There are clear differences and actions to take to help slow cognitive decline
We have all experienced some slips in memory: “Where are my car keys?” “Where did I park the car?” “What is her name?” When that happens, especially if it’s a family member with memory loss, you worry that this could be an ominous sign. However, our cognitive abilities do change with age. Some functions get better, like vocabulary and general knowledge, and others worsen, such as processing speed and attention.
Medical conditions, medications, both prescribed and over the counter, and changes in sleep, among other things, may impair cognitive functions. Knowledge of the warning signs of cognitive dysfunction and knowing what may just be normal aging allow us to know when to seek help for ourselves or our loved ones. It is important to know that there are causes of cognitive changes that aren’t related to dementia that can be treated and reversed, such as vitamin deficiency, medication side effects and depression.
The first step in evaluating changes in cognitive function is to make sure there are no treatable factors contributing to the symptoms. Conditions such as thyroid disease, untreated infections, poorly controlled diabetes mellitus (impaired insulin production that also damages metabolism) and undiagnosed obstructive sleep apnea could be impairing memory and thinking. Blood tests and a sleep study are recommended and can be ordered by your physician. Also, low levels of B vitamins such as B12, folate or thiamine, can affect the nervous system. These vitamins are easy to measure in the blood and can be supplemented. Low vitamin D may also increase the risk for dementia.
Medications that are prescribed for insomnia, anxiety and bladder control may also impact memory function, as can over-the-counter bladder and insomnia medications. Talk to a doctor about which medications have these potential side effects and eliminate them if possible. A doctor or specialist may recommend brain imaging to look at the structure and health of the brain. All changes in cognitive and behavioral function should be evaluated as soon as possible by an MD, preferably a geriatrician or a neurologist.
The Alzheimer’s Association’s 10 Signs and Symptoms list summarizes what can happen to your cognitive functions if you are starting to have serious problems from this disease. Keep in mind that some of the symptoms listed are also an example of what happens with normal aging, too:
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Decreased or poor judgment
- Withdrawal from work or social activities
- Confusion with time or place
- Changes in mood and personality
- Misplacing things and losing the ability to retrace steps
- Trouble understanding visual images and spatial relationships
- Difficulty completing familiar tasks at home, work or at leisure
- New problems with words in speaking or writing
If an individual is given a diagnosis of Alzheimer’s disease or any other related dementias, it is important for the caregiver to remember the 3 P’s
- Programs:Daily activities both physical and social
- Physical Environment
Alzheimer’s disease typically affects short-term memory first, so memory loss that disrupts daily life will usually be the first symptom noted. Problem-solving should remain intact as we age, although we may take longer to get to the solution. Being unable to solve daily challenges, being unable to perform tasks that are familiar and significant changes in judgment are red flags. Normal aging is associated with occasional difficulty in word retrieval. A constant, noticeable pause in conversation leading to difficulty in expressing thoughts is not typical of normal aging. Driving and navigation can be affected by Alzheimer’s due to problems understanding visual images. Being unable to learn a new route or getting lost in familiar places are red flags.
If an individual is given a diagnosis of any dementia, it is important for the caregiver to remember the 3 P’s — People, Programs (daily activities both physical and social) and the Physical Environment. The personal interaction they receive is the most important. The individual still requires love, patience and understanding from loved ones. It is extremely important that the caregiver learns about the clinical process and implications of progressive dementia, such as changes in personality, as well as changes in cognitive and physical function.
Lifestyle modifications may improve memory, reduce the risk for dementia or slow cognitive impairment. Physical exercise builds your muscles and your brain function. Increasing oxygen and blood flow to the brain will lead to healthier brain structures such as the hippocampus, which is essential to memory function. Physical activity will also protect the brain and make it more resistant to age-related conditions, such as stroke. Discuss starting an exercise program with a doctor first and build up slowly to reach or exceed 150 minutes a week of aerobic exercise mixed with resistance exercises.
Cognitive stimulation and social engagement keep us mentally sharp. Learning new things exercises the brain. Being social with others is beneficial for the brain by keeping it healthy and may decrease the risk for depression. Diets such as the DASH diet (Dietary Approaches to Stop Hypertension) and the Mediterranean diet, which emphasize fish, vegetables, whole grains and limit sugar and red meat, have been found to reduce the risk of dementia or slow cognitive decline.
Family caregivers can have a kaleidoscope of feelings, such as helplessness, frustration, anger, sadness, guilt, grief and depression. It can’t be stressed enough that caregivers need to receive support and may benefit from seeking therapy to talk about their feelings. As a family caregiver, you will need to learn strategies for problem-solving and stress reduction to alleviate troubling behaviors your loved one may experience. Caregivers must accommodate and support existing levels of function, rather than requiring people with dementia to perform in ways that are no longer possible. It is imperative for caregivers to acquire help so they can protect their own health and take the necessary time to rest, eat well, exercise and fulfill their spiritual needs.
Teresa Whittington is the VP of Clinical and Continuum Operations at C. C. Young. She is an RN, BSN, and has a passion for caring for seniors. She has worked in senior care for 27 years and strives to improve the care and services for seniors. She is a board member for SAGE (Society for the Advancement of Gerontological Environments) and has several certifications in dementia and Alzheimer’s care.
Mary Ellen Quiceno, MD, FAAN, is an Associate Professor of Neurology & Neurotherapeutics at the University of Texas Southwestern Medical Center in Dallas, Texas. She specializes in the diagnosis and treatment of cognitive disorders in older adults. Dr. Quiceno is an active member of the Greater Dallas Chapter of the Alzheimer’s Association. She conducts clinical research and is currently looking for volunteers to help prevent Alzheimer’s disease: http://www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp