Memory Loss is Normal for Older Adults (FALSE) … so WHY get tested?

First, Memory Loss is not normal as we age and is something you should discuss with your primary care physician if you notice it in yourself. There are several reasons why someone may have memory loss and many of them can be reversed. If you don’t pursue testing you will never know if your (or a loved ones) issue can be treated, slowed, reversed.

What is normal is slower processing speed. Our brain processing speed slows down generally at 50, but we should still be able to retrieve the information. If you believe you have short-term memory issues, speak with your primary care physician and request a visit to a neurologist for an evaluation if you don’t find a cause.

Understanding if you have a form of dementia can help you know if there are trials or treatments, as well as better plan for the future. It is also valuable to family members to know if and what form of dementia a relative may be diagnosed with.

I’m writing this as I am waiting for a client who is going through neuropyschological testing right now. Halfway through we shared lunch and she asked why she is bothering with this test since “memory loss is normal in someone my age.” We had a lively conversation around her believe that memory loss was a normal consequence of aging.

When she was losing her checkbook and couldn’t find it, ordering new checks and not recalling that she did it, and sending off money over and over to a friend, I asked her if she recognized she was having some issues with her memory. She said yes and she actually mentioned it to her primary care physician. He recommended she get a blood test, MRI, and neuro-psychological testing.

So here we are.

What I do know is that the testing was invaluable to me as the primary family caregiver for my parents. It helped me better understand the gaps in thinking for their different types of dementia (vascular and Alzheimer’s). I was able to attend the reporting session and what I learned help me realize that I was going to have to change because in all reality, my parent’s thinking was very different than it was previously. How they processed, and even recalled information had changed.

It also helped us understand how long they might live, and the type of care they were going to need.

For me, knowing was better than not knowing. I know everyone is different. Shared.

Difficult People and Dementia

see through boxersWhen I hear the statistics about older adults living with dementia, I immediately dismiss them because I believe they are just too low. I know there are many people living with dementia that were never diagnosed and so they have never been counted.

I understand why families choose not to pursue testing. However, I also know that there are so many factors that could contribute to create symptoms of dementia that some might be living with it needlessly.

There are a host of drugs that can alone or in tandem with other drugs may imitate dementia (The Washington Post).

I recently was involved with a family who were very concerned about their father. He was explained to me as a “very difficult person.” As I met with him and the woman who helps him out regularly, it was very clear to me that he had some form of cognitive issue. However, all of those around him are just chalking up his behavior as a personality quirk. The family confirms that he did not always behave in this manner, but over the years he has got more ‘difficult’.

As I was talking with him about how I could help with some of the daily money management issues it was clear he did not comprehend where some of his income was coming from — some was from military service and had been coming to him for over 60 years. There were several small things that demonstrated to me he was having trouble comprehending and processing the information. The fact that he has been unable to pay or manage his day-to-day finances is a big clue. So often I am called after there has been a financial boo-boo that was too glaring to ignore any longer. Ideally, you don’t want to strip them of their control, but just layer in some help.

My final clue was that when I met him, he was in his boxer shorts. He lives in a high-rise complex and was down in the lobby talking to a neighbor when I arrived. As we return to his apartment, I find that I can see right through his mesh boxers to skin. I mentioned this to the woman who is helping him on a regular basis and she confirms that she will ask him to put on a second pair before they leave for lunch. He is intelligent and curious, and as a man in his 90’s, I don’t think he recognized that he is walking around in public in his underwear.

I recognize all of the reasoning we used in my family. You want to respect and honor an individual, but often, it seems to reach the point of failing to possibly address the source of the behavior changes. Maybe they are caused by medication or even hearing loss (you don’t understand what your don’t hear.) For a variety of reasons, I ask that if you find yourself in this position, you advocate to get some medical attention to eliminate possible causes for the change. Suggested. 

 

According to the World Health Organization: “Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.”

