“Where did I put my car keys?” “Where did I park the
car?” “Do I have a car?”
Momentary lapses of memory can be annoying, but they generally are not
cause for concern. When memory loss or mental confusion is severe enough
to have a profound impact on a person’s everyday life, however,
it may be a sign of serious cognitive impairment.
“With normal aging, our thinking processes naturally slow down a
bit,” says Harman Chawla, MD, a physician specializing in geriatrics
and infectious diseases at Washington Township Medical Foundation. “As
we age, we may have trouble coming up with a specific word, struggle with
multitasking or face other minor limitations. Aging is a primary risk
factor for more serious cognitive impairment, however, and increased longevity
has led to a greater number of individuals with significant cognitive
impairment, including Alzheimer’s disease and other forms of dementia.”
To help people in the community learn more about cognitive impairment,
Dr. Chawla will be speaking at a free seminar, hosted by Washington Hospital.
His presentation will include discussions of medical assessments to diagnose
possible causes of cognitive impairment and advice for improving mental
function. The seminar is scheduled for Thursday, March 31, from 6 to 8
p.m. in the Conrad E. Anderson, MD, Auditorium at 2500 Mowry Ave. in Fremont.
Types of Dementia
According to the Alzheimer’s Association, “dementia”
is a general term for a decline in mental ability severe enough to interfere
with daily life. Alzheimer’s is the most common type of dementia,
accounting for an estimated 60 percent to 80 percent of cases. Difficulty
remembering recent conversations, names or events is often an early symptom.
Apathy and depression also can be early symptoms. Later symptoms include
impaired communication, disorientation, confusion, poor judgment, behavior
changes and, ultimately, difficulty speaking and walking.
Some other types of dementia include:
Vascular dementia occurs most commonly from blood vessel blockage or damage leading to infarcts
(strokes) or bleeding in the brain.
Dementia with Lewy bodies (DLB) is caused by abnormal clumps of a protein in neurons in the brain’s
cortex. These “Lewy bodies” also clump in the brains of people
with Parkinson’s disease (PD), which is marked by impaired body movement.
Mixed dementia is characterized by abnormalities of more than one cause of dementia —
most commonly Alzheimer’s combined with vascular dementia, followed
by Alzheimer’s with DLB and Alzheimer’s with both vascular
dementia and DLB.
“In addition to age, some other risk factors for dementia can include
a family history of dementia, head injuries, cardiovascular disease that
deprives the brain of the oxygen and nutrients, and mutation of specific
genes,” says Dr. Chawla.
“Some studies have shown that fewer years of formal education also
may be a risk factor,” he adds. “That possibly may be because
having more years of education increases the connections between neurons
in the brain that are needed to complete cognitive tasks. Women may be
more prone to dementia, perhaps because the production of estrogen declines
Dr. Chawla notes that a condition called “mild cognitive impairment”
(MCI) might increase a person’s risk for developing Alzheimer’s
or other forms of dementia. An individual with MCI has mild but measurable
changes in thinking abilities that are noticeable to the person affected
and to family members and friends. That impairment does not affect the
individual’s ability to carry out activities of daily living, referred
to as ADLs.
“In some cases, MCI might be an early stage of dementia, but MCI
does not always lead to dementia,” he says. “MCI sometimes
reverts to normal cognition or remains stable. In cases when a medication
causes cognitive impairment, MCI may be mistakenly diagnosed.”
Assessing Cognitive Impairment in Older Adults
Since cognitive impairment can be a result of factors other than dementia,
Dr. Chawla recommends a comprehensive, multidisciplinary physical assessment
of older adults who are experiencing noticeable changes in mental function.
Factors evaluated in such an assessment might include:
Functional Status – Evaluating the patient’s ability to perform ADLs such as
bathing, dressing, toileting, grooming and feeding, as well as “instrumental”
activities of daily living (IADLs) such as preparing meals, managing finances,
taking medications and managing transportation.
