The incidence increases dramatically as people move into their 90s. About 5% of those between 71 and 79 have dementia and about 37% of those in 90 live with it.
Older people may worry about their own loss of function as well as the cost and price of caring for someone with dementia. A 2018 study estimated that the lifetime cost of care for a person with Alzheimer’s, the most common form of dementia, is $ 329,360. That figure will no doubt increase, too, putting even more burdens on the family, Medicare and Medicaid.
In recent months there has been a lot of talk and there has also been talk of dementia due to the presidential elections. Some voters asked whether one or both candidates might have dementia. But is it also a fair question to ask? When these kinds of questions are asked ̵
First, it is important to know that dementia cannot be diagnosed from afar or by someone who is not a doctor. A person needs a detailed medical examination for a diagnosis. Brain imaging is sometimes needed.
And forgetting an occasional word – or even where you put the keys – doesn’t mean a person has dementia. There are different types of memory loss and they can have different causes, such as other medical conditions, falls, or even medications, including herbs, supplements, and anything over the counter.
Older people wonder and worry about “senior moments” and the memory loss they perceive in themselves and others. I see patients like this every week in my geriatric clinic, where they tell me their stories. They forget a word, get lost in a story, lose their keys or can’t remember a name. The details vary, but the underlying concern is the same: is this dementia?
Normal memory loss
As we age, we experience many physical and cognitive changes. Older people often have a decrease in recall memory. It’s normal.
Have you ever had trouble retrieving a fact from the deep end of your “Rolodex of mind”? Suppose you spot someone at the grocery store you haven’t seen in years. Maybe you recognize the face, but you don’t remember their name until later that night. This is normal, part of the expected changes with aging.
What’s more of a potential problem is forgetting the name of someone you see every day; forgetting how to get to a place you visit frequently; or having problems with activities of daily living, such as eating, dressing and hygiene.
When you have memory problems but they don’t interfere with your daily activities, this is referred to as mild cognitive impairment. Your primary care physician can diagnose. But sometimes it gets worse, so your doctor should follow you closely if you have mild cognitive impairment.
You want to note the timing of any damage. Has there been a gradual decline? Or did it happen suddenly? This, too, you should discuss with your doctor, who may recommend the MoCA, or Montreal Cognitive Assessment, which checks for memory problems and helps determine if further assessments are needed.
Additionally, the Centers for Disease Control and Prevention list problems in these areas as possible signs of dementia:
● Reasoning, judgment and problem solving.
● Visual perception beyond typical age-related changes in vision.
More serious problems
When memory loss interferes with daily activities, consult your doctor about what to do and how to make sure you are safe at home.
There are numerous types of severe memory loss. Dementia tends to be a slow progression that occurs over the course of months or years. Delirium is more sudden and can occur for hours or days, usually when you have acute illness. Depression can also cause changes in memory, particularly as we age.
Dementia, other brain problems
Alzheimer’s is the most common type of dementia, followed by vascular dementia. They have similar symptoms: confusion, getting lost, forgetting close friends or family, or an inability to do maths like checkbook balance. Some medical conditions – thyroid disorders, syphilis – can lead to symptoms of dementia, and less common types of dementia can have different types of symptoms.
Alzheimer’s has a distinct set of symptoms often associated with certain changes in the brain.
Focusing on safety and proper supervision, particularly at home, is critical for all people with dementia. Your doctor or social worker can help you find support.
It is also important to be aware of two other things that can lead to decreased mental functioning: delirium and depression.
Delirium, a rapid change in cognition or mental functioning, can occur in people with an acute medical illness, such as pneumonia or even covid-19 infection. Delirium can occur in patients in the hospital or at home. The risk of delirium increases with age or with previous brain injury; symptoms include impaired attention span and memory problems.
Depression can occur at any time, but it is more common with aging. How can you tell if you are depressed? Here’s a simple definition: when your mood stays low and you’ve lost interest or joy in the activities you once loved.
Sometimes people have recurring episodes of depression; sometimes it is a prolonged bereavement that becomes depression. Symptoms include anxiety, hopelessness, low energy, and memory problems.
If you notice any signs of depression in yourself or a loved one, consult your doctor. If you have thoughts of harming yourself, call 911 for help immediately.
Any of these conditions can be frightening. But even scarier is unrecognized or unrecognized dementia. You must, openly and honestly, discuss with your doctor the changes you notice in your memory or thinking. It’s the first step in understanding what’s going on and making sure your health is the best it can be.
And, as with any disease or group of diseases, dementia is not a “character defect” and the term should not be used to criticize a person. Dementia is a serious medical diagnosis – ask those who have it, the loved ones who care for them, or any of us who treat them.
Having dementia is a challenge. Find out what you can do to support people with dementia in your community.
Laurie Archbald-Pannone, who specializes in geriatric medicine, is an associate professor of medicine at the University of Virginia. This article was originally published on theconversation.com.