Knowing the type of Dementia Helps Everyone

I didn’t handle the diagnosis of my parent’s well. I thought that hearing a doctor tell them they had dementia would suddenly make helping them easier for me. I finally realized that it was equally devastating to my Mom every time she was told.

For a large majority of individuals with vascular dementia – the type that comes after a stroke – they are unable to recognize their loss. My Mom had no physical changes, and for the first few months thought I was making up the fact that she had a stroke. The medical term is Anosognosia and I wish I knew and understood this when my Mom was diagnosed. She was medically unable to perceive that she had difficulty with her thinking and memory.

In the years since I lived through caring for two parents with dementia, I have found many individuals that don’t understand why a diagnosis mattered at all.

A recent story on NPR Is It Alzheimer’s Or Another Dementia? The Right Answer Matters reinforces the need to get a diagnosis. Apparently, most people default to the belief it is Alzheimer’s, and having some insight can also help the care partners manage better.

I have had a long-standing discomfort with the share of voice Alzheimer’s has taken. First and foremost is because most people don’t even know it is the most common form of dementia. I didn’t realize it until my Mom was diagnosed with Vascular Dementia, while my Dad was diagnosed with Alzheimer’s.

What I have learned is that the primary types of dementia all come with varied behaviors, risks, possible treatments and care plans. One form of dementia comes with symptoms that present more as a personality change than symptoms of dementia. In general, changes in behavior, mood, and memory should all be discussed with your primary care physician. Knowing more can help everyone and I hope you will help learn more should you be concerned about your own health changes or those in a loved one. Encouraged.

Herpes Vaccine Fighting Alzheimer’s?

herpes virusSo, not that anyone is going to opt for herpes, but several recent studies reported that taking herpes medication lowers your risk of Alzheimer’s. The study published in Medical New Today reported that Alzheimer’s risk is 10 times lower with herpes medication.

“In the herpes group, the risk of dementia was over 2.5 times higher
than in the control group.”

Two articles (Tsai et al., published in PLoS One in November 2017; Chen et al., published in the January/February 2018 issue of Journal of Clinical Psychiatry) demonstrate an increased risk of subsequent senile dementia (SD) development in patients with acute varicella zoster (herpes zoster) infection. 

I found this to be a fascinating read and who knows where the cure might originate? Here’s to a cure. Intrigued. 

Another reason to eat our veggies!

leafygreensResearchers at Rush University Medical School in Chicago found that “one serving of leafy greens a day may slow brain aging by 11 years.”  I initially read the story in The Washington Post that reported “eating as little as one and one half cups of lettuce daily — or a bit more than half a cup of dark leafy greens — may delay the decline in memory and thinking skills that occur with age.”

For those of us with family members with any form of dementia, any and all proven methodologies are gladly received.

The report from Rush states that “cognitive abilities naturally decline with age” which is not the same as the wording in the The Washington Post story that gives you the impression that our memory will decline with age. I see and hear people buy into this belief too often.

In general, our processing speed does slow down staring in our 50s, but memory loss is not a normal consequences of aging. To quote Dr. Green of Total Brain Health, most of us have a “getting problem, not a ‘forgetting’ problem.” There are many things we can do to rev up our recall, and lots of reasons why we might not remember something which doesn’t mean we are showing early signs of dementia.

If you are having memory concerns, go see your doctor. If they don’t take your concerns seriously, ask for a referral to a neurologist. There are many mild cognitive issues that are reversible.

I watched as the doctor’s dismissed the overwhelming number of early warning signs for my parents and hope everyone has a better chance to battle and weather the life-stealing  beast of dementia.

Now off to the store to buy me some greens. Hungered. 

For more on the full report, you can visit: Neural and behavioral bases of age differences in perceptions of trust.  In summary:

“Older adults are disproportionately vulnerable to fraud, and federal agencies have speculated that excessive trust explains their greater vulnerability.

