Is it dementia or normal aging?
Are you getting forgetful? Have you misplaced your keys lately? You might be concerned that it’s something serious, like Alzheimer’s. Almost 6 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. It is estimated that one out of every nine people older than 65 has Alzheimer’s or another dementia and that one in three seniors will die from a form of dementia.
Because Alzheimer’s and other dementias are so prevalent in older adults, it’s important to know the difference between normal aging and signs of a problem — and when it may be time to seek help.
The aging process
It is normal for people in their 50s or 60s to have trouble with word retrieval or multitasking. “Older people, compared to younger people, may struggle to learn multiple things at one time,” said Jason Karlawish, M.D., co-director of the Penn Memory Center. “But what they do learn, they retain over time.” Retaining knowledge over time is known as fluid intelligence, and remembering the information is called crystallized intelligence. With aging, crystallized intelligence is stable or even increases as we learn new things. In contrast, fluid intelligence declines and this decline can get in the way with making decisions, but not with the kind of severity seen in a person with dementia.
The terms “dementia” and “Alzheimer’s” are often used interchangeably, but they are not the same. Dementia is a term that describes a syndrome caused by any number of different diseases, most commonly Alzheimer’s disease.
Dementia indicates a decline in the ability to display cognitive behaviors, which can include memory, language, attention, concentration, multi-tasking, problem solving and visual function. In someone with dementia, at least two of these cognitive abilities are impaired to the point that they are getting in the way of doing daily tasks.
“People misplace things, but they are usually able to trace their steps backwards to find them,” said Krista McKay, director of programs and services for the Alzheimer’s Association Delaware Valley Chapter. “Someone with dementia would put things in unusual places, such as leaving their car keys in the refrigerator.”
Signs of a cognitive decline that might be indicative of dementia can include a senior asking repetitious questions or telling the same story over and over again in the same conversation without providing new information. Difficulty identifying the day of the week, managing money or medicines, or cooking are also signs of a cognitive decline. “Dementia is not being able to retain adequate short-term memory,” McKay said. “Dementia is like hearing the information a new each time.”
It’s important to note that dementia is not a sudden change in memory or ability. “If someone has experienced noticeable cognitive changes that are interfering with daily life over the last several days or even a few weeks, that’s not dementia,” Karlawish said. “That’s a medical emergency.”
There are several medical conditions that may mimic dementia. Complaints about memory being a problem and lack of initiative are reported in people with both dementia and depression. Certain medications and urinary tract infections can also cause behavioral or cognitive changes that resemble dementia.
Someone with dementia has typically experienced at least six months of decline in cognitive ability to the point that it interferes with usual tasks, according to Karlawish. These tasks can include managing money, cooking a meal, finding their way around, or using a TV remote control, assuming the person used to perform these tasks without a problem. “Someone with dementia won’t bake anymore, or they tried to bake and it wasn’t as good as before,” Karlawish said. “They keep on having trouble using their computer, but they were fine before. They struggle to find their way around. These are signs that suggest dementia.”
Drastic changes in a person’s mood or personality over time may also signal dementia. “Your personality doesn’t really change over time,” McKay said. “It’s a tell-tale sign when someone has a favorite hobby, and they just regress from that. Your personality is set. When someone becomes aggressive, overly emotional or ‘just different,’ it’s probably time to see a doctor.”
Alzheimer’s disease is the most common cause of dementia. It is called a “neurodegenerative disease,” meaning that neurons, the cells in the brain, are dying. Other neurodegenerative diseases include lewy body dementia and Parkinson’s disease; the latter starts out as a movement disorder but can develop into dementia. Vascular disease can cause vascular dementia, in which the brain is damaged from impaired blood flow.
Traumatic brain injury, which results from an impact to the head that disrupts normal brain function, also can lead to dementia. “It may be something that only happens once, then that person is really impacted by it for the rest of their life,” McKay said. Chronic traumatic encephalopathy (CTE), which results from continuous trauma to the brain, is another cause of dementia. “We’re seeing it more and more with former athletes, like football players, who have repeated concussions and damage to the brain,” McKay said of CTE.
Frontotemporal dementia (FTD) is a fairly uncommon form of dementia, according to Karlawish. In FTD, the frontal and temporal lobes of the brain — the areas associated with personality, behavior and language — shrink or atrophy, causing dramatic changes in behavior. This disease often occurs in people 40-45, much younger than Alzheimer’s is typically diagnosed, according to the Mayo Clinic.
There are a host of causes for dementia, beyond those mentioned here. According to Karlawish, a good clinician can sort it out. “If you are concerned about yourself or someone else, start with your general practitioner,” he said. “It may result in correction of a medical problem or referral to a specialist.” Karlawish recommends that people who have a memory problem go to the doctor with someone who knows them well, such as an adult child, close friend or partner. “This person can help to add information about how the person is doing,” he said.
Alzheimer’s disease accounts for about 60 percent of dementia cases, according to the Alzheimer’s Association. Alzheimer’s is different from other types of dementia. “The disease progression is very subtle over stages,” McKay said. “It’s a very slow and steady decline over an eight- to 10-year life span of the disease. It’s characteristic to have memory loss as its primary and first-recognized symptom.”
There is no cure for Alzheimer’s. Fear of the disease and its effects may contribute to a delay in seeking diagnosis. “We have drugs that can treat the symptoms,” Karlawish said. “An early diagnosis is important because the patient is suffering.” Someone with Alzheimer’s is at risk of having an automobile accident, getting lost in a familiar area, becoming dehydrated from forgetting to drink water, or becoming a victim of a scam or crime. “While there is no cure for Alzheimer’s, there are other causes of dementia that can be treated,” McKay said. “It’s important to not be afraid. I urge people not to be despondent. There is help out there.”
The Alzheimer’s Association Helpline is staffed by trained clinicians 24/7, 365 days a week, at alz.org or 800-272-3900. The helpline refers callers to clinicians, support groups and legal and financial experts. The helpline can also provide information and locations for memory cafés — organized gatherings where people with memory loss and their care companions come together to make new friendships and support one another. “At the core of what we do is to help and support people within the community,” McKay said. “We don’t want people hiding in the shadows. Life is not over with dementia.”
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