AGING BRAIN - Normal memory lapse, or a sign of something serious?

January 26, 2012

Nothing escapes the aging process, the brain included. The brain’s normal aging process means the older we get, the more memory lapses we experience. We can also expect the brain’s speed and sharpness to continue their gradual, normal decline. But forgetfulness that affects a senior’s daily activities may be a sign of the more serious medical problem known as dementia. 


Normal memory lapse, or a sign of something serious?    
Every senior forgets things now and then. But when is a memory problem a sign of something more serious such as dementia or Alzheimer’s disease?

Nothing escapes the aging process, the brain included. The brain’s normal aging process means the older we get, the more memory lapses we experience. We can also expect the brain’s speed and sharpness to continue their gradual, normal decline. But forgetfulness that affects a senior’s daily activities may be a sign of the more serious medical problem known as dementia.       

According to Dr. Ketchai Suavansri, a cognitive and behavioral neurologist at Bumrungrad with many years’ experience helping patients with dementia and other cognitive impairments, dementia poses a greater risk the older we are: After age 65, dementia’s rate of prevalence is about eight percent; after age 75, the rate nearly doubles (to 15%); after age 90, the rate is nearly 50 percent.        

Understanding dementia     

Dementia is the medical term for a collection of disorders affecting brain function which have certain symptoms in common.  People with dementia experience brain impairment which interferes significantly with their daily lives and their socialization. “Dementia itself is not a disease,” Dr. Ketchai explains. “It’s the result of other diseases affecting the areas of the brain that control various bodily functions.”     

There are many disorders known to cause dementia. “While about 80 percent of the disorders cause permanent loss of brain function,” notes Dr. Ketchai, “early intervention can slow the progression and help dementia patients maintain a good life quality. The progression can be reversed for about 20 percent of patients, if the specific disease causing the dementia is identified and treatment begins earlier.”      

Degenerative brain-cell diseases, such as Alzheimer’s disease, cause progressive, irreversible damage to the brain. So-called reversible dementia, also known as secondary dementia, is caused by other treatable disorders, such as brain tumors, thyroid diseases, vitamin B12 deficiency or as a side effect from taking certain medications. 

Diagnosing dementia     

Since dementia has a number of possible causes, diagnosing it properly is a complex process requiring specialized training and expertise. “Even though memory loss is a common early-stage symptom of dementia, memory loss by itself isn’t enough to confirm a diagnosis of dementia,” Dr. Ketchai explains. “Dementia is only diagnosed after impairment is confirmed for at least two brain functions – usually memory plus something else such as language or perception impairment. Diagnosis also requires that the symptoms be ongoing for at least six months and are affecting daily activities.”     

To diagnose dementia, the doctor typically begins with a physical examination and a review of the patient’s health history. Caregivers and family members may be consulted, as early-stage dementia patients may not be aware of their symptoms. Blood testing may also be carried out to rule out the presence of certain diseases known to cause dementia.  To ensure diagnostic accuracy, the doctor may conduct further tests; brain scans, neurological evaluations and neuropsychological tests are used to confirm whether or not the patient has dementia, and if so, whether it is reversible.       

“It is very important to identify the type of dementia and its underlying causes,” says Dr. Ketchai. “Doctors need to be sure to leave nothing out, so the patient won’t miss an oppor-tunity to treat the diseases contributing to the dementia.” 

“By way of example, a relative brought their family member to see me about memory problems. After asking some questions, it was apparent that the patient was normal until the few days before we met, when suddenly he became unable to recognize family members. This didn’t match the profile of dementia caused by Alzheimer’s, but it fit the profile of secondary dementia caused by stroke. Based on that, by treating the stroke first, brain function might eventually return.” 

Leading cause: Alzheimer’s     

After ruling out other treatable causes, the next diagnostic step involves identifying the specific brain disorder causing the dementia, and then determining the best course of treatment such as medication.     

By far the most common cause of irreversible dementia is Alzheimer’s disease; it accounts for about 60 to 80 percent of all cases of dementia. Typically, symptoms of Alzheimer’s only become apparent around the age of 60 to 65. [Cases of earlier onset Alzheimer’s are rare and can usually be traced to gene mutations.]    

“Alzheimer’s disease is believed to be caused by the build-up of plaque in the brain which interferes with brain cell connections,” Dr. Ketchai explains. “The cells die or lose control over functions such as memory, perception, behavior, and cognitive and language skills.”    

