Dementia: The fading memory problem
By Dr.Achala Balasuriya

We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.

Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate. After a while, this makes it hard for the person to take care of himself or herself because it is a loss of mental skills that affects your daily life. It can cause problems with your memory and how well you can think and plan.

Usually dementia worsens over time. How long this takes is different for each person. Some people stay the same for years. Others lose skills quickly.

Your chances of having dementia rise as you get older. But this does not mean that everyone will get it. Many older adults never get it. By age 85, about 35 out of 100 people have it. That means that 65 out of 100 people this age do not have dementia. After age 85, though, even more people will get dementia.
If you or a loved one has memory loss that is getting worse, see your doctor. It may be nothing to worry about. If it is dementia, treatment may help.

Types and differences of dementia

The most common type of dementia is Alzheimer’s disease, which is thought to affect 4.5 million people in the United States, according to the National Institute of Health. Alzheimer’s disease is a progressive, degenerative neurological disorder that occurs when neurons in the brain die or break their connections with other neurons. This is believed to occur because of abnormal lesions in the brains of people with Alzheimer’s disease called beta-amyloid plaques and neurofibrillary tangles. These plaques and tangles disrupt brain function and are known to increase in quantity as Alzheimer’s disease progresses

What causes dementia?

Dementia is caused by damage to or changes in the brain. Things that can cause dementia include: Strokes, tumours, or head injuries. After Alzheimer’s disease, strokes are the most common cause of dementia. This type of dementia is called vascular dementia.

Diseases, such as Parkinson’s disease, dementia with Lewy bodies, and frontotemporal dementia.
In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and fluid build-up in the brain (normal-pressure hydrocephalus). In these cases, treating the problem may cure the dementia.
In some people, depression can cause memory loss that seems like dementia. Depression can be treated.

As you age, medicines may affect you more. Taking some medicines together may cause symptoms that look like dementia. Be sure your doctor knows about all of the medicines you take. This means all prescription medicines and all over-the-counter medicines, herbs, vitamins, and supplements.

What are the symptoms?

Usually the first symptom is memory loss. Often the person who has a memory problem does not notice it, but family and friends do. Dementia causes many problems for the person who has it and for the person’s family.

Some common signs of dementia are listed below. Not everyone who has dementia will have all of these signs.

As dementia gets worse,

You may have more trouble doing things that needs planning, like making a list and going shopping.

You may have trouble using or understanding words.

You may get lost in places you know well.

Other features of dementia

Recent memory loss:

All of us forget things for a while and then remember them later. People with dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.

*Difficulty performing familiar tasks: People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.

*Problems with language: People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.

Time and place disorientation: People who get lost on their own street. They may forget how they got to a certain place and how to get back home.

Poor judgment:

Even a person who doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.

Problems with abstract thinking:

Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.

Misplacing things:

People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.

Changes in mood:

Everyone is moody at times, but people with dementia may have fast mood swings, going from calm to tears to anger in a few minutes.

Personality changes:

People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.

Loss of initiative:

People who have dementia may become passive. They might not want to go places or see other people.

What if I have any of these signs of dementia?

Talk with your doctor. Your doctor can do tests to find out if your signs are caused by dementia. The sooner you know, the sooner you can talk to your doctor about treatment options.

Mild cognitive impairment

Some people have memory loss but do not have dementia. They have what is known as mild cognitive impairment, a middle ground between normal aging and dementia. People with this condition are at risk of developing dementia; but, not all people with mild cognitive impairment will progress to dementia.
People with mild cognitive impairment often know that they have lost memory, and tests can confirm some loss. But they have normal overall mental functioning and can carry out normal activities of daily living.

Doctors should evaluate people with memory loss, and those with mild cognitive impairment should be monitored because of their risk for developing dementia. Several studies are being done to see whether medication can delay the development of dementia in people with mild cognitive impairment.

How can I help my loved one with dementia?

If your family member has some of the signs of dementia, try to get him or her to go see a doctor. You may want to go along and talk with the doctor before your relative sees him or her. Then you can tell the doctor about the way your relative is acting without embarrassing him/her.

How is dementia diagnosed?

There is no single test for dementia. To diagnose it, your doctor will:

Ask questions about recent and past illnesses and life events. The doctor will want to talk to a close family member to check details.

Ask you to do some simple things that test your memory and other mental skills, like asking what day and year it is, repeat a series of words, or draw a clock face.

The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI and a CT scan. These tests can help your doctor find a tumour or brain injury.

They can also show if there has been shrinking in parts of the brain. This can be a sign of dementia.

(The writer is a Consultant Physician)

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