Forgetfulness: “Aging” or Early Signs of Dementia?
Sunday, May 8, 2011

Dr. Robert C. Robinson III, MD

“Dad just doesn’t seem to be himself lately.  Yesterday when I was visiting with him he called me by your name and insisted that mom was in the house with us. Mom has been dead for 15 years now! I’m starting to become worried.  Last week he called me from his cell phone and told me that he didn’t remember how to get home from the grocery store that is just around the corner from his house! What do you think we should do?”

Does the above scenario sound familiar?  All too often lapses in memory and changes in behavior are attributed to “normal aging”, but something far more serious could be at fault.  It is important to recognize the signs and symptoms of dementia so that intervention can occur at its earliest stages.  Here we will discuss some of the more common signs of dementia to help you determine if your family member or loved one is suffering from this potentially life threatening condition.

Dementia is defined as the loss of brain function occurring in certain diseases, which affects memory, thinking, language, judgment and behavior.  As the definition implies a number of medical conditions can cause dementia and it is important to establish what the underlying cause of an individuals dementia symptoms might be.  This is important because while most cases of dementia are irreversible (degenerative) there are some conditions where if treated effectively, dementia might resolve.

What are the signs or symptoms of dementia?

Here is a list of signs and symptoms that might be indicative of a diagnosis of dementia:

Signs/Symptoms of Dementia

* Language problems or difficulty naming familiar objects or people
* Frequently misplacing items
* Getting lost on familiar routes
*Behavioral/personality changes
* Losing interest in things that you previously enjoyed
* Difficulty performing tasks that take some thought (i.e. balancing a checkbook, playing card games or board games, learning new information

As the dementia worsens, the symptoms may become more obvious and interfere with the ability of the individual to care for themselves.

Are there different forms of dementia?

As indicated above dementia can be defined as irreversible (degenerative) or reversible.  Here is an explanation of the different types of dementia and examples of what conditions fall into each category:

Irreversible (Degenerative) Dementia Causes

* Alzheimer’s Dementia – This is the most common form of dementia in all age groups and the one most people are familiar with.  There are two forms of this disease identified as early and late onset:
          o Early Onset Alzheimer’s Disease – Symptoms first appear BEFORE age 60. This is a rare form of Alzheimer’s but tends to progress rapidly.  Early onset AD may run in families and several genes have been identified that may cause this form of AD.
          o Late Onset Alzheimer’s Disease – This is the most common form of Alzheimer’s Disease and develops in people age 60 and over.

The cause of Alzheimer’s Dementia is not known but it is felt that genetics and environmental factors play a role in the development of Alzheimer’s dementia.  While your chances of developing Alzheimer’s Dementia increase as you get older, it is not a normal part of the aging process to develop Alzheimer’s Disease.

* Lewy Body Disease – Lewy Body disease is the leading cause of dementia in the elderly (those individuals over the age of 65). It is caused by abnormal protein structures in certain areas of the brain.

* Vascular (multj-infarct) Dementia – The second leading cause of dementia cases for individuals over the age of 65 in the United States is vascular dementia (sometimes referred to as multi-infarct dementia).  This form of dementia occurs in individuals who have suffered from previous strokes or multiple “mini-strokes”.  It usually affects individuals between the age of 55-75 and more commonly affects men than women.

Other medical conditions that may contribute to the development of irreversible dementia include:

* Huntington’s Disease
* Parkinson’s Disease
* Frontotemporal Dementia
* Leukonencephalopathies

Reversible Dementia

Some cases of dementia, when treated appropriately, are reversible.   Below are some of the causes of reversible dementia.

* Brain Tumors
* Vitamin B12 deficiency
* Thiamine Deficiency
* Hypothyroidism (low thyroid function)
* Infection
* Drug intoxication (including prescription medications)

How do I distinguish normal forgetfulness of aging from what might be dementia?

Some forgetfulness due to aging is normal.  This is known as mild cognitive impairment (MCI).  The difference between MCI and dementia is that the forgetfulness seen with MCI does not typically interfere with the individual’s daily activities.  Additionally, in MCI the patient is often aware of their forgetfulness. Whereas in dementia, the forgetfulness has not been recognized by the patient itself.

How is dementia treated? Can it be cured?

In the cases of reversible dementia mentioned above it is possible that the individual’s symptoms of dementia may be “cured”.  If the medical condition causing the dementia is treated, symptoms may improve or go away completely.   In the case of irreversible dementia, treatment is aimed at preventing the dementia from worsening or slowing the progression.  In these situations the individual may not get any better but they may remain stable.

If you have concerns about your own forgetfulness or that of a family member seek the advice of your primary care provider and express your concerns to them.  Your primary care provider will likely perform a physical exam along with certain blood tests and other studies to ensure that your symptoms are not the result of another medical problem.

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Dementia-Urban Legends

1.     Everyone develops dementia if they live long enough.  This is completely false.  While it is normal to experience some memory loss with aging, the memory loss seen with dementia is progressive and only one of many symptoms that establishes a diagnosis of dementia.  If you are concerned about your memory loss or that of a loved one, seek the help of your primary care provider.

 2.     Dementia is not serious, it is not life threatening.  Dementia is a very serious condition and when it progresses it can be life threatening.  In severe cases of dementia the patient may begin to experience difficulty with some of the more basic activities of daily living including bathing and eating.  It is not uncommon that patients forget to eat, leading to malnourishment.  Patients in advanced stages often develop swallowing difficulties which can lead to breathing problems and pneumonia.

3.     No one in my family has dementia so I have nothing to worry about.  While some forms of dementia are believed to have a genetic (inherited) component, this is not true of all forms of dementia.  Certain forms of dementia have more to do with lifestyle and other medical conditions that an individual may have.  Excessive alcohol ingestion, drug use, uncontrolled hypertension (high blood pressure), diabetes and heart disease are all potential risk factors that may lead to vascular dementia.   Additionally thyroid disease and certain vitamin deficiencies may lead to dementia.

4.     Once someone is diagnosed with dementia it is downhill from there.  This is not necessarily true.  Some forms of dementia are reversible if the underlying medical issue causing the dementia is treated effectively.  In the case of irreversible dementia, some medications may slow the progression of the disease to a point where the patient doesn’t lose any more function than at the time of diagnosis.

May 8, 2011 - May 21, 2011 Edition


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