That moment is frightening: Someone you love has “just” had a little lapse of memory. But then you realize these simple lapses are happening over and over and over again. Soon, it’s not just memory, but there’s confusion about daily tasks like how to get dressed or how to cook dinner. Psychiatrist Christopher Dennis, MD, MBA, explains dementia and what it may mean for you and your loved one.
Dementia is a group of symptoms related to a decline in memory, reasoning, or other thinking skills severe enough to reduce someone’s ability to perform everyday activities.1 Four million to five million Americans have dementia, the most expensive disease in the U.S.2 A 2010 study funded by the National Institute on Aging estimated that it costs up to $215 billion a year to care for dementia patients, surpassing heart disease ($102 billion) and cancer ($77 billion).2 Vascular issues, thyroid problems, and even vitamin deficiencies can cause dementia, which is not a disease in and of itself, Dr. Dennis explains.
The signs and symptoms of dementia differ from person to person, but include impairment of at least two of these functions:
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
“The early signs of dementia are usually very subtle,” Dr. Dennis says. “It might not be noticed by the person who’s providing the most care. A child may come home for the holidays and say that mom doesn’t seem exactly the same. She may be more apathetic, distant, and not as interactive or reactive to what’s happening around her.
“It becomes more noticeable when the functional challenges start to grow,” Dr. Dennis adds.
A person with dementia may do unusual things, like hide his toothbrush in the refrigerator, put shoes on the dinner table, or repeatedly forget to turn off the stove. You might also see forgetfulness about appointments, trouble paying bills, or misplacing important items like a wallet or keys.
Dementia is most common in adults over 60 years old and nearly 30 percent of those over 85 experience the symptoms.3 Since it gradually gets worse over time, visit a doctor to determine the cause as soon as you notice an issue: Sometimes there are treatments that can address the cause and help the person get better.
Alzheimer’s disease, the most common type of dementia, accounts for 60 to 80 percent of dementia cases.4 It usually begins slowly with some mild memory loss, trouble thinking, and behavior that is “out of character,” Dr. Dennis says.
Since it affects the parts of the brain that handle thoughts, memory, and language, it can worsen to the point that the person feels disoriented, deeply confused, and even unable to have a conversation. In the latest stages of the disease, even walking and swallowing become a challenge.
Alzheimer’s disease is the fifth-leading cause of death for adults over 65.5 And there are over 200,000 people in the U.S. under age 65 with Alzheimer’s, known as early onset.4 Regardless of when symptoms of decline first appear, it’s important to remember that Alzheimer’s is not “a normal part of aging,” Dr. Dennis says.
If you suspect that a loved one has dementia or Alzheimer’s, don’t wait to get help.
Dementia: Now What?
If you notice some form of cognitive decline and are concerned about dementia or Alzheimer’s disease, see a physician right away. Make sure you can report the types of symptoms, how often they occur, when you first noticed them, and if they’ve gotten worse. Your physician will also review medical history, medications, and may order lab tests and other exams.
Mental status and neurological tests will help determine if there’s a cognitive problem and how severe it is. A 10-minute exam called the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE) are used in screening. Your primary care physician may refer you to a psychiatrist or neurologist, especially if there are other issues like depression, anger, hostility, or wandering behaviors.
“Safety is always paramount,” Dr. Dennis says. “A patient will need further psychiatric evaluation if there could be danger there.”
If the patient does have dementia, the tests may be able to tell if it is reversible—caused by medications, depression, alcoholism, infection, thyroid problems, or vitamin deficiencies. These dementias are treatable.
Irreversible dementias, like Alzheimer’s, cannot be cured. Dr. Dennis notes that the support resources available are key in helping both the patient and family members manage the disease. If there are complications, seek specialty help, including mental health professionals and home health or nurse aides. Certain drugs like Aricept and Namenda may improve thinking, behavior, and function. The Alzheimer’s Association also has excellent resources that provide support for caretakers, who often experience “caregiver burnout,” Dr. Dennis says.
Finally, Dr. Dennis recommends getting a second opinion about a dementia or Alzheimer’s diagnosis and treatment plan. “The diagnosis of dementia is generally one of exclusion. Oftentimes there are other conditions that may mimic it, so you want to make sure you have ruled out all treatable causes of dementia by getting a second opinion.”
If you’re feeling unsure about a recent dementia diagnosis, a specialist in our pool of 50,000 medical experts can review your medical records to make sure you’re lined up for the best treatment possible.
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