Normal Aging or Dementia?
As you get older, delays in recall become more common and you may ask yourself if it’s normal or the start of dementia. You can’t remember where you put the car keys … again. You start to introduce a friend and, embarrassingly, can’t remember her name. You begin to tell someone about that fun movie you watched last night, but you’ve forgotten its title. Aurgh! Not only is it frustrating, but a thought wiggles into the back of your head: Is this how dementia starts? Am I getting Alzheimer’s? Slowed recall commonly starts in your 50s or 60s, but experts say you can relax: It’s very unlikely to be dementia or Alzheimer’s Disease. In fact, recent studies show that the overall rate of dementia has declined over the past 10 years in older Americans age 70 and over due to cardiovascular disease prevention. According to Amy Ehrlich, M.D., associate chief of geriatrics at Montefiore Health System in New York City. “It’s very typical as you age that you have trouble remembering a name, then it will just pop into your head,” says Dr. Ehrlich. “That is not a sign of impending dementia, as dementia is a disabling condition.” According to leading dementia researcher Dr. Kenneth Langa, professor of medicine at the University of Michigan, 90% percent of older adults do not have dementia. Still, it is true that the risk of getting Alzheimer’s doubles every five years after you turn 65. According to research by the Lancent commission, older adults can reduce their risk of dementia dramatically by:
treating high blood pressure
maintaining a normal weight/BMI
increasing physical activity
Who’s Qualified to Diagnose Dementia? Older adults who have noticed cognitive changes should see their primary care physician first to eliminate treatable conditions and order further testing. Patients may be referred to a neurologist — a doctor who specializes in the brain and nervous system. Often, brain imaging is required for a definitive diagnosis. Geriatric psychiatrists, neuropsychologists, and geriatricians can also specialize in diagnosing dementia. If there is no such specialist in your community, check with the neurology department of the nearest medical school. An affiliated hospital may also have a dementia disorders clinic where expert evaluation can be found. Types of Dementia Dementia actually covers a variety of cognitive disorders, of which Alzheimer’s is the most common. Another kind is Lewy body dementia, which happens when tiny deposits damage brain cells. Vascular dementia is caused by reduced blood flow to the brain due to heart disease or stroke. Lay diagnosing, especially among grown children and well-meaning friends, is common and often causes family strife. Never assume it is Alzheimer’s Disease or dementia, get a diagnosis. Getting some baseline testing is a good idea if you think you, or someone you know, is beginning to show signs of dementia. Two assessments can be better than one using practitioners in complementary disciplines, such as a geriatric psychiatrist/psychologist and a neuropsychologist. Dementia and Drugs The effects of certain drugs can mimic dementia, causing confusion, disorientation, and memory loss. These medications include antihistamines and those used to treat Parkinson’s, and belong to a class called anticholinergic drugs. Even some doctors are fooled into thinking patients exhibiting symptoms of mild cognitive impairment have early dementia and treat them accordingly by mistake. Health care professionals should assess patients for use of anticholinergic drugs before beginning therapy for cognitive decline. Always consult a medical professional before discontinuing any treatments or medications. Heavy alcohol use and urinary tract infections can also interfere with memory and mimic dementia. Blood clots, brain tumors, vitamin deficiencies, depression, sleep disorders, head trauma … the list of causes for problems that resemble dementia is quite long. Rule out any of these possibilities before deciding you may have dementia. Dementia and Sleep Apnea Recently, sleep apnea has been linked with an increased risk of dementia and brain damage, especially among older women. Low oxygen levels have been linked to reduced thickness in portions of the brain vital for memory which change with the onset of dementia. Obstructive sleep apnea (OSA) occurs when the sides of the throat relax, narrowing the airway and impeding the flow of oxygen. A recent study found that older adults should be routinely screened for the condition by a medical professional, since the chances of having it increase with age. Normal Signs of Aging Dr. Ehrlich discussed what she looks for when she’s evaluating patients for signs of dementia. First, she’ll check if they can still learn new technology. It’s normal if it takes a little longer to get the hang of your new smartphone, but if you can learn a new task, it’s not likely to be dementia. Multitasking becomes more difficult with age and that is part of normal aging. However, semantic memory, or memory involving facts and concepts, tends to remain at the same level or dip slightly with age. At middle-age, some women find themselves forgetful and distracted due to menopausal hormonal changes. Impaired episodic memory, which affects your ability to recall a significant personal event from long ago, such as a marriage or graduation, is a hallmark sign of dementia. There are a host of other causes having nothing to do with aging that can affect episodic memory as well. Not being able to recall the author of the book you just read or a recent appointment, on the other hand, is merely a sign of normal aging. But if you pick up the book and wonder what it is, that is not a sign of normal aging and you should consult a medical professional. Certainly, if you suspect that you or a loved one may have dementia, or you just want some assurance that you do not have it, call your doctor. After ruling out a physical cause, she can run a combination of cognitive and neuropsychological tests to assess mental functioning. In older adults, the majority of dementia-like symptoms are not dementia at all but treatable conditions known as pseudodementia. This article was corrected on August 6, 2020 from its original publication on July 30, 2020. 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