Forgetful or First Sign of Dementia?

Memory is something patients bring up often in my clinic. As you age, you may struggle to remember words, or find it’s harder to recall the names of acquaintances. People ask me if they should be concerned about these issues and what to do about them? Here’s answers to common questions I get asked about brain health. 

If I forget words, should I be worried about dementia?

Forgetfulness is a common concern, especially as we age. However, it's important to distinguish between normal age-related memory changes and potential signs of dementia. 

• Normal aging involves a gradual slowing of cognitive function. It might take you a bit to remember words or learn new information, but your functioning is not affected and you can perform all your daily activities independently. 
• Mild cognitive impairment can become slowly noticeable, especially to other people. You might struggle to come up with words or remember things, but you are still able to function in daily life. You may need to use lists or notes as reminders to stay organized. 
• Dementia is a broader term that describes a significant decline in cognitive abilities that interferes with daily life. It's not a specific disease but rather a syndrome caused by various underlying conditions, including Alzheimer's disease, vascular dementia, and Lewy body dementia.
  • The noticeable cognitive decline you see in dementia may manifest as struggling more with memory, planning, or social interactions that affects your ability to participate in daily activities. For example, you might make mistakes when paying bills or forget the ingredients for a recipe you’ve been making for years. The key is that your memory and thinking interfere with functions of daily life.

Does forgetfulness always lead to dementia?

No, not necessarily. While some people with cognitive decline may progress to dementia, most do not. In fact, only 10% of people with mild cognitive impairment develop dementia within a year.

Keep in mind there are many different kinds of dementia. While Alzheimer’s disease is very common, memory problems can also be caused by vascular disease dementia, which results from constricted or blocked blood vessels which can occur with a stroke or transient ischemic attack (TIA).

Are there other things that can affect cognitive function?

Stress, depression, anxiety, and certain medications can all affect your cognitive functioning. It's important to rule out or treat these factors before diagnosing cognitive decline.

Can medications improve dementia?

The short answer is probably not. Despite the different options, I generally don’t recommend supplements and dementia medications should be used with some caution if you decide to try them. 

• Supplements. Unless you have a specific vitamin deficiency, such as being low in B12, there’s no FDA-approved supplement that can treat dementia. 
• Medications. Cholinesterase inhibitors and NMDA inhibitors are the mainstay of dementia treatment. They can help some people with cognitive decline but can also have side effects such as nausea, dizziness, and in rare cases heart slowing. I recommend talking to your doctor about the risks and benefits to see if a trial of these is right for you.  
• Newer medications. Monoclonal antibody-type medications attack the amyloid that is involved in the development of Alzheimer’s disease. These are FDA approved but efficacy is minimal and they can have severe side effects like brain bleeding and brain inflammation. I generally do not recommend these newer medications because the risks and benefits do not seem well balanced and more study is needed.

What can I do if I'm diagnosed with dementia?

There are steps you can take to manage the condition and maintain your quality of life. Start by  maintaining regular routines, staying socially active, and participating in activities that keep you engaged. Everything that is good for the heart is also good for the brain. Make sure you stay physically active, exercise regularly, and eat a healthy, low fat and low cholesterol diet. Use alcohol in moderation if at all. Flex your brain muscle by playing games (cards, chess or memory games), take a class, try new recipes or consider learning a new language. 

Where can I find help and support for dementia?

Several organizations are available to help individuals and families cope with dementia. Your provider can also direct you to appropriate agencies and resources.  

• Local Area Agency on Aging (AAAs). Provides services to help older adults remain independent. Eldercare.gov
• Aging and Disability Resource Centers (ADRCs). Offers information, advice, and assistance for long-term care needs. Eldercare.acl.gov
• Aging Life Care Association. Connects you with geriatric care managers who can provide support and guidance. Aginglife.care.org
• Family Caregiver Alliance. Offers resources and support for caregivers. caregiver.org/family-care-navigator,
• Alzheimer’s Association. Offers a helpline, education,  support and early-stage social engagement programs.  Alz.org/help-support,