Alzheimer’s is a progressive disease categorized in three stages:     
Mild/Early stage Frequent recent memory loss, particularly involving recent conversations and events. Depression and apathy may occur and may be accompanied by mood swings as patients start to notice their own symptoms. “At this first stage, the caregiver may not know how best to deal with the situation,” says Dr. Ketchai. “It’s fine to remind the patient once or twice if they forget something or their speech rambles on. But don’t pressure the patient to the point where they suffer stress which can lead to depression.”

Moderate/Middle stage Symptoms have become more noticeable, making it impossible for the patient to cover up the problem. Patients may fail to recognize their spouse and family members. Mood and behavioral changes are usually seen. “At this stage, patients have become more dependent with everyday activities,” Dr. Ketchai notes. “Pay close attention to the patient’s safety; watch them when they go outside and restrict access to dangerous objects such as knives and fire sources.”    

Severe/Late stage Symptoms have worsened, with the patient gradually losing ability to remember, communicate, move around or care for himself. “The patient’s health continues to decline,” adds Dr. Ketchai. “The patient cannot be left alone.” Brain cell decline reaches extensive levels, causing grave damage to brain function. The patient’s condition continues weakening, putting them at serious risk for malnutrition and infections, some potentially fatal.      

Alzheimer’s disease remains incurable at the moment, and current treatments are only able to slow the speed of progression. “It’s very important to detect and diagnose Alzheimer’s disease as early as possible,” says Dr, Ketchai. “Earlier intervention slows disease progression while boosting quality of life for patients and caregivers. It also helps reduce the risk of complications from injury, infection and the patient becoming unable to conduct daily activities. The medical community continues working to develop new medications and potential cures. I believe the chances are good that those efforts will succeed during the next five or ten years.” 

The importance of caregivers     

Caregivers play such an important role in helping patients with dementia maintain a quality of life as normal as is possible. Caregivers make numerous sacrifices for the good of their patients; their dedication often requires changes to their schedules and normal daily activities, and the demands that come with caregiving can cause a great deal of physical, mental and emotional stress.     

“It’s very important that caregivers develop a solid base of knowledge about dementia. The patient’s doctor can help prepare the caregiver to know what to expect and how to handle specific problems,” Dr. Ketchai notes.“More importantly, caregivers must not forget about taking care of their own health, both physical and mental. Caring for a dementia patient is never easy, and it can quickly  take a toll on a caregiver’s well-being. “     

Dr. Ketchai continues: “Providing loving care requires patience and understanding. Remind yourself that the frustrating symptoms and behaviors you must deal with are not coming from the patient; they are coming from the illness. It also helps to divide up the responsibilities; having at least two caregivers for a patient provides time to rest and relax. That’s a good thing for caregivers, and for their patients, too.”

Maintaining good brain health

Though some cases of dementia cannot be prevented, most people can reduce their dementia risk by incorporating these brain-healthy habits into their daily lifestyle:

Maintain a healthy weight; obesity causes a number of chronic conditions that lead to dementia;    

Make brain-healthy food and supplement choices, including omega-3 in the form of DHA, which helps protect nerve cells;     

Be sure to get enough sleep every night;    

Stay socially active and keep contact with family and friends;     
Learn new things and do something different, e.g.  practice using your other hand during meals;     
Do 30 minutes of aerobic exercise at least four times a week.   Courtesy of Sallaya Kongsomboonvej, a US board-certified dietician at the Vitallife Wellness Center.

10 Alzheimer’s disease symptoms you should not ignore

  1.     Frequent and worrisome forgetfulness    
  2.     Inability to recall recent events    
  3.     Communication difficulties, e.g. inability to use correct wording that people  will comprehend    
  4.     Lost away from home – can’t find the way back home after going out    
  5.     Dressing improperly or not taking care of personal hygiene    
  6.     Inability to perform simple math functions like addition or subtraction    
  7.     Irrational misplacement of things, e.g. placing shoes in the refrigerator    
  8.     Unexplained mood swings    
  9.     Rapid changes in personality    
  10.     Rarely responsive or pervasive loss of interest

Did you know?
Among seniors, some symptoms of depression can be difficult to distinguish from symptoms of dementia. These include memory loss, confusion and hallucinations. Neuropsychological testing is used to diagnose depression.

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