~Dementia vs Normal Aging~
One of the most common questions I am asked is how to tell the difference between dementia and normal aging, especially when we occasionally call our youngest child the name of our oldest one, can’t remember the telephone number we’ve had for 20 years when asked for it by a sales clerk or are unable to recall where we put our car keys the evening before.
What’s important to remember is that dementia is not a normal part of the aging process. It is a disease of aging, but not normal aging. Most of us will live and die experiencing only the forgetfulness that all human beings exhibit.
During normal aging, the body’s organ systems begin to decline in function after the age of 35. These changes are slow and gradual, and the body makes adjustments throughout life to compensate for them. By the time a person reaches 60, her systems have lost 30 percent or more of their original function. Have you ever wondered why you don’t collapse from your organ systems lessened functions? It is because your body started with systems that actually run above 100 percent of what you need to survive.
You probably are familiar with many of the common changes that occur. For many individuals, posture becomes more stooped; skin wrinkles and dries; and eyes lose some peripheral vision, visual clarity, depth perception and the ability to adapt to light changes. Most adults also suffer some hearing loss when the inner ear’s moveable pieces become stiffer and vibrate less readily. Lungs have a decreased reserve capacity, and the heart is less able to respond to stress. Skeletons suffer a loss of bone tissue, painful arthritic changes take place in the joints and mobility is affected by a lessened ability to move quickly.
Even with all the physical changes that are a part of normal aging, the body’s various systems are still quite functional into a person’s 90s. Think about aging this way, a 90-year-old person is actually a person in her 10th decade of life and her body is still working.
I always thought the extra decade information was really neat. When my mother turned 70, I proudly congratulated her for making it to her eight decade of life. I though I was delivering great news. A few years later I turned 50. I woke up feeling great and went over to my mom’s for a birthday lunch. Everything was going wonderfully until she grinned an evil little grin and welcomed me to my sixth decade. Somehow, my day wasn’t the same after that.
The point is as we age our brains remain fully functional with just some minor structural difference. Any changes in brain function that occur with aging more likely are related to the fact that people tend to not use their brains as much as they did when they were younger. An 80-year-old retired person probably does not read as much as when she was younger, is somewhat structured in her everyday life and simply does not challenge her brain the same way as a young adult.
In fact, the brain of an 80-year-old person is much more powerful and complex than that of a 20-year-old and not at all the stereotyped befuddled and confused elderly person portrayed on television. On the morning Dr. Sally asked me why she was in a dementia community (from my previous article on Dementia vs Delirium), she named the bones in my skeleton from head to toe to prove she was alert and oriented and her brain was functioning normally. (She then asked if I would like to review the muscular structure of the human body, but I was convinced.)
In the aging process, a lifetime of living experiences result in rich dendritic and neuron growth in our brains. The hemispheres of the brain begin working in a dual function after the age of 50, a process not yet fully understood. Moreover, most elderly people learn at the age of 80 at the same rate they learned at the age of 20. Given enough time to take a test, an 80-year-old woman will do just as well as she did in her younger years. Older folks may be a little slower on testing, as they are out of practice, but given enough time, their learning skills and cognition are intact.
The fact is that normal forgetfulness can trick you into thinking that you have dementia. As you go about your day, your brain assigns value to all information around you. It is constantly reading and scanning stimuli, whether it is visual or auditory, smell, touch, light, darkness, etc. The brain is deciding what is important and what is not. That is why the noise in a restaurant or the lights in traffic or the crowd around you do not overwhelm you.
Your brain is also deciding what information you should pay attention to, for how long you should hang onto that information, what information you can ignore and what information you can dismiss as soon as the brain finishes with it.
Think about how your brain works when driving in heavy traffic. Your brain automatically assigns value to the cars around you. It decides which car needs to have your attention because that car is turning or slowing or speeding by you, and it decides which cars can be ignored at that particular time. Your brain is aware and watching for traffic lights, police, accidents and erratic drivers. As soon as the brain determines it no longer needs information for a specific car, it dismisses that information.
The same sorting of information or stimuli happens in your brain all day long. If you get up from your chair and go to another room to get something but then can’t remember why you went into the other room, your brain is not demented. Instead, it simply didn’t assign value to the information. In other words, your brain didn’t think what you were looking for was important enough to remember.
When you look up a telephone number and forget that number before you even dial it, chances are you are not exhibiting signs of dementia. The brain simply decided the telephone number was one you likely would never need again, so it immediately discarded the information.
And when you can’t remember someone’s name but can “see” the face and “feel” the name on your tongue, you likely don’t have dementia. Instead, you just filed the information in a different manner than you are now attempting to access it. Think of the brain’s memory like a computer.
If I once filed Brad’s name in the Jennifer file and am now looking for him in Angelina’s file, the computer won’t be able to locate Brad. The difference between the brain and the computer, however, is that the brain will continue to try and solve the problem. This is why you will suddenly remember the name Brad at a later time.
Here’s another example of how the brain looks at information: Even though you are reading this article, you likely won’t remember my name. Later when a friend asks who wrote it, you won’t know because my name isn’t that important to your brain. What is important is the information in the article and you’ll be able to tell him information about dementia, normal aging, and heredity.
If that same friend asks about your daughter Mary, you’ll immediately be able to recall her birthday is next Saturday and she’ll be 21. Your brain knows where she goes to college, what she is majoring in, the color of her car, her favorite ice cream, and the name of her current beau.
