Dementia is a diagnosis that has to do with the loss of cognitive abilities and capacity. It also is a broad description of a group of brain illnesses.
The use of the word Dementia has changed over time. A number of years ago, “senile dementia” was thought to be a normal occurrence for people as they aged. They would get forgetful, need more assistance with executive decision making and judgment, and become more fragile, needing support in areas of daily living. As time went on, diagnostics improved through the use of non-invasive scanning, and expertise expanded in being able to read these scans. Additionally, clinicians gained more and more experience with these types of illnesses. With a larger demographic group of people living longer, they were able to understand specific physical changes to the brain that occur with aging. This lead to the discovery of many types of cognitive illnesses that make up the group of Dementia, which turned the word into an umbrella term that includes a variety of different types of dementias under it.
Alzheimer’s disease is a form of Dementia, it is the 6th leading cause of death in our country and the largest category under this umbrella, making up about 70% of dementia diagnosis. Typically, the longer you live the more risk of getting Alzheimer’s you have; people over the age of 85 have a 50% chance of getting it. Alzheimer’s has some specific issues, with excessive production of protein amyloid plaques in the brain, neural fiber tangles, with neurons dying and being unable to transmit neural chemicals correctly, and brain matter loss, with atrophy of the brain. There can be 20 years of changes in the brain before you have outward signs of cognitive loss, and the disease can last 2 to 25 years with the average being 8 to 12 years. Alzheimer’s is challenging for the person with the disease and for their caregivers. Due to global impact and losses in the brain, it eventually affects every aspect of the person’s life.
There are other types of Dementia, also known as Chronic Organic Brain Syndromes, such as Cardiovascular Dementia, Lewy Body Dementia, Frontal Temporal Lobe Dementia, Parkinson’s Related Dementia, and other types but these dementias make up a smaller percentage of cases under the umbrella of Dementia.
Alzheimer’s and all of these types of dementia are non-reversible and at the moment have no cure.
It is best to check in with the person’s regular MD first, letting them know you have some concerns about cognitive changes and you would like them to do a thorough evaluation. This means getting a physical with full-screen blood work, lab work, and evaluating outcomes. There should also be a review of any medications the person might be taking, to make sure there are not drug interactions affecting mentation. Another important thing to consider and share with the doctor are the social and life situations the person is in. Were there any recent losses; work, retirement, changes in spousal relations, or a death in the family? Any history of addiction and concerns about a relapse? Mental health concerns either old or new such as depression, even insomnia, or sleep apnea can cause changes in function that are possibly treatable.
The MD is looking for anything that might cause a change in cognitive functioning that might be rooted in a physical cause that could be treated, or an emotional, or mental health area that again could be addressed with different kinds of support. The MD will be able to provide an evaluation of some kind regarding cognition. There are a couple of tests typically used (the SLUMS test, Mini-Mental State Exam (MMSE), and the Mini-Cog test), all of which can be done easily with the primary MD. Sometimes a person has a psychiatrist that is able to make a preliminary diagnosis of cognitive loss and will send them on to other specialists as well. There are more specialized clinics, such as memory clinics, neurology offices, and research hospitals working on brain health that can offer more involved testing. If the MD is able to rule out any other causes but corroborates the concern about cognitive changes and loss, the next step is usually brain imaging to see what changes are occurring in the brain. This imaging helps the clinician and the person with the illness know what good next steps might be and what things to plan ahead for.