“The number of cases of dementia in the U.S. is rising as baby boomers age,
raising questions for boomers themselves and also for their families,
caregivers and society. Dementia,
which is not technically a disease but a term for impaired ability to think,
remember or make decisions, is one of the most feared impairments of old age.
Incidence increases dramatically as people move into their 90s. About 5% of those age 71
to 79 have dementia, and about 37% of those about 90 years old live with it.
“Older people may worry about their own loss of function as well
as the cost and toll of care giving for someone with dementia. A 2018 study
estimated that the lifetime cost of care for a person with Alzheimer’s, the
most common form of dementia, to be US$329,360. That figure, too, will no doubt
rise, putting even more burdens on family, Medicare and Medicaid.
“There’s also been a good deal of talk and
reporting about dementia in recent months because of the U.S. presidential
election. Some voters have asked whether one or both candidates might have
dementia. But, is this even a fair question to ask? When these types of
questions are posed – adding further stigma to people with dementia – it can
unfairly further isolate them and those caring for them. We need to understand
dementia and the impact it has on more than 5 million people in the U.S. who
now live with dementia and their caregivers. That number is expected
to triple by 2060.
“First, it is important to know that dementia
cannot be diagnosed from afar or by someone who is not a doctor. A person needs
a detailed doctor’s exam for a diagnosis. Sometimes, brain imaging is required.
And, forgetting an occasional word – or even where you put your keys – does not
mean a person has dementia. There are different types of memory loss and they
can have different causes, such as other medical conditions, falls or even
medication, including herbals, supplements and anything over-the-counter.
“Older people wonder and worry about so-called
senior moments and the memory loss they perceive in themselves and others. I see patients like this every week in my
geriatric clinic, where they tell me their stories. They forget a word, get
lost in a story, lose keys or can’t remember a name. Details vary, but the
underlying concern is the same: Is this dementia?
Normal
memory loss
“As we age, we
experience many physical and cognitive changes. Older people often have a
decrease in recall memory. This is normal. Ever have trouble fetching a fact
from the deep back part of your ‘mind’s Rolodex’? Suppose you spot someone at
the grocery store you haven’t seen in years. Maybe you recognize the face, but
don’t remember their name until later that night. This is normal, part of the
expected changes with aging.
“What’s more of
a potential
problem is forgetting the name of someone you see every day;
forgetting how to get to a place you visit frequently; or having problems with
your activities of daily living, like eating, dressing and hygiene. When you
have troubles with memory – but they don’t interfere with your daily activities
– this is called mild cognitive impairment. Your primary care doctor can
diagnose it. But sometimes it gets worse, so your doctor should follow you
closely if you have mild cognitive impairment.
“You want to note
the timing of any impairment. Was there a gradual decline? Or did it happen all
of a sudden? This too you should discuss with your doctor, who might recommend
the MoCA, or Montreal
Cognitive Assessment test, which screens for memory problems
and helps determine if more evaluation is needed. Also, the Centers for Disease
Control and Prevention lists problems in these areas as possible
signs of dementia:
· Memory
· Attention
· Communication
· Reasoning,
judgment and problem solving
· Visual
perception beyond typical age-related changes in vision
More severe issues
“When memory loss interferes with daily
activities, see your doctor about what to do and how to make sure you’re safe
at home. There are numerous types of severe memory loss. Dementia tends to be a
slow-moving progression that occurs over months or years. Delirium is more
sudden and can occur over hours or days, usually when you have an acute
illness. Depression can also cause memory changes, particularly as we get older.
Dementia and other brain issues
“Alzheimer’s dementia is the most common type of
dementia, followed by vascular dementia. They have similar symptoms: confusion,
getting lost, forgetting close friends or family, or an inability to do
calculations like balance the checkbook. Certain medical conditions – thyroid
disorders, syphilis – can lead to dementia symptoms, and less common types of
dementia can have different kinds of symptoms. Alzheimer’s has a distinct set
of symptoms often associated with certain changes in the brain.
“Focusing on safety and appropriate supervision,
particularly in the home, is critical for all people with dementia. Your doctor
or a social worker can help you find support. It’s also important to be aware
of two other things that can lead to decreased mental functioning – delirium and
depression.
“Delirium, a rapid change in cognition or mental functioning,
can occur in people with an acute medical illness, like pneumonia or even
COVID-19 infection. Delirium can occur in patients in the hospital or at home.
Risk for delirium increases with age or previous brain injuries; symptoms
include decreased attention span and memory issues.
“Depression can happen at any time, but it’s
more common with aging. How can you tell if you’re depressed? Here’s one simple
definition: when your mood remains low and you’ve lost interest or joy in
activities you once loved.
“Sometimes people have recurring episodes of
depression; sometimes, it’s prolonged grieving that becomes depression.
Symptoms include anxiety, hopelessness, low energy and problems with memory. If
you notice signs of depression in yourself or a loved one, see your doctor. If
you have any thoughts of harming yourself, call 911 to get help instantly.
“Any of these conditions can be frightening. But
even more frightening is unrecognized or unacknowledged dementia. You must,
openly and honestly, discuss changes you notice in your memory or thinking with
your doctor. It’s the first step toward figuring out what is happening and
making sure your health is the best it can be.
“And, as with any disease or disease group,
dementia is not a ‘character flaw,’ and the term should not be used to
criticize a person. Dementia is a serious medical diagnosis – ask those who
have it, the loved ones who care for them or any of us who treat them. Having
dementia is challenging. Learn what you can do to support those with dementia in your own
community” (The Conversation).
Laurie
Archbald-Pannone, Associate Professor
Medicine, Geriatrics, University of Virginia
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