Dementia is common.
The World Health Organization reports that currently, more than 55 million people worldwide are living with dementia, and 10 million news cases are diagnosed every year.
Here in the United States, the Centers for Disease Control and Prevention estimates that 5 million adults over the age of 65 are living with dementia. That number is projected to rise to about 14 million by 2060.
What exactly is dementia?
“There are many conditions that result from brain diseases,” says Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus. If these conditions “are to such a degree that they lead to interference in day-to-day functioning, they’re called dementia conditions.”
Alzheimer’s disease, a condition in which certain proteins accumulate in the brain and disrupt normal functioning, account for about 60% to 70% of all dementia cases. But there are several types of dementia.
Across these various diseases, the resulting dementia doesn’t develop overnight, says Dr. William Nields, medical director of Cognitive Health Centers in Sarasota, Florida. “Dementia is a late stage in the process of cognitive decline and may be preceded by 20 years of pathological processes in the brain.”
Dementia symptoms can be hard to spot early on.
Symptoms may only surface after years of the changes taking place in the brain.
“In the case of Alzheimer’s Disease, beta amyloid plaques (tangles of proteins that interfere with normal brain functioning) may be building up in the brain 20 years before dementia, and years before symptoms are even present,” Nields says. Dementia is typically diagnosed after “significant cognitive decline has occurred and a person has difficulty caring for themselves.”
In some cases, there’s a period when the individual notices their own decline before anyone else does. “This stage is called subjective cognitive impairment,” Nields says, “and we believe this is the time to intervene, even if screening tests aren’t sensitive enough to pick it up. A loved one may hide cognitive decline for a long time with vague responses, deflecting humor and avoidance of questions which they cannot answer.”
Symptoms of dementia are different from typical aging.
“One of the things that’s really difficult with making an Alzheimer’s or dementia diagnosis is that in the very early stages, it’s very difficult to discern between just normal aging or forgetfulness and the signs of something much more serious happening,” says Lisa Skinner, a Napa, California-based behavioral expert in the field of Alzheimer’s disease and related dementias.
“The symptoms are very subtle in the beginning and almost unnoticeable. For that reason, most people are not diagnosed with Alzheimer’s or one of the other many brain diseases that causes dementia until they’ve already progressed into their mid-stage.”
However, there are some warning signs that may indicate it might be time to talk with your doctor.
1. A decline in memory, thinking or attention.
Perhaps the most recognizable sign of Alzheimer’s disease or dementia is a downturn in the ability to remember, make new memories or engage in more complex thought processes.
“Early signs may include deteriorating memory, difficulty planning or organizing or slower processing of information,” Nields says.
2. Decline in planning complex tasks.
Financial management, driving to a new location and other complex tasks that involve pre-planning or complex thinking also typically become very difficult for someone living with dementia as the disease progresses.
“Getting lost or difficulty navigating in new or familiar places” are key signs that something more than typical aging may be at play, Nields says.
3. Changes in mood or behavior.
Dementia is “not just memory loss or confusion,” Skinner says. “This disease ravages a lot of the parts of the brain, and as a result of that, family members or caregivers will see behavioral changes or changes in mood.” For example, increased irritability is a hallmark of Alzheimer’s and some other forms of dementia.
In patients who have frontotemporal dementia, a disease that hits especially hard in the front of the brain where your personality and emotions are housed, aggressive outbursts and erratic or overly sexualized behaviors or mood changes may signal something is wrong.
4. Decline in functional abilities.
“Another obvious symptom is that thinking abilities become so impaired to actually interfere with daily functions,” Skinner says. More than just general forgetfulness, this shift affects the patient’s ability to complete daily tasks in ways that “don’t happen with normal aging.”
For example, as the disease progresses, some people will develop an unsteady gait when walking or may have difficulty taking care of household tasks like laundry, cooking and cleaning.
5. An increase in confusion.
Everyone experiences confusion from time to time, and garden variety forgetfulness, such as occurs when you’re preoccupied or under stress, is normal. But people experiencing cognitive decline related to dementia may begin to lose the ability to recognize common objects.
“That’s a sign of a more serious disease happening” rather than just general aging, Skinner says. She gives the example that forgetting where you’ve put your keys isn’t that big a deal — everyone does it sometimes. But if when you find them, you’re not able to remember what you’re supposed to do with them, “that’s a huge red flag.”
6. Decline in social cognition.
“Difficulty recognizing faces, names or responding to social cues” can also be early signs of dementia, Nields says.
