Dementia

Dementia is defined as a mental decline that is severe enough to impact a person’s day-to-day ability to function. While Alzheimer’s is indeed one cause (accounting for 60 to 80 percent of cases), dementia is caused by damage to brain cells and can be the result of a stroke (vascular dementia, the second-leading cause), thyroid problems and even vitamin deficiencies. People with dementia have great difficulty remembering things and focusing on tasks; their ability to communicate may be affected, along with their reasoning and judgment. Diagnosis is through tests and examination of a patient’s medical history and behaviors. Two or more symptoms must be present before a doctor will label it dementia. But it’s often hard for doctors to be specific about what type of dementia a person might have, because symptoms overlap. Dementia is not an inevitable part of aging, as the term “senility” falsely implies.

We all have those moments, and at times it may seem that we are heading toward certain mental decline. But for most of us, those frustrating moments when you misplace your phone or forget what you wanted to tell a friend are just symptoms of a busy, tired or stressed mind—a temporary lapse that you can laugh off once you remember what you forgot. You also don’t need to worry if you forget directions to a place you haven’t been to in several months, if you can’t remember the word you wanted to say or if you forget a person’s name right after you meet. And as we age, the sharpness of our memories can fade a bit—you may not remember the name of the band from your wedding, but you can remember your song—and it may get tougher to multitask. All of these things are normal occurrences for an older brain. New information shoves aside older information for space and we have to work harder to recall. But unless these incidences become frequent enough to disrupt your daily life, you probably don’t have to worry.

While you may be blissfully unaware that anything is brewing, biological changes in your brain that can lead to dementia can start at least a decade before you experience symptoms. For this reason, experts say you should take steps as early as your 40s to prevent or significantly delay dementia. If most people would make lifestyle changes to improve brain health, experts believe one-third of dementia cases worldwide could be prevented. This includes, first and foremost, controlling high blood pressure. Over time, hypertension damages blood vessels in the brain, but you can prevent it with interventions that include exercise, diet, meditation and medication. Even if you don’t have high blood pressure, regular physical activity is key to fighting dementia. A minimum of a brisk, 20-minute walk daily can help maintain brain health. You should discuss your day-to-day habits, including diet and how you feel mentally, with your doctor and work together to make beneficial, manageable changes.

America’s workforce is aging; many older adults have no plans to retire before they are well into their 70s, even 80s. And this may prove quite beneficial in preventing dementia. Research shows that education—and putting that education to work throughout life—helps build a cognitive “reserve” that can balance out the natural, age-related slowdown of the brain. One study of almost a half million people showed that, for every year they delayed their retirement, their risk of developing dementia (and Alzheimer’s) was reduced by 3.2 percent. In other words, the more you use your brain, the more slowly you’ll lose your ability to do so. Continuing to work into your later years helps ensure that you’re engaged and processing information on a regular basis. The type of job doesn’t seem to matter, as long as your brain is being stimulated to take in and put out information.

In a June 2017 report, the National Academies of Sciences, Engineering and Medicine (NAS) reported that it could not link ginkgo biloba or vitamin E to brain health, despite marketing claims by makers of these supplements. In fact, the NAS was reluctant to say that any supplement in particular was a brain booster. (The report did note that vitamin B12 and folic acid may be beneficial, but that research was still too scarce to make a formal recommendation.) A diet that centers on getting a healthy balance of vitamins and minerals from food, rather than from supplements, seems more important. As for brain games like number and word puzzles, the NAS report did say that cognitive training may help keep the brain sharper into the later years, but that this would not prevent dementia. That doesn’t mean you should give up your crossword puzzles, but the NAS said what matters most is a strong education and lifelong mental stimulation.

Uncorrected hearing or vision impairment seem to raise the risk of dementia, experts say. A study published in JAMA Opthalmology in August 2017 reported an association between poor vision and poor cognition. The study’s author said that poor eyesight itself isn’t a proven cause of dementia, but that vision impairment can cause a person to disengage from the world, and that leads to a decrease in cognitive stimulation. The same goes for hearing loss. One study showed that older adults with poor hearing experienced cognitive decline—difficulty with memory and thought processes—40 percent faster than their peers with normal hearing. Both hearing and vision impairment may cause a person to become more isolated and may cause the brain to receive garbled signals, and all of that contributes to cognitive loss. Can correcting the senses make a difference? The experts say vision correction can help a person with cognitive loss function better, perhaps slowing the decline. The word is still out on hearing aids. Studies are underway with results expected in 2022. If your doctor recommends sight or hearing correction, we strongly encourage you to take the advice seriously.

A 2018 study by the Yale School of Public Health showed that attitude affects cognitive health. Older people who think about aging positively are less likely to develop dementia than their peers who have a negative mindset about growing old. The four-year study looked at people who carry the E4 variant of the APOE gene, which puts individuals at a higher risk for dementia. The positive thinkers were almost 50 percent less likely to develop dementia than the negative thinkers. The study’s authors say these results show that an anti-ageism, public health campaign could be beneficial in fighting entrenched negativity toward aging.

If you have started noticing lapses in your memory or if you’re mixing up words more than usual, don’t jump to the conclusion that you’re in cognitive decline. You may be experiencing side effects from a medication. Both prescription and over-the-counter drugs can cause symptoms, from mild to severe, that are easily mistaken for dementia. The list of potentially problematic meds is long and includes: anti-anxiety and antiseizure drugs, medications to treat Parkinson’s, hypertension and incontinence, plus statins (to lower cholesterol), narcotic painkillers, sleep aids and even some antihistamines. If you are experiencing memory loss while taking medication, you really should speak with your doctor. Changing your medication may eliminate the cognitive problems. There may be alternate drugs that don’t affect your memory or even lifestyle changes that could eliminate (or reduce) the need for certain medications. (But never quit taking a prescribed medication without consulting your health care provider first.)

While most people suffering from late-stage dementia succumb instead to a medical condition like pneumonia, infection or a blood clot, dementia itself can be fatal. It is a progressive brain deterioration. Along with cognitive lapses, people will begin to have trouble getting dressed, using the bathroom and eating. In later stages, a person will need full-time care as he or she becomes bound to a bed or wheelchair, unable to walk or sit unassisted. According to WebMd, once someone is diagnosed with dementia, life expectancy is about four and a half years (with women living about a half year longer than men). If dementia is diagnosed before age 70, however, people can live a least another decade. The frailer they are when diagnosed, the shorter the time they can expect to live.

The verdict is still out on this one. Scientists are studying neurogenesis—the creation of new neurons in the brain—in the hope that they can find ways to help the human brain protect itself, to some extent, from Alzheimer’s. A Columbia University study published in 2018 found signs of neurogenesis in adults well into their 70s. A small study from Spain reported that older people without dementia not only showed neurogenesis but that their brains produced neurons at higher rates than those who had Alzheimer’s disease. But researchers at the University of California at San Francisco said otherwise in a report that claimed neurogenesis stops completely after adolescence. Scientists on both sides of the debate do agree that human neuron production wanes with age, but what age is a question that will be debated for some time.