Understanding Dementia and Cognitive Impairment

Aging, Neurology Steward Health Care

The discussion of dementia usually prompts several questions. Among the most common: What are my risk factors for dementia? What are the early signs and symptoms of the disease? How can you prevent dementia from starting? Can any medication counteract the onset of dementia or cognitive impairment? Does a family member with dementia significantly elevate your own risk of the disease?

More than an age-related decline

To understand the risk of developing dementia, it is important to see dementia as a departure from expected, age-related changes. In the clinic, I typically tell patients that the body and its pieces gradually wear down as they age. Hearts don’t work as well, joints don’t work as well. Eventually, brains don’t work as well, either.

It is very common to notice the impact of aging on our brains. People commonly report increased forgetfulness and difficulty finding the right word. However, a professional evaluation is required before those symptoms can be pieced together as something more than age-related forgetfulness.

Managing cognitive impairment

Cognitive impairment becomes much more common as people reach into their 60s, 70s and 80s. Characterized by progressive changes in memory, changes in personality and increasing frailty, cognitive impairment can slowly devolve into dementia. Research indicates that by age 65, an estimated 5 percent of people will have dementia, with the prevalence climbing to 20 percent at age 85. Diagnosing cognitive impairment helps patients and families manage symptoms as they progress.

Symptoms of dementia

Patients with dementia can experience a wide range of symptoms. The loss of independent functioning is one of the key features of dementia. At first, the affected person may start to ask repetitive questions or make repetitive statements. An inability to perform tasks that were once common – taking care of personal finances, working around the house, or even driving to the grocery store – can be overwhelming. This may signal a decline in cognitive performance. Each of these symptoms can occur separately and their progression can lead to a steady decline in independence.

Interestingly, dementia does not seem to affect long-term memory. Day-to-day functional impairments are the hallmark of progressive cognitive decline. The preservation of distant memories can be falsely reassuring.

Treatment

Treatment of cognitive impairment and dementia consists of support at this time. There are no medications proven unequivocally to prevent, halt or slow the progression of dementia. There is no single “silver bullet” that works for every person, every time. A revolutionary “miracle” treatment does not seem to be around the corner. Nonetheless, symptomatic medications can sometimes temporarily augment memory or treat assorted mood changes associated with the disease. Currently, medical research is seeking to diagnose, treat, and hopefully prevent cognitive decline in the future.

Finally, treatment of dementia is more than treatment of an individual. This is a disease that touches all members of the family. It is vital that families have conversations about how to arrange care for the patient to provide the best quality of life for each individual.

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