Dementia is a crippling brain disorder that can dramatically impair cognitive functions like language, memory and the ability to make decisions to a point that it can interfere in daily life.In addition, someone with dementia may experience personality changes and some people with the condition can’t control their emotions. Dementia is an umbrella term for a cluster of neurological symptoms that affect the brain and get progressively worse over time and according to Alzheimer’s Disease International, “There are over 100 forms of dementia, with the most well-known form of dementia being Alzheimer’s disease.”
The Alzheimer’s Association states, “Alzheimer’s disease accounts for 60-80% of cases. Vascular dementia, which occurs because of microscopic bleeding and blood vessel blockage in the brain, is the second most common cause of dementia. Those who experience the brain changes of multiple types of dementia simultaneously have mixed dementia. There are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.”
Dementia is a common condition that mostly affects people over 65, but it’s not a normal part of aging and younger people can have dementia as well. There’s many familiar signs of dementia such as memory loss, getting most in known areas or settings and experiencing difficulty with usual tasks. But there are other signs to be aware of and Eat This, Not That! Health spoke with Paul E. Schulz, MD, neurologist with UTHealth Houston and Memorial Hermann-Texas Medical Center who explains what to know about dementia and hidden symptoms to pay attention to.
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Dr. Schulz explains, “Normal aging definitely causes changes in cognition. We say that from age 20 to 85, our concentration goes down about 40%.And, concentration is the first step in memory and word finding. So, everyone over about age 50-60 notices, because we are down about 20% already, that our memory and word finding aren’t what they used to be. Not to personalize it too much, but if I didn’t study dementia, I would worry that I have early dementia because I see changes in memory and word finding in myself.
We ask people whether:
Their memory is worse than their spouse and friends, who are often the same age; Their spouse, co-workers, and friends have said anything to them about being forgetful, etc. If none of these people notice a difference between a patient and age-matched people, then oftentimes their testing shows that they just have age-associated memory impairment. That means that the person is on the same slope as we all are. It’s when testing shows that someone falls below the “normal rate of decline” that we get worried and investigate further. It is less common to have changes with age in wisdom (e.g., judgment, abstract reasoning, insight) and visuospatial function (finding home, a restaurant, one’s barber, the grocery store, etc.). So, if someone has a change in behavior (poor judgment, spending money irrationally, being a victim of a hoax, etc.) or one is getting lost going to the store, etc., then we think less about aging and worry more about a brain change. To me, it’s a lot like jogging. I practice a great deal, but the younger runners still beat me all the time.”
Dr. Schulz shares, “Dementia is very, very common. 6 million Americans with Alzheimer’s alone. A few million have other dementias. And we may be diagnosing only a percentage of those with dementia due to healthcare access issues. It doesn’t respect sex, nationality, intelligence, etc. We have people in the clinic from all walks of life. That includes even fellow physicians. It can onset at any age. It’s most common as we get older.
We say that 1% at age 60 have dementia, doubling every 5 years to 32% at age 85. But, we see patients who are in their 40s and 50s, as well. Obviously, when we see younger clients, we look more exhaustively for other causes of dementia besides neurodegenerative disorders. For example, we want to rule out autoimmune diseases, infections, vitamin deficiencies, thyroid deficiencies, etc.”
Dr. Schulz emphasizes, “Dementia sneaks up insidiously. For several years, it can include episodes of forgetting some things and recalling others. So, it often doesn’t reach the level of recognizing it until it is very obvious. Considering that all of our treatments work best when started very early, we are very distressed when we see new patients who have advanced quite a ways before seeing us. The patient with early dementia often doesn’t recognize it. They appear to forget that they forget. In fact, when a spouse says that a person is forgetful, the more vehemently that the patient denies it, the more suspicious we get that it is real. Lack of recognition, then, is a very common part of a person with dementia’s presentation.
Because of that, it can be very difficult to get folks to come see us. We had a patient this morning who is midway through Alzheimer’s, and she was not brought in sooner, when we could do more, because she was embarrassed by someone testing her a few years ago. It’s a tremendous lost opportunity. No one’s fault. It’s just that we are human and don’t always want to find out about something like dementia, especially when we don’t see it. After an hour with her, the patient told me that she’s sure this is just normal aging and isn’t sure whether she needs to be evaluated.”
According to Dr. Schulz, “Depression that is of long duration and untreated appears to be a risk. So, we suggest treating someone with depression as much as possible (I say that because not everyone with depression responds to current medications and procedures). It’s less easy to show that treating depression prevents dementia, but we all believe that it is probably true.
Hearing loss often results in a person not hearing conversations, or misunderstanding them. At a minimum, hearing loss contributes to cognitive impairment in dementia. It’s unclear whether hearing loss is a risk factor for dementia, as opposed to just appearing to have it.
Cardiovascular risk factors. We and others have many studies demonstrating that the traditional cardiovascular risk factors (those for stroke, heart disease, and peripheral vascular disease) also accelerate dementia progression. So, we measure many of them in our Neurocognitive Disorders Center every day. We check cholesterol, blood sugar, blood pressure, blood fat (triglycerides), weight (BMI), and others.
Concussions have been in the news the last few years and genuinely seem to increase dementia risk. So, wear a helmet when skiing or biking, wear your seat belt in your car, etc.
Physical and Mental exercise, in the other direction, are thought to be protective from dementia.
Genetics is a currently unmodifiable risk factor, but one that can be significant. The good news is that one can still reduce the risk of even familial dementia by controlling risk factors. But, it will be a while before we can change one’s risk factor genes.”
Dr. Schulz says, “It is challenging to decide whether dementia is more common now than in the past because: People often hid loved ones with dementia as it was seen as reflecting poorly on a family. Some ethnic groups in Texas still do that. Through no one’s fault, many cultures believe that dementia is shameful. So, we don’t see those patients at all. Or, if we do, we see them very late when families are desperate.
We knew very little about dementia just a few years ago. In the 60s, we talked about hardening of the arteries. In the 70s we started to talk about those over 65 having normal aging, and only defined dementia when it was present in younger people. Then we discovered in the 80s that dementia isn’t “normal aging.” And over the last 30 years, we have discovered that not all dementia is due to Alzheimer’s disease. We have now identified many other types.
So, looking at records from more than 10-20 years ago is typically fraught with not being sure what someone had. Also, we are now much more likely to identify dementia now (with the caveat that some folks with signs of dementia still don’t come to the clinic). For those who come to the clinic, we have gotten much better at being able to diagnose them and give a solid answer about what is transpiring. This starts with people seeing their primary care physician, many of whom are now aware of the issues related to dementia and are screening for it. So, more people are captured earlier.
On the other hand, the Framingham heart study, which has been following people for decades, reported that for each age, the risk for dementia is declining. However, because more people are living longer, thank goodness, it means that many more people are at risk for dementia. A simple way to think about this is that when humans didn’t live too long, then people didn’t get to be old enough to be at significant risk for dementia. So, the bottom line is that we certainly see more patients with dementia now, but it’s very difficult to say whether that means that it is more common, or we are living longer, or that we see our doctors more and they are sensitive to the huge problem of dementia.”