Ask Dr. Pat

Dr. Pat Consults: Dementia—Symptoms, Risk Factors, and Diagnosis

1191298435_0b95af8b7c_zFor those with dementia, memory loss significantly impairs their ability to take care of daily activities.
(Image by Ehsan Khakbaz via Flickr. Creative Commons License)

There are a number of risk factors for developing dementia. These can be thought of broadly in two categories: those that you can do something about and those that you cannot. Risk factors you can’t change include aging—risk dramatically rises with age, with over 50 percent of those older than 85 being affected—and genetics. A family history of early onset Alzheimer’s, which develops prior to the age of 60, has the strongest and best understood genetic connection. You mention your mother developed Alzheimer’s in her 80s. For late onset Alzheimer’s, the underlying genetics are thought to be much more complex. Thus, while you are at somewhat greater risk of developing Alzheimer’s than someone without an affected parent, it is less likely than those with a family history of the early onset form of the disease.

The good news is that there are some risk factors you can alter and you are already doing this. High blood pressure, high cholesterol, and diabetes all increase risk for Alzheimer’s disease as well as another form of dementia called vascular dementia. Smoking has also been associated with increased risk of dementia. Finally, repeatedly studies have shown a positive impact of an active lifestyle. Maintaining a strong social life, getting regular exercise and continuing to be mentally active have all been associated with decreased rates of dementia later on.

A certain level of cognitive decline is a normal part of the aging process. Most often, this consists of a slower rate of processing information and mild impairments in memory. However, unlike dementia where there is an ongoing significant decline in function, in normal aging this does not typically impair your ability to go about your regular daily activities, like washing clothes, grocery shopping, paying bills, and driving home from work. Most often, it is the family that first notices the change and loved ones are more likely to pick up on the early stages of dementia than the person affected with the illness.

Dementia is diagnosed with a combination of careful interviewing and cognitive testing. While the issues you describe—occasional trouble with recent memory and misplacing items—sound more like normal aging than dementia, you may want to further discuss your concerns with your physician. Also, a full physical exam and laboratory testing are important to rule out other physical causes that can cause memory difficulties. It is important to recognize as well that, for some, depression can appear very similar to dementia and one can respond well to antidepressant medication and therapy.

Unfortunately, we do not have effective treatment for Alzheimer’s disease. Much of the current therapy focuses on managing such behavioral changes as angry outbursts, mood swings, and difficulty sleeping. We have made little progress, however, in slowing the ultimate cognitive decline. The most popular set of medications to target the cognitive effects of the disease— cholinesterase inhibitors, like Aricept, Exelon, and Razadyne, or memantine (trade name Namenda)—don’t actually halt the progression of the disease, but may stabilize symptoms for a little while. For about half the patients in the early stages of Alzheimer’s who take these medications, they show modest benefits for about six months, allowing some people to remain in their home longer than they might have otherwise. However, right now our best approach is to do exactly what they did in the film, which is to focus on maintaining quality of life for individuals affected while maintaining safety. This can include things like simplifying the daily routine, labeling everyday items, and placing locks on doors. As with Glen, loved ones play a central role in helping maintain quality of life for those living with Alzheimer’s and other forms of dementia.

Hopefully, with an increased awareness will come an increase in money for research into possible treatments for this devastating illness. Currently, although the cost for caring for those with Alzheimer’s has surpassed the cost of treating cancer, funding lags far behind. While the government plans to spend more than $5 billion on cancer, only about a tenth of that amount is being spent on Alzheimer’s research. Only with more money will we have a chance at discovering effective treatments.

In sum, some decrease in memory is normal and you are already taking steps to decrease your risks by remaining active and controlling your high blood pressure. If you are concerned or you find yourself having more difficulties with your memory, consider making an appointment with your primary care doctor for a thorough assessment. Hopefully, the coming years will see scientific advancements to help halt this tragic illness.

 

References

Alzheimer’s Association. (2014). Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 10, Issue 2.

American Psychiatric Association. (2013). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Reid TR. (2015). Falling Behind on Alzheimer’s Research. In AARP Bulletin.

Shadlen M, Larson EB. (2015). Risk factors for cognitive decline and dementia. In UpToDate.com.

Sherva R, Kowall NW. (2015). Genetics of Alzheimer disease. In UpToDate.com.

 

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  • Megan Riddle July 17, 2015 at 2:15 pm

    Dear Brenda,

    Excellent question! Is this something you’ve always done or is it new? If it’s something new, please make an appointment to discuss it with your primary care doctor. For those with dementia, it is fairly unusual for them to have the insight to realize they are saying or doing anything that is abnormal. They are typically entirely unaware that they just blurted out something inappropriate at the dinner table or went out without socks and shoes in a rainstorm. That being said, the fact that you are avoiding social engagement could really have a negative impact on your life. Have you talked to anyone else about this? Sometimes we can be overly self-conscious about what we say, while others barely notice a thing. If, though, you find it affecting your life, a trip to your primary care doctor and meeting with a therapist might be reassuring and help improve your social life.

    Best,
    Megan

    Reply
  • Brenda Yates July 13, 2015 at 10:20 pm

    You mention “Social Cognition”… Sometimes I hear myself say the most inappropriate things.. it’s embarrassing! I find myself avoiding social situations more now..
    Do you have any advice for me? Am I (hopefully!) only losing a small part of my mind?
    Thanks to you..

    Reply