depending on the severity of your symptoms.
There are a number of conditions that can mimic dementia, including depression, anxiety, and even medication side effects. Depending on the results of your initial visit, we may request some additional tests to evaluate the specific cause of your dementia, which will help us recommend the most appropriate treatment. Tests may include:
There is no definitive scan or laboratory test to confirm a diagnosis of Alzheimer’s, although there are some features of brain scans, such as significant atrophy (or shrinkage) of the brain, that can sometimes support the diagnosis.
Certain medical conditions and some types of medication side effects may seem similar to dementia. They include:
There are several medications used to treat the symptoms of Alzheimer's. Unfortunately, no medication has yet been developed to stop the disease from progressing. All current approved medications work by improving cognitive and behavioral symptoms.
Unfortunately, there are no drugs yet available that can actually prevent or slow the progression of Alzheimer’s disease. At the moment, Alzheimer’s drugs temporarily treat the symptoms of the disease only. There may be clinical trials that would be appropriate for you or your friend or family member. The National Institutes of Health provides information on clinical research trials that are available on its web site called Clinical Trials.gov
Exercising your brain can help reduce symptoms of dementia. Try the following:
People with advanced dementia should not drive because it is unsafe. Even people who are in the very early stages of dementia may be in danger when driving. The best way to decide if you or a family member can drive safely is to ask the Department of Motor Vehicles to evaluate driving fitness. Clues that you or a family member may be having difficulty driving include:
The California Department of Motor Vehicles (DMV) provides helpful information.
California Law (California Health and Safety Code Section 103900) requires physicians to report people with conditions that result in lapses of consciousness, episodes of confusion, or dementia.
The DMV has the sole authority to grant you driving privileges. We do not have the authority, nor are we able to hasten the review process. The DMV will send paperwork to you that has a section for us to complete. Please bring it with you to an appointment or mail it to us. Expect that it will take about a week for us to complete the paperwork. If you would like a copy, please indicate that on the forms.
Caring for a loved one with Alzheimer’s is very stressful and one person cannot do it alone. Our Health Education department has books, videos, and fact sheets that help you understand dementia and plan for the future.
Too much stress can be damaging to both a caregiver and the person with Alzheimer’s. If you are a caregiver and you feel overwhelmed and are neglecting your own physical, mental, and emotional well-being, you may be putting your health and yourself at risk.
If you are experiencing stress on a regular basis, discuss this with us or consult your doctor.
Dementia causes a number of behavioral problems including agitation, combativeness, hallucinations, incontinence, sleeplessness, and sundowning, which is an increase in erratic and disruptive behavior in the evening and nighttime hours.
Because cognitive functioning is already impaired, people with dementia are more susceptible to side effects, such as confusion, caused by medications that affect behavior. For this reason, we will help you consider non-medication alternatives to behavioral problems before we prescribe medications.
There are legal considerations for people with dementia. If you are suffering from dementia, choose someone to make medical choices for you, in case you become unable to make those decisions yourself. We strongly encourage you and your family members to complete an advanced directive and a durable power of attorney for health care.
If you were chosen by a person with dementia to make medical decisions for them, talk to them about their health care wishes now. This discussion should include the kinds of medical treatment that they would want and would not want. This information will allow you to carry out their wishes.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your medical and family history and I will assess your cognitive function―your ability to think, learn, and remember. I recommend that you bring along a friend or caregiver who can offer an objective opinion about how you are managing your daily activities.
I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.