“You’ll notice signs that the person’s social skills are changing, and they tend to avoid or withdraw from social situations or isolate themselves,” Skinner adds. This can lead some people to withdraw from social settings, which only further compounds the problem and could increase risk for loneliness and depression. Depression can exacerbate the situation, but it can also be a sign of dementia in its own right.
“This is a really common sign,” Skinner says. “A lot of people with dementia will repeat the same questions over and over and over again in the same conversation, or they’ll repeat the same story. They’ll tell it to you over and over and over again.”
8. Changes in language use.
In addition to the typical word-finding difficulties, people experiencing cognitive decline may display, in more advanced cases and in folks who speak more than one language, there may be a reversion to the native language, Skinner says.
“Some people, when they’re experiencing damage to the brain due to brain disease, they actually will revert back to their first language. So, if your mother came from Italy and Italian was her first language, she might just all of a sudden start speaking in Italian without even realizing it.”
In other cases, when word-finding issues arise, the person might sub in a made-up word. “They might say, ‘I put my laundry away in the thingamajig,’ because they can’t find the word for dresser drawer,” Skinner says.
What to do if dementia symptoms arise.
If you notice any of the above symptoms, it’s worth talking with your primary care provider. Scharre says this clinician will “take a history, perform a pen and paper test, do a physical examination, order lab tests and order a brain scan to help identify what the cause may be.”
Scharre adds that “you can also assess your cognitive abilities free of charge at your doctor’s office or at home by downloading and taking the Self-Administered Gerocognitive Examination (sagetest.osu.edu) to get a baseline level and then check again every six to 12 months. If you see a decline, let your doctor know.”
Early detection is important.
“If you notice these symptoms, you should come in and get evaluated immediately,” Nields says. “There is no benefit to waiting. Just like a person might undergo a colonoscopy for certain symptoms, we recommend a ‘cognoscopy’ to evaluate what is driving the problem.”
The good news is this “cognoscopy is much more pleasant than a colonoscopy. It includes a detailed interview and a panel of bloodwork initially, which may be followed by further specialized testing.”
When screening tests finally are able to pick up the cognitive changes, this stage is called mild cognitive impairment, or MCI, Nields explains. “MCI is actually a later stage in the process, and we believe ‘mild’ is a misnomer for this reason. MCI may eventually progress to dementia if the processes driving the neurodegeneration aren’t arrested.”
For that reason, he says it’s important to seek help early, before you get to that dementia stage. “We prefer to see people much earlier in the process when changes are just beginning to take place. We can do a thorough evaluation of factors that drive cognitive decline and address these biological processes before they cause the neurodegeneration that results in dementia.”
Scharre agrees that the longer you wait to address issues related to cognitive decline, the harder it becomes to slow the progression of the disease. “The earlier you detect cognitive decline the more beneficial are the treatments,” Scharre says. “Alzheimer’s disease has a course of typically 8 to 12 years. Starting treatments earlier can probably slow the decline.”
Treatments are available.
Skinner notes that while there’s currently no cure for Alzheimer’s and other forms of dementia, there are treatments available that can “delay the progress of the disease.”
These medications aren’t effective for everyone, and there can be a lot of variability in how the disease progresses even after the patient begins treatment. But she says there’s hope that early intervention can give you a better quality of life for longer.
A new, controversial drug called aducanumab (Aduhelm) was recently approved by the FDA and offers hope that treatment may offer a better quality of life. However, this medication has to be started as early as possible to be effective, and some providers aren’t using it because they don’t see the benefits as being worth the high price and potential downsides.
Activity and social engagement can help.
While medications offer some hope, other interventions can also help. Skinner recommends getting and staying as active as possible if you’re dealing with dementia.
“It’s very important for people with Alzheimer’s disease (and other dementias) to be provided with the right type of activities and stimulation and environment to delay the progression.”
She recommends finding activities that engage the body, mind and spirit “that will match the skill level that the person is at. You don’t want to overwhelm them with something that’s too difficult because that also causes agitation and frustration.”
From music therapy to gardening and gentle exercise, getting and staying engaged in ways that use all five senses can help stretch the brain and slow the progression of cognitive decline.
The brain is like any other muscle in the body, Skinner says. If it’s not kept active, it can atrophy and die. But, you can delay brain atrophy with physical and mental activities and social engagement.
8 early signs of dementia:
— A decline in memory, thinking or attention.
— Decline in planning complex tasks.
— Changes in mood or behavior.
— Decline in functional abilities.
— An increase in confusion.
— Decline in social cognition.
— Changes in language use.
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