General Medical · Health

Dementia: A Significant Decline in Cognitive Ability

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dementia refers to a number of different disorders that are characterized by a significant decline in cognitive ability. Alzheimer’s is the most common type of dementia, accounting for 60 percent to 80 percent of all cases of dementia and affecting more than 5 million people in the United States and more than 35 million worldwide. Those numbers are expected to increase significantly in coming years as the population ages.

It is most troubling when co-workers, friends, spouses, and children of aging parents notice symptoms before the affected person has been able to accept that there is a problem. Primary care doctors are often the ones first asked about how to arrange for evaluation when the symptoms have progressed beyond simple memory loss or occasional forgetfulness. The most common areas that seem to be noticed by others are disruption in:

  • Executive function, planning and decision making: this is especially difficult to pinpoint early if the person has a staff to organize appointments and carry out the daily routines.
  • Memory: the most difficulty comes with recent memory. People may repeat themselves over and over again in a single conversation and may need to be reminded about the current task they are trying to complete.
  • Language difficulties: using vague descriptions instead of articulating an idea clearly or avoiding the use of a word that can not be recalled with a “you know”
  • Dis-inhibition: saying or doing inappropriate things due to a lack of restraint with apparent disregard for social conventions, impulsivity and poor risk assessment. People with dis-inhibition may demonstrate rage.

Neurologists who are specialists in dementia are those who we rely on for evaluation, diagnosis and the development of a plan of care for the person who may not be capable of understanding the significance of their problem. Dr. Gayatri Devi, a neurologist who is the founder of The New York Memory and Aging Services Center is a compassionate physician who understands the importance of evaluating people who may be developing cognitive impairment that affects their ability to do their work. She serves as consultant to the New York State Committee for Physician’s Health, assessing physicians on behalf of this committee for cognitive and neurological deficits. Today, Dr. Devi discusses a more common problem: a woman with an over stressed and over committed life who is concerned that she is developing dementia in her 60’s — “just like her mother did.” We welcome Dr. Devi to our Medical Advisory Board.

Dr. Pat

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