Two studies, one behavioral and one using neuroimaging methodology, identified age differences in trust and their neural underpinnings. Older and younger adults rated faces high in trust cues similarly, but older adults perceived faces with cues to
untrustworthiness to be significantly more trustworthy and approachable than younger adults. This age-related pattern was mirrored in neural activation to cues of trustworthiness. Whereas younger adults showed greater anterior insula activation to untrustworthy versus trustworthy faces, older adults showed muted activation of the anterior insula to untrustworthy faces. The insula has been shown to support interoceptive awareness that forms the basis of “gut feelings,” which represent expected risk and predict risk-avoidant behavior. Thus, a diminished “gut” response to cues
of untrustworthiness may partially underlie older adults’ vulnerability to fraud.”

Tougher Rules for Elderly Drivers

conesOn January 1st, Virginia implemented tougher rules for elderly drivers. They include requiring the individuals to renew in person, renewing their license every 5 years (instead of 8), and passing the Virginia Department of Motor Vehicles’ vision requirements or presenting a vision statement no older than 90 days from an optometrist or ophthalmologist.

When we started to see dings on my dad’s car multiplying, we stopped asking him to pick up the kids from school. When they would get lost driving to my house, I was very concerned about having them behind the wheel and the safety of the other drivers on the road. They had driven to my home hundreds of times and my dad began to get repeatedly lost on his way over. When he finally did arrive, he would be relieved, but had no recall of any previous instances. My dad was finally diagnosed for Alzheimer’s.

My parents felt that driving was a right, not a privilege. I recognized and appreciate the need to be able to get around, but they were unsafe drivers long before the doctor finally submitted the papers to the DMV to rescind their licenses. They bought into a Continuing Care Retirement Community (CCRC), but would repeatedly tell us they weren’t old enough to move in full-time.

For detailed information on how we dealt with and managed this, you can read a summary of the steps we took that I posted as we were facing this very issue.

I’m glad the state is taking some action, but know that my parents would have passed the test well into the first few years of dementia. I believe that driving is a privilege we should have to earn probably more frequently than the initial milestones when we are in our teens and now these minor checks at 75. My parents managed to renew their license early and I shared my concern back in 2012 that the DMV was not doing enough. I consider this often as I imagine where my husband and I should live next and how we might manage our driving. Pondered.

Please share what your state has done about this issue, if anything. 

 

 

 

 

My Mom Repeats Herself, But She Doesn’t Have Dementia

Understanding Dementia
Understanding Dementia

I cared for two parents with dementia and in many conversations, I have someone share “My Mom repeats herself, but she doesn’t have dementia.”

I started in the same place, before Mom was diagnosed. You just notice something is different, but you don’t know what it is exactly or what, if anything, you can do about it.

I noticed that my Mom would repeat herself, and my Dad was less talkative and seemed depressed. Both of my parents had changing behaviors which is a signal that something is wrong. When my parents were first diagnosed, I was confused about the difference between Alzheimer’s and Dementia.

The common office test given is called the mini–mental state examination (MMSE) or Folstein test. It’s 30 questions and is really only going to capture someone who is moderately impaired. The only true early detection system will be your own observations of someone who you know well. My parents scored in the high 20’s over the course of two years – even when the administering doctor could tell something was not cognitively right with my parents. A better understanding of their strengths and weaknesses was revealed when they were given a Neuropsychological Evaluation. This test takes around 2 hours.

I hope you will consider that any change in your parents could be an early warning signal to future more complicated issues — not just cognitive. Please know there are many other things that can cause memory loss that can be easily treated. Start with a visit to the doctor and join them. The more you can do early, the better off everyone will be. Warned.

Additional Resources:

Get a copy of Kay’s Best-Selling Book that will help you and your loved ones get things organized to ease the caregiving journey.

Understanding the Durable Power of Attorney

A fellow blogger Butch shared this post. For some eye-opening reading, check out this Forbes article: Are We Underestimating How Much Help Aging Parents Need At Home?