What is the difference between forgetfulness that comes with age and forgetfulness that comes from a disease like Alzheimer’s? Dr. Masil George, an Associate Professor from the Department of Geriatrics at UAMS recently went on AFMC TV to discuss memory loss and Alzheimer’s. She breaks down the differences between Alzheimer’s and dementia, the overall warning signs, and actions patients can take to mitigate their risk or live more independently if they do have Alzheimer’s.
So, let’s address the first concern: When is forgetfulness normal, and when is it something more?
“All of us are going to have cognitive aging,” Dr. George says. “When we’re four, we learn everything quicker. As we get older, cognitive decline occurs, and we start to learn new things more slowly and remember things more slowly.” Aging and memory loss go hand-in-hand, but whenever it affects a person’s ability to function independently, that’s when there is cause for concern. “Most elderly adults are able to function independently without dementia,” Dr. George says. “Dementia is memory loss that affects a person’s ability to function and do what they need to do to live a normal life.” In short, it’s complicated. Like most diseases or disorders, there is no black-and-white difference between memory loss and dementia. It’s more of a grey area.
Dementia vs. Alzheimer’s
“We often struggle to understand the difference between all of these terms associated with memory loss,” Dr. George says. “Dementia is cognitive decline to the extent that it affects a person’s ability to do things independently. Alzheimer’s is the most common form of dementia.” Most memory loss that occurs with dementia and Alzheimer’s typically happens after age 65. In fact, old age is the biggest risk factor for developing dementia. “While Alzheimer’s is the most common form,” Dr. George adds, “other forms of dementia do exist, such as vascular dementia, Parkinson’s, and Louie Body Dementia.”
It is important to periodically assess the cognitive ability of someone over the age of 65 to ensure that they are not experiencing symptoms of dementia. When it is time to have a conversation with that person about seeing a doctor, gentleness and sensitivity are crucial. “It’s embarrassing to tell someone they are having memory problems,” Dr. George said. “Some of my patients that I see now are ready to talk about it and are very open. Some are not.” If a patient is not ready to talk about it or is not willing, it is important to talk to someone close to them that can help ease the older person into understanding that an assessment may be needed.
“We see the earliest problems with memory loss in executive functions,” Dr. George states. “These are more tasks like managing finances, driving, or even taking medications.” If someone does not know their own cognitive struggles, they may do these things wrong, which can cause a safety concern for themselves or those around them.
“What we may see socially are things like asking the same questions or repeating yourself multiple times,” Dr. George adds. During the holidays, it’s normal to have someone ask the same questions a few times because of the hustle and bustle of being together, but an older person repeating the same statements or questions within a span of five minutes may be a legitimate concern. The Cognitive Assessment Toolkit from alz.org provides some great resources and a general practitioner cognitive assessment that doctors can use to assess a patient’s cognitive function. There are also other resources out there that a practitioner can use to detect a patient’s cognitive impairment level during a visit.
While dementia and Alzheimer’s are more common in older adults, there are conditions that can predispose younger people to develop cognitive disorders later in life. “Many people with Downs Syndrome are at risk for developing dementia a lot earlier than normal,” Dr. George says. “There are also other conditions, such as frontotemporal dementia (FTD), that are typically seen in younger adults.” Any memory loss that causes a person to lose the ability to perform regular functions independently would be a cause for concern and warrant a visit to a PCP or geriatrician. There are other conditions that can coexist with dementia that can be diagnosed and treated. Depression and thyroid conditions can cause memory loss, but, if treated, memory loss can be reversed in most cases.
UAMS Dementia and Alzheimer’s Resources and Advancements
Dr. George gave great information on the types of support services UAMS offers for individuals who struggle with cognitive impairment: “We have primary care physicians (PCPs) who are the first person that patients develop relationships with. We also have geriatricians who can guide more of the complex decision-making by ordering tests to see if an older adult is safe to drive. We have social workers who can help to increase the support at home to ensure they can be independent in their own homes. We also have neuropsychologists who can do more sophisticated screening and testing as well as imaging centers where we order imaging to diagnose memory loss.” UAMS can provide any service that a patient struggling with cognitive impairment or their family needs.
“The common medications we use are to help with cognitive processing so that adults can be more independent for longer periods,” Dr. George says. “The category of medications that we would use are the cholinesterase inhibitors. Other medications can be used for neuroprotection, and there are several medications that have been developed for treating new levels of cognitive impairment, but they are still in development.” While larger advancements have not yet been made in treating dementia, Dr. George mentioned that she likes to think of dementia not as something that we can diagnose, treat, and cure, but rather something like a chronic disease. “If we treat it like hypertension or diabetes and find the steps we can take to manage the disease in the meantime, we can take steps to still have a great quantity of life, despite the complications from dementia. Instead of relying on a cure, we must find ways to live alongside it,” she says.
Just like people with diabetes and hypertension can make healthier choices to increase their quality of life, it is possible to do things that can increase the quality of life for a person with dementia. “Anything that is good for your muscles and your heart is good for your brain,” Dr. George says. “Novelty is vital to keeping something fresh.” People can take the same steps to manage their dementia as they do to manage other chronic health problems: managing weight, exercising, and eating right. “You could also try learning a new language, cooking, or dancing,” Dr. George suggests, “Try to be as active and as independent as possible.”
While potential genetic links can predispose patients to dementia and Alzheimer’s, a patient can do many things to mitigate their risk. With better lifestyle choices, patients with Alzheimer’s and their families can maintain a better quality of life and not live with the struggles that dementia and Alzheimer’s often leave behind.