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Worried About Dementia?

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Memory loss is not always the first sign…

Chances are you notice every little blip in your memory if you’re over age 40. That’s because most people who are middle-aged or beyond fear that any sign of memory loss is a red flag for Alzheimer’s disease.

What you may not realize: While memory loss does occur with Alzheimer’s disease, there are other symptoms that often get overlooked by patients and their doctors. These symptoms can also be the key to identifying other causes of dementia that are less well-known than Alzheimer’s disease.

Important: Dementia-like symptoms are sometimes due to medical conditions, including depression…traumatic brain injury…diabetes…tumors…thyroid disease…vitamin B-12 deficiency…and kidney disease. Certain medications can also be to blame—including drugs that block the neurotransmitter acetylcholine, such as those for over-active bladder, allergies, anxiety and depression.

If you or a loved one is showing any of the symptoms described in this article, consult your primary care provider. He/she can perform simple memory tests or refer you to a specialist, such as a neurologist, psychiatrist, neuropsychologist or geriatrician, for a more comprehensive evaluation, which may include an imaging test of the brain, such as an MRI or a CT scan.

To learn more about the complex interplay between memory and dementia, Bottom Line Health spoke with Dr. James E. Galvin, a renowned authority on dementia.

FOUR MAIN CAUSES OF DEMENTIA

Of all the possible causes of dementia, the majority of cases are due to one of the following disorders—and many people have a combination of two or more disorders…

1. Alzheimer’s disease. It’s true that memory (problems with learning new things and recalling past information) is significantly affected by this disease. But memory problems aren’t the only warning signs.

Non-memory symptoms include: Changes in mood (including the onset of depression, anxiety or paranoia)…behavior (such as withdrawing from hobbies and social activities)…language ability (such as difficulty finding the right word)…and problem-solving skills and concentration (such as finding it hard to keep track of monthly bills).

When Alzheimer’s typically strikes: It mainly hits people in their mid-60s to mid-80s. Early-onset Alzheimer’s disease can appear in one’s 40s or 50s.

2. Lewy body dementias. Lewy body dementia and a related form of dementia that accompanies Parkinson’s are caused by clumps (called Lewy bodies) of a protein that forms in cells throughout the brain. With Lewy body dementia, the protein clumps start in the cerebral cortex, which can lead to memory loss.

Non-memory symptoms that may occur with Lewy body dementia: Visual hallucinations…perceptual difficulties (for example, bumping into doors)…frequent staring spells…and/or sleep disruptions that cause one to act out dreams.

When dementia accompanies Parkinson’s, similar cognitive symptoms develop a year or more after the onset of the movement changes that characterize Parkinson’s, including slow movement, muscle rigidity and tremors. The movement problems occur when abnormal protein clumps form in the brain stem and later spread to other brain regions. 

When Lewy body dementia and Parkinson’s disease with dementia usually strike: In one’s 60s to late 70s, but early-onset Parkinson’s with dementia can occur under age 50.

3. Vascular dementia. In people with vascular dementia, brain cells become damaged by “mini” strokes that are often so small that they may go unnoticed. Memory problems may occur but sometimes after the other symptoms described below.

Non-memory symptoms may include: Changes in one’s ability to plan, organize and make decisions (such as those required for daily activities)…and mood (such as depression and lack of motivation).

When vascular dementia strikes: Risk is highest after age 65, but it can occur at any age.

4. Frontotemporal dementia (FTD). This degenerative disorder mainly affects brain cells in two parts of the brain—the frontal lobe (responsible for behavior and emotions) and temporal lobe (involved in language and memory skills).

Memory problems are more prominent at a later stage than with Alzheimer’s disease. Language is frequently affected, either with difficulty producing words or in understanding the meaning of words.

Non-memory symptoms that may occur: Changes in personality (a shy person becoming boisterous, for example) and/or trouble with problem solving and other executive functions (such as the ability to handle everyday situations, including driving a car and shopping for groceries) develop when the frontal lobe is mainly affected.

When FTD strikes: Typically in one’s 50s or 60s.

TREATMENT OPTIONS

Regardless of the cause of dementia, an early diagnosis helps…

For Alzheimer’s disease, medications are available to help slow the progression, and doctors may use the same medications to help treat the symptoms of other causes of dementia.

For vascular dementia, you can work with a doctor to control risk factors, such as high blood pressure or high cholesterol. For Lewy body dementia and frontotemporal dementia, there are no treatments for the diseases themselves, but research is ongoing to change that.

There is also accumulating evidence that certain lifestyle factors may reduce risk of developing dementia and slow symptoms of disease. These include daily exercise (aerobic, resistance training, flexibility)…mental stimulation (games, lectures)…social engagement…and a healthful diet (fruits, vegetables, whole grains, lean meats).

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Source: James E. Galvin, MD, MPH, professor and associate dean for clinical research at the Charles E. Schmidt College of Medicine and professor in the Christine E. Lynn College of Nursing, both at Florida Atlantic University (FAU) in Boca Raton, Florida. He also has developed a number of dementia-screening tools, including the “Lewy Body Composite Risk Score” and the “Quick Dementia Rating System.” You can find these tests by searching at FAU.edu.

Date: May 1, 2016 Publication: Bottom Line Health
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