Understanding Dementia, Alzheimer's Disease and Normal Aging

Normal aging may include occasionally forgetting a name or misplacing your keys, but the information usually comes back later and doesn't interfere with daily life.

Dementia is not a normal part of aging. It is a syndrome characterized by a decline in memory, thinking, or reasoning that affects a person's ability to function independently. Alzheimer's disease is the most common cause of dementia, accounting for approximately 60-80% of cases.

Think of dementia as an umbrella term. Many different conditions can cause dementia.

Alzheimer's disease is the most common cause of dementia and typically begins with gradual memory loss before affecting language, judgment, and other cognitive abilities over time. However, every person is different, and many individuals might have a combination of conditions causing their dementia.

It's time to speak with your primary care provider when memory changes begin affecting daily life. Examples include:

• Repeatedly asking the same questions

• Getting lost in familiar places

• Missing appointments despite reminders

• Having difficulty managing medications or finances

• Or family members noticing significant changes in thinking or behavior

Early evaluation is important because some causes of memory loss are treatable, and earlier diagnosis allows patients and families to plan and access therapies sooner.

Changes are concerning when they represent a noticeable decline from a person's usual abilities.

Some of the most overlooked signs of dementia include:

• Difficulty completing familiar tasks, such as managing finances or following a favorite recipe

• Trouble finding the right words or following conversations

• Poor judgment or impaired decision-making

• Changes in mood, personality, or motivation

• Becoming disoriented in familiar environments

• Increased reliance on family members for tasks that were previously managed independently

Risk factors include:

• Age

• Family history

• High blood pressure

• Diabetes

• High cholesterol

• Smoking

• Obesity

• Hearing loss

• Physical inactivity

• Poor sleep, depression, social isolation, and prior strokes have also been linked to an increased risk of cognitive decline

The encouraging news is that research suggests up to nearly half of dementia cases may be preventable or delayed by addressing the above risk factors.

Maintaining good cardiovascular health, exercising regularly, eating a healthy diet, getting adequate sleep, protecting your hearing, staying socially connected, and continuing to challenge your brain throughout life all support healthy aging.

The takeaway is simple: What is good for your heart is good for your brain. While we cannot change our age or genetics, the choices we make today can have a meaningful impact on our brain health for years to come.

An evaluation always begins with a conversation. It is incredibly important to listen to both the patient and a family member or close friend, followed by a physical examination and brief cognitive screening tests such as the Mini-Cog test, the Montreal Cognitive Assessment (MoCA), or the Mini-Mental State Examination (MMSE).

Blood tests are often performed to look for reversible causes of memory problems, such as thyroid disease or vitamin B12 deficiency. Brain imaging, typically an MRI or CT scan, may help identify strokes, tumors, hydrocephalus, or other structural abnormalities.

Earlier this year, the FDA approved the first blood test to assist in the diagnosis of Alzheimer's Disease, and there is palpable excitement around these tests. These blood tests are intended for use in those 50+ and older who are experiencing memory changes, but they are not yet validated in those without memory challenges. These tests will help with early diagnosis and improved, objective monitoring of the disease.

Treatment depends on the underlying cause of memory loss. Some conditions that can mimic dementia, such as medication side effects, depression, thyroid disorders, sleep disorders, or vitamin deficiencies, may be reversible or significantly improved with treatment.

For Alzheimer's disease, medications such as cholinesterase inhibitors and memantine can help manage symptoms and maintain function for a period of time. Newer disease-modifying therapies that target amyloid protein are also available for carefully selected patients with early Alzheimer's disease.

While these treatments are not cures, they represent an important step forward. Research is advancing rapidly, with promising therapies targeting amyloid, tau, and other disease pathways. There is real reason for optimism that future treatments will continue to slow disease, preserve quality of life, and eventually help prevent Alzheimer's disease before symptoms begin.