This month for our Healthy Actions topic, we are going to look into dementia, memory loss and Alzheimer's.
I sought the expertise of University Hospital's Dr. Alan Lerner, director of the Brain Health and Memory Center Neurological Institute, UH Neurological Institute.
Q: What is the difference between dementia and Alzheimer's?
A: Dementia is a symptom of memory loss severe enough to cause functional decline. Alzheimer's is the most common form of it.
If you forgot one appointment, that's not dementia. To me, the importance is a pattern of it. Does it occur on a regular basis? Does it occur in different situations such as work and home?
These things often come on over a period of time. Dementia could occur in a day if someone had a severe head injury, but much more commonly, it evolves over months, if not years. It can be difficult to tell what's going on when someone is close to you, and you see them varying in their abilities from day-to-day.
Q: What should I do if I am concerned about memory loss for myself or a loved one?
A: It should always be taken seriously. If I went into the doctor and complained of chest pains, I might get an EKG, a stress test or an echocardiogram. If I complain of memory problems, they pat me on the back and say “We're all getting older.” Evaluation can be labor-intensive and in today's medical system that's not always easy.
Q: So who do I go to?
A: Start with your primary care physician. That doctor can refer you to a neurologist or psychologist. There are many different specialties who can help treat a patient.
Q: I have aging parents. How can I tell the difference between dementia and getting old and having some memory loss?
A: Old age is not necessarily associated with dementia. Dementia is a symptom of memory loss.
We have to recognize that “normal” is a moving target. What's “normal” is different at different ages. What is normal at 85 is not normal at 55 or 65. It also needs to be seen through the lens of race, ethnicity, socioeconomic status, education and age. All of those things affect cognitive performance.
Here's the philosophical question: if we all live long enough, are we all going to get demented? The answer is a little unclear. It's not necessarily a common trait of aging, even if you want to hide behind the lens of “we're all getting older.” We all know a very sharp 100-year-old. Are they the ones who are “abnormal” because they're not demented? What is the disease? Who gets to define it?
Ultimately it is about function: Can they function in their environment? Can they drive to the supermarket safely? Can they cook without setting the house on fire? There's also quality of life. That's certainly more true in older people who tend to be more socially isolated, for example a widow living alone who can't function independently or to the extent as she could a few years ago.
Whether you call it old age or dementia or whatever you call it, it threatens their life as we expect it to be.
I'm trying to not get into labeling, but the person is more important than the polysyllabic name we give them.
We did an interesting study in which we asked people about other family members. As it turned out, if they thought that a family member or other relative had a problem, they were right about 85 percent of the time. If you're looking at your parents and you're thinking “Oh, my God,” that's really powerful. Before we get to old age versus dementia — the line is a little blurry — old age is not a disease.
Q: So when should someone be concerned enough to take a loved one to the doctor?
A: The most common symptoms of significant memory loss are repeating oneself, asking the same question over and over again or getting lost. The Alzheimer's Association has put out the 10 warning signs (See those 10 signs in the sidebar to this column).
Alzheimer's disease doesn't happen in a minute. It usually comes on over years and is not necessarily a medical emergency, but don't wait until it's a medical emergency.
Q: Is Alzheimer's genetic?
A: If people have a parent or first-degree family member (sibling or child) with Alzheimer's, they are at higher risk of developing this disease.
Q: Is there anything preventative I can do if I'm at higher risk?
A: Nothing that's been proven to help. My personal opinion is: “carpe diem” — seize the day and make the most of your current life. Living a great life is the important thing. Making life meaningful and making the world a better place is valuable. To just focus on a possibility is to miss the boat. I'm going to spend the next 20 years worrying I have it and what if I don't get it? Its not the only risk of conditions related to aging. In general, what's good for the heart is good for the brain: diet, exercise, mental activities, getting enough sleep, social interactions. As Americans, we love to have a pill. We don't have a pill. Vitamin E may slow down the progression of dementia, but doesn't necessarily prevent it. There's hundreds of millions of dollars being spent working on prevention.
We do know that the changes in your brain start 15 years before any symptoms, but its hard to tell that's happening.
Q: What is the treatment?
A: There are several FDA-approved medications and a lot of research on new treatments.
Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or firstname.lastname@example.org. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty