What is normal memory loss, and how is it different from dementia? Even with normal aging, memory loss is common. We will all have some degree of memory loss as we get older given that changes in memory parallel the expected declines seen in normal aging (i.e., changes in hearing, vision, speed to process information, etc.). In fact, changes seen in normal aging are a part of normal development. A very common example of normal memory changes is forgetting why you walked into a room. For some older persons, however, declines in memory (and other capabilities) go beyond what may be considered normal and are progressive; significantly impacting their ability to be independent. These more aggressive forms of decline, which impact more than just memory, are commonly caused by dementia.
Dementia is a permanent and progressive condition that usually impacts memory first but over time impacts thought processing, moods, behaviors, etc., leading people to be dependent on others for their needs. Dementia does not mean a person is “going crazy,” “stupid” or is an “invalid.” I only mention that because often that’s what patients (and sometimes their families) think that is what it means when I am talking to them about the diagnosis. Thinking it means the person is going crazy, stupid or will be disabled often causes people to delay reporting concerns to the physician in a timely fashion. It is important to talk about changes with your physician so they can help determine if the changes are normal or abnormal. Early diagnosis and timely intervention for probable dementia have several benefits including starting treatment, institution of safety measures and starting caregiver support and training.
Are there disparities in diagnosis and management of dementia in minority communities? Yes. There are variations in diagnosis, death rates, use of medications and other interventions, as well as use of long-term services and supports, health care costs, quality of care, and caregivers. For example, considering prevalence, Black people are about twice more likely than Whites to be diagnosed with Alzheimer’s disease, and Hispanics are about 1.5 times more likely than Whites to have Alzheimer’s disease, according to the National Institutes of Health. Even despite these alarming statistics, data suggests not only increased incidence in some minority populations, but also MISSED diagnosis and LATER diagnosis. These missed and more-so late diagnoses often lead to more distrust of the health care community, increased use of medical services and substantially higher costs at the end of life. Based on my knowledge, there are numerous underlying causes including factors related to measurement of the disease, vascular risk factors, genetics, socio-economic factors, cultural differences, lack of culturally competent providers and discrimination.
What’s the difference between Alzheimer’s and dementia? Dementia itself is an umbrella term that covers various conditions that cause significant decline in one or more areas, resulting in overall functional decline. Alzheimer’s disease is a type of dementia, and it is the most common type of dementia, but is it not the only type of dementia. About 60% to 80% of people diagnosed with dementia have Alzheimer’s disease, according to the Alzheimer’s Association. However, other types of dementia include vascular dementia (can be seen following stroke), Parkinson’s dementia, Lewy body dementia, Frontotemporal dementia and mixed dementia. The type of dementia is often determined based on the onset and type of symptoms.
How is dementia diagnosed? Dementia is a clinical diagnosis, which means that most cases can be diagnosed in the primary care setting using a combination of tools. They can include (most importantly) history as well as physical examination, labs, imaging and cognitive testing. Discussing even mild memory concerns with your physician is important as it starts a conversation where you can determine if the changes you are experiencing are normal. History and exams (including labs and imaging) are also important because they can help identify potentially reversible causes of memory loss or if you have conditions that can mimic dementia such as delirium or depression.
How is dementia managed? While there are prescription medications that have been approved for management of dementia, there is no cure. Available medications try to slow down the cognitive decline, but they do not stop or reverse the decline, so it is important to have realistic expectations when using medications for dementia. Your physician may prescribe medications for the management of behavioral problems, especially with concern for patient distress, or patient/family safety. Maintaining a routine, healthy diet, exercise and managing the environment by providing support to the patient are the best ways to help manage patients with dementia.
How does dementia impact caregivers? The impact of dementia on the patient is only one aspect of the total burden. The emotional and physical toll is immense for both patients and their families. Many primary caregivers of patients with dementia can experience psychologic distress – particularly depression – and get more physical health issues. In fact, caregivers of patients with dementia report that their health has worsened due to care responsibilities. Caregiver stress and burnout can be associated with patient decline. Perceived burden on the caregiver is a strong predictor of premature placement in a facility. Caring for the caregiver is just as important as caring for the patient because it helps the entire home or support system.
Caregiver education about the patient’s dementia diagnosis, treatment options, discussion about expected decline, safety and changing roles over time are important in the care of the patient. This reinforces the overwhelming theme that dementia impacts the entire family, not just one person (the patient). Recent research has focused on developing strategies for use by caregivers. Several of these studies have shown positive results and techniques that are often taught through programs offered through community programs and support agencies.
Separate from caregiver training programs, support groups play a pivotal role in managing caregiver distress. Caregiver distress is often reduced with participation in support groups, which may relieve common feelings of anger, frustration and guilt. Use of support groups and counseling services by family caregivers has been associated with a delay in nursing-home placement. Respite care is another community resource that offers caregivers relief.
What would your advice be about dealing with memory loss? Simply put: stay active, eat smart, minimize stress and get enough sleep. If possible, I recommend exercising five days per week for about 30 mins per day. Challenge your brain: like muscles in our body, if we don’t use our brain, it gets weaker over time. Connect with others: interacting with others stimulates our brain and can actually improve our overall well-being. Eat smart: what is good for our heart is good for our brain. Take care of your health conditions, especially high blood pressure, cholesterol and diabetes, as they can increase your risk of memory problems.
Don’t Forget! Not all memory loss is dementia, as some memory loss is normal with age. Don’t be afraid to talk about it with your physician. Talk to them as well as your loved ones about changes you have noticed in yourself or others. An open and honest discussion about memory loss is important for overall health. Remember, we are here to help.
Learn more about dementia and Alzheimer’s disease at kp.org.
Dr. Jarrod A. Carrol is a geriatrician at Kaiser Permanente’s West Los Angeles Medical Center. He credits his decision to pursue a career in geriatrics to seeing his grandparents navigate the health system, as well as the effects that their aging had on the entire family. As he continues on his journey, he looks forward to continuing to grow in medicine with interests in healthy aging, memory assessment and care, caregiver health, elder abuse and medical education.