So why can you remember Mary’s birthdate, but not the birthday of the next-door neighbor, in spite of having attended his birthday party? Because the information about your daughter’s birthday is far more important to you, therefore your brain has a file for Mary’s information, but not the neighbor’s.
Now that you understand how a normal brain functions, also keep in mind that as a caregiver, you are more likely to read negative consequences into normal brain behavior. Because you are stressed, because you are caring for a loved one, because you have teenager, because you are afraid of developing dementia too, you can be tricked into believing that your brain is not working properly.
If you are concerned about your brain (or your loved one’s) not functioning or thinking clearly, the time to take action and insist on a proper medical evaluation is before you start to show increasingly progressive memory failures.
For example, family members or friends may find their loved one frequently asking the same questions again and again despite having been given the answer a few minutes or hours earlier. Or an individual may have regular trouble coming up with a common word or names of famous people and close family members but not be aware of the mistake.
The key point to remember is that dementia is not part of the normal aging process and should not be brushed off as such or ignored until the disease progresses to the point where a person gets lost going to the grocery store or is unable to dress appropriately. Professionals who work with the aging population believe the threshold for seeking medical attention for memory changes should be very low.
Dr. Ronald Devere, a board-certified neurologist and fellow of the American Academy of Neurology says you should look at persistent memory loss the same way you would a persistent headache and seek medical attention. A diagnosis from a specialist in memory disorders (neurologist) will be helpful to an individual and family in that either:
- They are reassured there is no reason for concern.
- They learn the cause of memory loss is not related to dementia and is treatable.
- They can be proactive about preparing for a future that will be affected by dementia.
Dementia vs Heredity
Another commonly asked question by family caregivers is whether dementia is hereditary and whether they can pass the disease on to their children. Overall, most types of dementia do not appear to have a traceable hereditary pattern. Some rare forms of dementia, such as Huntington’s (fifty percent of the children develop the dementia) have a strong genetic component. It has been suggested that some forms of FrontoTemporal Dementia (FTD) also seem to move through the female lineage in the family, but other studies appear to point to a strong male tendency and no familial link.
In Dementias of the Alzheimer’s Type (DAT), the only form that has a clear hereditary connection is the rare early onset type (EOA) also called Familial Alzheimer’s Dementia (FAD) where someone shows signs of the disease well before age 65. This form accounts for about three percent of Alzheimer’s cases. It is estimated approximately 5,000 families in this country have EOA-FAD and those families originated from the same valley region of Germany. It is currently theorized these families have the same genetic mutation.
If your loved one developed Alzheimer’s after age 65 you are not necessarily pre-destined to develop the disease, though there are some family clusters. However, studies of identical twins seem to indicate if one twin has Alzheimer’s the other twin has only a 60 percent chance of developing the disease.
In some families, we see one child in 10 with the disease; in others we see all 10 children with EOA-FAD. Some studies show if your parent has Alzheimer’s, your risk goes from roughly 10 percent up to 30 percent. Many people may believe their great-great grandmother, great grandmother, grandmother, and mother all had Alzheimer’s, because it is the most recognized dementia. However, this would be difficult to prove because when great-great grandmother and great grandmother and grandmother had Alzheimer’s, medical science simply didn’t have enough knowledge about the disease process to be sure. There is a greater chance the family line suffered from Vascular Dementia rather than Alzheimer’s, given the lack of medications for vascular diseases. We didn’t have treatment for high blood pressure at that time, so be certain to always make your physician aware of your family history especially if you have a dementia concern.
Also remember your gene package (the foundation of each cell) comes from your mother, so a father with dementia doesn’t spell doom. Likewise, a mother’s dementia has a higher impact for you, so remember to include all your family history. Don’t expect the doctor to ask.
The fact is researchers do not yet completely understand the role of heredity in Alzheimer’s disease. One theory is Alzheimer’s is a virus lying dormant in every human that turns on in some people for no reason. Another theory is environmental triggers are behind the disease. Another is the genetics theory. And another involves chemicals in processed foods.
New theories point to greater connections between diabetes and Alzheimer’s. Other theories call Alzheimer’s the bigger cousin to Lewy Bodies and Parkinson’s Disease Dementia.
What’s important to know is so far researchers have not determined a clear known cause or inheritance pattern for regular or late onset Alzheimer’s.
Healthy Aging for the Brain
Researchers have confirmed smoking, excessive drinking and a sedentary lifestyle are not conducive to positive aging. Smoking blocks the intake of oxygen to the brain, alcohol is technically a poison the brain must filter and a sedentary lifestyle means in aging the brain receives less oxygen. Sitting too much is now being called the new smoking, because it is recognized that humans need 60 minutes of cardiovascular activity each day.
The diet receiving the most attention at this time is the Mediterranean Diet. This is because of its high Omega 3 fatty oils, vegetables, and small amounts of red wine. Talk to your physician for more information.
Five Exercises for Your Brain
Dancing – The brain is required to work large muscle groups in time to music and if you are dancing with a partner, your brain has to work with that complication as well.
Games – Playing board games requires the brain to strategize with numbers, colors, etc. The social interaction as you figure strategies, signals, suits, mathematical figures are a great exercise for your brain.
Playing a musical instrument – This activity requires the brain to use a completely different set of neurons and connections (Remember, it is never too late to learn!)
Puzzles, puzzles, puzzles! – Any kind of word games, crosswords or number puzzles all help keep the brain firing and functioning.
Reading – This also keeps the brain functioning at a higher level, but remember to challenge yourself with new types of literature.