Nutritional Status – Screening for malnutrition, which may reflect medical illness,
depression, functional losses or financial hardship. Patients are evaluated
for low body mass index (BMI) and unintended weight loss.
Vision – Checking for cataracts, glaucoma, macular degeneration or other
conditions. Patients also are asked about everyday tasks such as driving,
watching TV and reading, often including a performance-based screening
of having the patient read aloud.
Hearing – Testing for hearing loss, which is common among older adults and
can result in depression and social withdrawal. After assessing the patient
for impacted earwax, additional testing is conducted with a handheld device,
followed by formal audiometry testing, if necessary.
“The assessment also includes screening for cognitive loss, with
a variety of performance measures,” Dr. Chawla says. “For
example, one simple test would be to have the patient repeat a list of
three items. We also would administer other tests, including the widely
used Folstein’s mini-mental state examination to test the patient’s
orientation, recall, attention, calculation, language and visuospatial
skills. In addition, we would assess the patient’s psychological
status, looking for signs of depression, anxiety and bereavement.
“It is important to screen for cognitive loss because most people
with dementia do not complain of memory loss,” he adds. “Older
persons with cognitive impairment are at a higher risk for accidents,
delirium, disability and an inability to comply with medical instructions
from their doctors.”
Treatments for Cognitive Impairment
“The primary goal of treatment for cognitive impairment is to enhance
the patient’s quality of life and functional performance by improving
cognition, mood and behavior,” Dr. Chawla notes. “Non-medicinal
approaches might include regular doctor appointments, individual or group
therapy, and modifications to the patient’s living environment with
special attention to safety. Referrals to specialists such as psychiatrists,
neurologists, social workers, physical therapists and nurses also may
help. Many such services are covered by Medicare.”
Medicinal treatment for cognitive impairment might include cholinesterase
inhibitors, which improve central nervous system function. Another drug
sometimes used in patients with dementia is memantine, which may improve
memory, attention, reason, language and the ability to perform simple
tasks. Other medications and supplements that may be of value include
vitamin E, estrogen, gingko biloba and nonsteroidal anti-inflammatory drugs.
“For patients suffering from depression, which often accompanies
cognitive impairment, antidepressant medications may be useful,”
says Dr. Chawla. “In some cases, patients may benefit from ‘psychoactive’
medications similar to the drugs used to treat narcolepsy or sleep apnea.”
Dr. Chawla also offers a variety of tips for improving memory:
- Stay mentally active with stimulating activities such as crossword puzzles,
reading, playing a musical instrument or volunteering
- Socialize regularly with loved ones, friends and others to help ward off
depression and stress
- Organize your life by reducing clutter, jotting down appointments in a
notebook or calendar, keeping to-do lists and setting aside specific places
for your wallet, keys and other essentials
- Focus your attention by limiting distractions and avoiding trying to do
too many things at once
- Eat a healthy diet with low-fat protein, fruits, vegetables and whole grains,
since a heart-healthy diet can be as good for the brain as it is for the heart
- Include physical activity in your daily routine to improve blood flow to
the body, including the brain
- Manage chronic health conditions such as diabetes, high blood pressure
and depression by following your doctor’s treatment recommendations
“Annual medical screenings for cognitive impairment generally begin
around age 65, but patients who are concerned about memory loss or mental
confusion should start screening earlier,” Dr. Chawla advises. “If
you have trouble performing tests designed to assess cognitive function,
your physician is likely to recommend tests such as a CT scan or MRI to
evaluate for other causes of dementia that are mimicking the symptoms
of Alzheimer’s. There currently is no cure for Alzheimer’s
or some other forms of dementia, but new treatments may delay memory decline,
improving the quality of life for patients and their caregivers.”
To register for the upcoming seminar on March 31 or for more information,
visit www.whhs.com/events or call (800) 963-7070.
If you need help finding a physician who specializes in diagnosing and
treating cognitive impairment associated with aging, visit www.whhs.com
and click on the link for “Find Your Physician.” For additional
information on Alzheimer’s disease, visit the website for the Alzheimer’s
Association at www.alz.org.