Over the past few weeks, I've written about the science of cognitive health (is coffee good for your brain?), memory strategies (the power of habits; the importance of writing notes; making memorable associations), tools for thinking (breaking down goals; making good mistakes; taking well-deserved breaks), and mental health (reframing winter; removing negatives; paying attention to the positives).
But I haven't yet directly addressed the one topic I'm asked about most often, and that's the D-word: dementia. We all know that it's bad, and we hope that we and our loved ones are never afflicted with it. But what is it? What causes it? How is it assessed or diagnosed? Can it be treated? And most importantly, what do I do if I'm worried I may have it?
Most simply dementia is a progressive disease of the brain involving deterioration in cognition (e.g. memory, language, planning and organizing etc.), as well as a lack of ability to care for oneself independently. So, typical symptoms might include things like:
memory:
forgetting to take medications
repeating questions or comments
missing appointments
getting lost in familiar places
language:
difficulty remembering names
trouble expressing oneself
planning and organizing:
difficulty making complex decisions
problems in preparing meals or banking
While some or all of these symptoms may seem all too familiar, it's important to note here that dementia is not the same thing as normal aging. As many of us can attest to, our cognitive abilities change over the course of our lives, and not always for the better. This does not mean that we will all eventually develop dementia. To the contrary, the declines in thinking ability that occur in dementia are much more substantial than those that occur for most people over their lives. It's also important to remember that while the risk of developing dementia does increase with age, it's also true that the vast majority of people will never develop dementia.
So what causes dementia? Dementia has a number of causes, including Alzheimer's Disease, Lewy Body Disease, Parkinson's Disease, and damage to the brain's many blood vessels. But wait, aren't Alzheimer's Disease and dementia the same thing? No. And this is an important distinction. Alzheimer's Disease can cause dementia (remember: decline in cognition and ability to care for oneself), but it is not the only possible cause. Think of 'dementia' as a kind of umbrella term that describes the problem, but does not specifically identify the causes, in the same way that we might say someone has a 'cough' without knowing exactly what has caused it.
How is dementia assessed and diagnosed? Currently dementia is diagnosed clinically, meaning that the symptoms (e.g. decline in cognition and inability to care for oneself) are evaluated by a physician or neuropsychologist to arrive at the most responsible and accurate diagnosis. In the future, we may be able to make these diagnoses with blood tests or brain scans, but not just yet.
Unfortunately there is no cure for dementia in 2020. There are medications, sometimes called "cognitive enhancers" that can in some cases temporarily slow the declines in cognition. And for dementia caused by blood vessel damage, controlling risk factors like high blood pressure, high cholesterol, and diabetes can also be helpful in slowing the progression of the disease.
With this in mind, the most important question is: I'm worried that I have dementia - what do I do about it? The simple answer is, take the difficult but important first step of discussing your concerns with your family physician. They will be able to medically screen you for other potential causes of your difficulties, and refer you on for specialized cognitive testing if necessary.
Next week, we'll explore some of the lifestyle factors that can help reduce the risk of dementia.