Dementia? Or Normal Aging?
If you are of a certain age, you may have asked yourself these questions:
• What was it I came in here for?
• Where are my… (glasses, phone, keys, wallet, etc.)?
• It’s the…what’s that word?
• What was I talking about? I lost my train of thought!
Most likely, these are normal everyday cognitive failures (NECFs) and not a harbinger of dementia. NECFs occur in everyone and not just in those 50 and older. But, as we age, they become more frequent. This is because our brain’s processing speed slows, and it takes more time to retrieve information. At the same time, the good news is that we actually continue to learn and build wisdom as we age. We are not just losing it!
But what, exactly, is dementia? It’s a progressive loss of cognitive abilities (e.g., attention, memory, language, visuospatial skills, planning, and problem-solving) and an associated loss of the ability to function without assistance.
Alzheimer’s Disease (AD), which is the most common form of dementia, typically begins with subtle changes in the ability to learn and remember new information. Old memories, such as from one’s childhood or the distant past, remain intact. Word retrieval difficulties also are common. For some, changes in the ability to perceive and identify what we see can be an early sign. Over time, usually seven to 10 years, cognitive abilities decline to the point that a person may be bedridden and unable to care for him- or herself.
Early onset AD, which begins in the 50s and 60s (though sometimes begins in the 40s), is usually genetic and seen in individuals with a strong family history. The prevalence of AD increases as we age; by the time we get to around age 85, almost 25 percent of adults will have symptoms. But when these symptoms occur later in life, the course may be slower.
The cause of AD is unknown but is believed to be due to the presence of amyloid deposits (plaques) and neurofibrillary tangles in the brain. However, recent research has started to question whether these are the cause or are a byproduct of the disease.
Vascular dementia (VD) is caused by changes in the veins and arteries in the brain, typically due to high blood pressure and/or high cholesterol. In the past, this was referred to as “hardening of the arteries.” Brain imaging may show small strokes in the brain that cause progressive cognitive changes.
It was once thought that VD was characterized by slowed processing speed and difficulty with information retrieval without deficits in learning and retention of information. However, researchers now believe that brain changes common in AD can be seen in VD, and the vascular changes common in individuals with VD can be seen in those with AD. So, researchers see the two as less distinct.
Frontotemporal dementia (FTD) is more common in individuals in their 50s and 60s. The beginning symptoms typically include changes in behavior and personality, poor judgment, and difficulty with planning and problem-solving. However, in one form of FTD, there is a progressive loss of language and the ability to express oneself—actor Bruce Willis likely has this.
Parkinson’s disease, which mainly affects motor functioning, can cause cognitive deficits including, most commonly, slowed thinking and difficulty with information retrieval. But researchers are increasingly concluding that some with Parkinson’s dementia actually have AD.
So how do you know if your forgetfulness is a sign of dementia? NECFs usually are not. But, if we begin to notice and attend to them, we can become increasingly anxious and exacerbate the problem. This is because emotional distress can interfere with thinking clearly. The following are signs that, if cognitive lapses occur regularly, you should consult your doctor:
• You have difficulty finding your car in a parking lot.
• You get lost while driving, especially when going to familiar places.
• Your spouse, partner, or other family member notices that you are asking the same question repeatedly and are not recalling things you have been told.
• Your forgetfulness is interfering with your work or everyday functioning.
Your doctor can do a simple screening test to determine if there is cause for concern. However, these tests can miss subtle changes in individuals who are very bright and high functioning. Consequently, your doctor may decide to refer you to a neurologist or a neuropsychologist who, using more extensive testing, can look for profiles that are associated with dementia or that just reflect emotional distress.
In my next column, I will talk about what you can do to maintain or improve brain health. ▼
Dr. Robb Mapou is a board-certified neuropsychologist. In addition to evaluating older adults who have concerns about cognitive changes, he specializes in evaluating teenagers and adults for autism spectrum disorder, specific learning disorders, and attention-deficit/hyperactivity disorder. You can find him at drrobbmapou.com.