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Memory loss and dementia are among the healthcare problems that people fear the most. They are also among those that create the most significant challenges for families and caregivers, and often without the supports or resources to respond as fully as we would like. But knowledge is power and the more we understand the problem, the better prepared we will be to deal with it. So here are some basics.

What is dementia?

Most simply, it describes difficulty with reason, judgment, and memory. There are normal, age related changes that are not dementia (for example, occasionally forgetting a name or an appointment, requiring assistance with new technology, misplacing things) but it’s important to recognize when the problem may be more significant. There are 10 warning signs that can help you to know whether a memory problem or other intellectual decline should cause concern:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning, or in solving problems.
  3. Difficulty completing familiar tasks.
  4. Confusion with time or place.
  5. Trouble understanding visual images.
  6. New problems with words in speaking or writing.
  7. Misplacing things and being unable to retrace steps.
  8. Poor judgment.
  9. Social withdrawal.
  10. Changes in mood or personality.

What causes dementia?

Alzheimer disease accounts for 60 to 80% of dementia. We know that this involves deposits of a substance called beta amyloids (known as plaques) in brain cells, and that there are also disordered protein fibers called neurofibrillary tangles. We do not know what causes these changes and we do not yet have effective treatment. There are medicines which can lead to minor and temporary improvements but they have significant potential side effects as well.

Other causes of dementia include poor circulation to the brain, Lewy Body Dementia, caused by another abnormal protein structure and often associated with symptoms of Parkinson’s Disease and with vivid hallucinations, Parkinson disease itself, and Pick’s Disease, usually occurring at an earlier age and often with speech and language impairment. Alcohol and repeated brain injuries can also lead to dementia. And it is always important to consider whether any medications a person is taking could be causing side effects which contribute to these symptoms.

Who is at risk for dementia?

The risk increases with aging. Dementia is rare before age 50 and common after age 80. Alzheimer disease tends to run in families, and a person with a parent or sibling with Alzheimers may have a 10 to 30% risk of developing it themselves. The family risk is higher if it developed at an earlier age. High blood pressure, smoking, and diabetes may play a role, particularly in the damage they cause to blood vessels.

What can I do?

It appears that staying physically active, socially connected and mentally engaged reduces the risk of dementia. Also, being alert to the symptoms and seeking evaluation early may be important.

www.alz.org has some very important resources, including a checklist for preparing for a visit with your doctor or primary care provider. It includes writing down details about changes in memory, prompts to identify important changes in memory and intellectual function, medication lists and questions to ask your doctor. It can be found here: http://www.alz.org/documents/national/ed_doc_checklist.pdf

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Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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