“I’m feeling pretty good today. Not every day, of course,” says Jim, who was recently diagnosed with Lewy body dementia at age 79. For years, he’d been experiencing symptoms ― sleep disturbances, dizzy spells ― that puzzled his doctors. A health nut and born optimist, Jim continued to play basketball with friends at a nearby gym. He drove to games and to visit his grandson, despite a couple of recent fender benders.
The diagnosis was a reality check. “They’ll probably take my driver’s license away,” he says, sounding mostly resigned. “I agreed not to drive just because the doctor asked me, but that’s not binding. I hate losing my license, because it’s so final.”
“He’s really more at peace now,” counters Christy, his wife of 50 years. “After the diagnosis, he immediately had a to-do list. He reassured me that I didn’t have to worry.” Together, they’re educating themselves about the condition and attending support groups where individuals share how they’re coping. Still, Jim says, “I’m in the dark with a lot of it. I would like to know more.”
The words Alzheimer’s and dementia strike fear in many adults. But the average person has little understanding of what these terms mean. Are changes in memory and thinking just a natural part of old age? Is dementia preventable? While doctors don’t have all the answers, they have some strong hunches about how to reduce your risk.
“Dementia” refers to a decline in thinking that affects daily living and social functioning. More than memory loss, symptoms can include disorientation, decreased attention span, slower response time and changes in personality and mood. “Senility,” the old-fashioned term for mental and physical decline, used to be synonymous with the aging process. “We were taught in medical school that we were all going to get it eventually ― some earlier, some later,” says Gabriela Cora, MD, a psychiatrist and medical director with Aetna Behavioral Health.
Today, we understand that dementia is far from inevitable. About 1 in 10 Americans develops Alzheimer’s, a disease that’s responsible for half of all dementia cases. Rates vary from culture to culture, suggesting that factors like diet, education level and proper health care can have an impact. Researchers are now testing interventions to prevent or delay dementia’s onset.
As for plain old forgetfulness, that does naturally increase with age, according to the National Institute on Aging. “Normal absentmindedness is usually about not paying attention,” says Dr. Cora, who once conducted research into dementia at the National Institutes of Neurological Disorders and Stroke. “I come home and throw down my keys, and then don’t remember where I put them. That’s not a sign of dementia. I didn’t put any effort into making that memory stick. But that kind of thing can get worse as we get older, especially when we’re in unfamiliar environments.”
Determining the underlying cause of dementia is important to ensure the most effective treatment. Alzheimer’s is associated with brain inflammation (swelling), for instance, while Vascular dementia is caused by narrowed or blocked blood vessels. Dozens of other health conditions can cause problems with thinking: infection (such as Lyme disease and AIDS), alcohol abuse, blood clots and more. Sometimes dementia has mixed causes, and one type seems to predispose the brain to other problems. Doctors often see overlap between Alzheimer’s and Vascular dementia, or alcohol abuse and blood clot due to a fall.
When a patient comes in with cognitive complaints, doctors consider their medical history, the severity of the symptoms and the speed of their onset. “Some forms of dementia are reversible with treatment,” says John Moore, DO, an Aetna medical director and senior health specialist. “It’s very important to see your primary doctor if you suspect that you are ― or someone you care for is ― displaying signs of dementia.”
There is no definitive test for Alzheimer’s. Doctors generally make an Alzheimer’s diagnosis only after eliminating other possibilities they can test for. Those tests may include:
Potentially curable causes of dementia include vitamin deficiency, thyroid problems, stress and depression (more on that below). Reactions to prescription drugs are another common factor. As we get older, our liver and kidneys slow down, making medications linger in our system longer. Adjusting your dosage and timing can eliminate chemical buildups that have a toxic effect on brain cells.
Medications and other treatments are available to delay the progress of some forms of cognitive decline. Once again, early detection is vital. Clinical trials usually welcome participants only in the early stages of dementia. “With most forms of dementia, nothing reverses the process, as far as we know,” says Dr. Cora. “But some medications claim to maintain a higher plateau of memory.”
Studies have shown that gingko biloba and commercial supplements marketed as “brain boosters” don’t offer any measurable benefit. Plus, they can interact with prescription medications, actually contributing to memory and health problems. Online brain games don’t improve cognitive performance either. As for the headlines about strawberries, green tea or olive oil turning back the clock on Alzheimer’s, it’s not that easy. But if you enjoy those foods, doubling down on them won’t hurt.
Many people with dementia also have other health conditions, which exacerbate one another. A whole-body approach to dementia treatment offers the best chance of slowing its effects and allowing individuals to enjoy life for the longest time. That means managing underlying medical conditions, caring for mental health and getting help with medication and daily living.
Some experts believe the key to treating dementia may be all in the timing. Although it’s diagnosed later in life, dementia likely develops years ― even decades ― earlier in a “silent” form with no noticeable symptoms. “I personally believe that ‘treatment’ should start before memory issues begin,” Dr. Cora says. “There’s a lot of correlation between dementia and heart disease, diabetes, high cholesterol, high blood pressure. The healthier you can stay, the better your dementia prognosis.”
If you’re having trouble managing your condition, your health insurance may be able to help. Aetna’s Resources for Living consultants can help arrange home-delivered meals, pet care, home cleaning and other support services. And the medication therapy management (MTM) program can review your prescriptions and coordinate with your doctor to resolve issues.
Some researchers estimate that 35 percent of dementia risk is “modifiable,” or in the individual’s control. Some of these factors make intuitive sense. Others may seem like a stretch, but a closer look can reveal a lot about the challenges of studying and managing brain conditions.
Hearing was only recently recognized as a significant factor in brain health, though the connection is still unclear. One possibility is that the blocked blood vessels that lead to vascular dementia also contribute to hearing loss. Another theory is that hearing loss stresses the brain, leaving less energy and space for other tasks. Difficulty hearing could also lead to social disengagement and depression, accelerating brain atrophy. With 1 in 3 people over 55 suffering some hearing impairment, managing hearing loss could make a significant impact on dementia as a public health issue.
Other factors surely play a role as well. Visual impairment may contribute in a similar way as hearing loss. Sleep disorders are known to disrupt essential functions in the brain. And there’s some evidence that air pollution accelerates brain degeneration in several ways.
Strangely, some people with physical signs of Alzheimer’s, Vascular dementia, Lewy body ― or even all three ― show no cognitive symptoms at all. The reason is a mystery, and the medical community refers to it as “resilience” or “cognitive reserve.” “We don’t know much about it,” Dr. Cora admits. “But the more you use your brain ― develop connections and associations ― the easier the brain can look for other areas to resolve issues.”
Certain activities are especially good for strengthening connections and keeping your brain spry. Dr. Cora recommends:
Seeking out intellectual stimulation is something you can do at any age. “Some of my friends say they can’t learn new things. I say, that’s not true!” says Dr. Cora. “But if you believe it’s true, you’re going to be stuck. Your brain can function in an agile way as you get older. I remain very hopeful.”
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Maureen Shelly is a health and science geek living in New York City.
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