Ask Dr. Pat

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

Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.— a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to address a woman concerned that her small lapses in memory are early signs of dementia.

 

Dear Dr. Pat:

My friends and I saw the Glen Campbell movie, I’ll Be Me, that talks about his struggle with Alzheimer’s disease and recently aired on TV. Now it is a continued topic of conversation. We’re a group of women, in our late 50s and early 60s. We’re active, most of us still work full-time and we meet regularly to walk on local trails. However, we’re reaching the age where, every time one of us leaves the milk out or can’t find our glasses, we wonder, “Could this be Alzheimer’s?

For me, I’m 63 and, like Glen in the documentary, I am in good physical shape, just taking a medication for my high blood pressure. I do worry, though, that I am not as mentally sharp as I once was. The other day, when my husband got home from running errands, he found the keys in the front door, where I had left them when I got home from the grocery store. The other day, I couldn’t remember the name of someone at work whom I was introduced to the day before. My husband says I’m making a mountain out of a molehill and that he hasn’t noticed any changes, but from the movie it seems that things start very gradually. I shared all this with my friends and, while some laughed, others have had similar experiences—forgetting someone’s name or walking into a room and not being able to remember why they went there. My mother developed Alzheimer’s in her late 80s and had to be put in a nursing home when the family could no longer safely care for her. I worry that that is where this is going. Watching the film last weekend really brought all of this to the forefront. What do you think? Could I be developing Alzheimer’s?

Sincerely,
Marion

 

Dr. Riddle Responds:

Dear Marion:

Thank you for writing in. I’ll Be Me has put the spotlight on Alzheimer’s, raising public awareness about dementia. Your apprehension about your memory is both understandable and also normal, as we try to decipher whether small lapses in memory are normal or an indication of something more significant. Given your experience with your mother, it is not surprising that you would be concerned.

For those who have not had the opportunity to see the film—and I would recommend it if you have not—the documentary follows singer Glen Campbell and his family on his farewell tour after his Alzheimer’s is diagnosed. What was initially planned to last five weeks stretched into a year and a half, as Glen performed at more than 150 shows across the country, his children playing on stage with him. It is an intimate portrait of a man and a family struggling with what is currently a progressive and incurable illness.  With the film, we have the opportunity to see the sorrow and the anger, but also the lighter moments and small triumphs. I’ll Be Me along with the award-winning film Still Alice, released earlier this year for which Julianne Moore won an Oscar, reflects an increasing awareness of the rising tide of Alzheimer’s disease affecting our country as the nation ages.

Dementia is an umbrella term referring 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, with those numbers expected to increase significantly in coming years as the population ages. In the latest version of the DSM, the diagnostic text used by psychiatrists, dementia has been renamed as Major Neurocognitive Disorder, which, although a mouthful, is an accurate description as dementia is a neurological disorder that affects cognition, people’s ability to think.

Dementia goes beyond simple memory loss or occasional forgetfulness. The diagnosis of dementia includes trouble with at least one of the following:

  • Complex attention: This includes the ability to pay attention to one thing when there are competing things going on as well. For example, individuals may be unable to follow a conversation when the TV is on in the background.
  • Executive function: This encompasses planning and decision making. An individual may have trouble organizing daily activities, like putting together a shopping list.
  • Learning and memory: Typically, the greatest difficulty is with recent memory. Individuals repeat themselves frequently within a single conversation and may need to be reminded often about current tasks they are trying to perform. As we see in the Glen Campbell film, longer term memory is initially preserved, but even this can fade with time.
  • Language: People affected may struggle with word-finding, using generic phrases like “you know what I mean” and “that thing.” Eventually it may progress to an inability to speak.
  • Perceptual-Motor: This can include getting lost in familiar environments or an inability to do tasks that were once easy, like using tools or operating household appliances.
  • Social Cognition: Those with dementia may show significant changes in social behavior, like saying or doing inappropriate things, being insensitive to others, and behaving in ways that may be unsafe. They may dress inappropriately, wearing a T-shirt out in cold weather, or display significant paranoia.

While we all (regardless of age) may occasionally have trouble recalling a word, be unable to remember where we parked the car, or awkwardly miss a social cue, for those with dementia, this significantly impairs their ability to take care of their daily activities, interfering with their ability to live independently.

Next Page: Risk factors for developing dementia.

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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