Dementia is a progressive brain disorder that affects memory and is becoming increasingly common across the globe. “Dementia as a broad category is a decline in cognitive function that most of the time is not reversible. The disease causes memory loss as its earliest sign and progresses to interfere with one’s daily life,” Dr. Theodore Strange, Chair of Medicine at Staten Island University Hospital such as Eat This, Not That! Health. He adds, “Normal forgetfulness of aging is not dementia. Dementia negatively impacts memory and Alzheimer’s not only affects the memory but also cognitive function.” According to the World Health Organization, “Currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year. Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain.” Dr. Andrew E. Budson, MD. a contributor for Harvard Health states, “this number is estimated to rise to 78 million by 2030 and 139 million by 2050. There are simply not enough neurologists, psychiatrists, geriatricians, neuropsychologists, and other specialists to diagnose these individuals with cognitive decline and dementia. Primary care providers will need to take the lead.” Eat This, Not That! Health spoke experts who explain signs of dementia to watch out for and what causes the condition. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
Dr. Cathryn Devons, MD, MPH Director of Geriatrics Phelps- Northwell Sleepy Hollow, New York tells ETNT! Health signs that are particularly disturbing to her:
– “Short term memory loss.
-Confusion with medication may ensue, causing safety issues.
-Driving concerns. Safety for patients and others.
-Ability to live safely on one’s own
-Ability to take care of oneself, and the home.
-Traumatic brain injuries.”
Dr. Strange adds, “The worrisome signs would be first memory loss of normal routine activities or surroundings which may manifest as repeating questions or avoiding answers. Secondly, when daily living activities are affected which could include not remembering to shut off the stove, driving issues with recent accidents, or starting to not care for personal needs is next to be worried about. Finally, when patients become dependent on others to care for their personal adult daily living activities like grooming, toileting, dressing, ambulating etc.; this is the most worrisome and probably too late to treat.”
According to Dr. Strange, “One needs to seek medical attention for Alzheimer’s type dementia when memory loss, personality changes, problem solving abilities, getting lost easily from normal surroundings become apparent. This would be at a mild stage. When this progresses to a moderate stage, patients may need help with daily living activities like shopping, banking, driving or even personal activities like grooming and self-care. Personality and behavioral changes become more apparent. The progression to severe disease occurs with symptoms including the loss of ability to communicate that may make sense, assistance with personal care including bathing, toileting and dressing, and overall, decline in physical abilities. The earlier these stages are picked up, treatment options can be considered to slow the progression of the disease. Some can last and be treated very effectively for over 10 years.”
Dr. Devons lists several causes of dementia which include:
-Cerebrovascular disease – sometimes involving a series of strokes.
-Fronto-temporal dementia – often in younger people and more rapidly progressive – affects personality and judgment.
-Primary progressive aphasia – affects language first.
-Parksinson’s disease – often starts with tremor, movement disorders.
-Lewy body dementia – often associated with hallucinations.
-Brain tumors – often rapid onset – and sometimes seizures occur.
Some types of multiple sclerosis
Dr. Strange says, “There are some ways to slow the progression down which include healthy living with exercise and good nutrition. If there is a vitamin deficiency like b12, they’ll need to replace the deficiency, and medications like donepezil, memantine or the newest approved treatment named Aducanumab, could help.”
Dr. Devons says the following are reversible causes of memory loss/confusion:
-“Depression/anxiety – can look like dementia when untreated
-Medications – pain medications, sleeping pills, anxiety medications –
especially if not taken as prescribed – or multiple interacting medications from different providers.
-Medical illnesses – kidney disease, liver disease, uncontrolled diabetes,
infections – can all lead to delirium – an acute reversible confused state.
-Brain injury from a fall and head trauma.
-Untreated thyroid disease
-Untreated anemia – both pernicious and iron deficiency”
Dr. Devons states, “The first step in treatment is a comprehensive evaluation. Often either by PCP, neurologist or geriatrician. It is Important to evaluate the cause and rule out reversible contributors. Treatment of depression if appropriate can be very helpful.
–Get medical attention if there is any concern regarding memory loss.
–Doctor will take a careful history – when did concerns begin? How acute?
–Memory testing – brief tests such as 30 item mini-mental and often more comprehensive –
–Blood tests – especially looking for reversible causes.
–Include brain imaging – CT/MRI brain.”
Dr. Devons explains, “Dementia is a general description of a group of brain diseases in which a person has changes in memory, cognition, and personality.
Alzheimer’s disease is the most common cause of dementia, but not the only cause. Alzheimer’s disease is diagnosed after comprehensive evaluation.
A progressive cognitive disorder – often but not always starting in the 70s and 80s. Generally starts with short term memory loss and progresses to affect long-term memory and other aspects of cognition. It can also cause behavioral and mood problems. Sometimes it’s hard to differentiate normal aging from Alzheimer’s. Some forgetfulness can be normal as we age. Comprehensive neuropsychological testing can be very helpful with distinguishing the two.
This is a two-hour battery of tests of many aspects of memory and cognition. The results can be compared to norms for age, intelligence, and education.
Sometimes older people have ‘mild cognitive impairment (MCI).’ This can be a precursor to Alzheimer’s disease. Some people may not progress or progress very slowly. People with MCI should have repeat testing annually.”
Dr. Devons says, “Treat any underlying or contributing causes. For people with Alzheimer’s disease have a consistent supportive environment, intellectual stimulation, orientation aides – like clocks and calendars, eat a healthy diet – the Mediterranean diet is helpful, take medications – acetylcholinesterase inhibitors when indicated -Aricept (donepezil), Exelon (rivastigmin), Razadyne (galantamine) can be combined with Namenda (memantine) these are the standard approved medications. Many patients become depressed and or anxious and this should be treated. There are also concerns re wandering – special locks, bracelets, GPS systems and consider advance directives when people still have the capacity.”