It is perfectly normal as we age to experience slower cognitive processing speeds. It’s normal to walk into a room and forget why you are there, to forget a name momentarily, or misplace your keys even though you just had them in your hand (or thinking they are misplaced until you realize they are still in your hand!). Mild cognitive impairment and dementia both go beyond the normal slow-down of our brain processing and memory.
Dementia vs. Mild Cognitive Impairment
Dementia is not a disease, it is a word used to describe a medical condition that involves cognitive impairment that impacts daily life. Alzheimer’s is the most prevalent, accounting for about 70% of all dementia cases. Vascular dementia is the second most common, at 10%; and the remaining cases include Lewy body and frontotemporal, along with rarer forms of dementia such as Parkinson’s, Korsakoff syndrome, and hydrocephalus.
Mild Cognitive Impairment (or MCI) is not dementia, and less than one-third of those with MCI will develop dementia. This is such a new area of study that often physicians are not aware that all MCI cases do not develop into dementia. In fact, the studies on MCI are very hopeful, indicating that lifestyle and diet are significant factors in slowing or even reversing it.
With either diagnosis, it is critical that, if someone is experiencing symptoms, a thorough search for any underlying medical condition is performed. This will answer an important question when the word “dementia” is being used: Are the symptoms related to an impairment of the brain, or is there a medical issue creating dementia-like features?
There are literally dozens of medical issues that can cause cognitive impairment or dementia-like symptoms, including:
- Underactive thyroid
- Vitamin/mineral deficiencies (B-12, D, potassium)
- Depression
- Brain tumors
- Medication reactions
- Infections (urinary, pneumonia, flu)
- Dehydration and/or malnutrition
- Hypoxia (poor heart/lung function)
Most of these issues are medically reversible, so testing is absolutely critical for someone who is showing symptoms. Especially if the change has been sudden or acute, make sure a physician tests for infection or prescription drug reactions. Even if someone is in their 90’s, don’t let doctors write off their symptoms as dementia, get a full medical (bloodwork and CT scan) to rule out any underlying medical issues.
Once medical causes are ruled out, it’s important to understand that each type of dementia progresses differently. Some are like a stair step, all is well for a certain amount of time, then there is a significant sudden decline; other progressions are marked by very slow regression over time. And for vascular dementia, good nutrition and exercise can allow a patient to maintain with no decline for a very long time.
And as for MCI, the hopeful news is that lifestyle, diet and exercise changes may not only halt any progression, in more and more cases the effects are reversed entirely.
Evaluating Dementia
If someone says you have a dementia, it means you have some type of brain impairment impacting daily life – but what IS that cognitive impairment? What is the cause of the dementia?
As noted earlier, approximately 70% of dementias are Alzheimer’s related – but that means 30% are something different. Very often it is a vascular dementia, resulting from problems with the vascular system.
This type (along with the rare frontotemporal dementia) presents very differently, not with short-term memory loss but with symptoms of frontal lobe damage – verbal confusion, poor impulse control, and decreased executive functioning. This may come to the family’s attention when the person shows uncharacteristically poor judgment, giving away money or falling for scams.
Other dementias also impact behavior dramatically. They may have some Alzheimer’s-type features, but also can create psychosis, paranoia, delusions. This is why it is critical, in terms of care planning and treatment options, to understand the type of dementia, because each type has a different trajectory.
At certain stages, Alzheimer’s disease can be indicated with a short screening for basic memory problems, attention span, ability to do simple arithmetic, etc. In non-Alzheimer’s cases, often families suspect there is a problem, but their loved one, with an engaging, social personality, can go to the doctor and present very well in a 15 minute medical appointment. Her language is good, she is oriented to time and place, even her memory is good… but those closest to her know she’s not the same.
When the family knows something is wrong, that a person is making poor choices, those dementias get more complicated to diagnose, and sometimes require evaluation by a neuropsych or neurologist. Bloodwork and a CT scan are critically important for this more complex diagnosis.
Care managers can do cognitive screening to look for deficits, using comprehensive screenings that involve talking with family members, charting the history of who the person is now vs. who they were, and noting what changes have been seen. This basic screening can indicate more testing is needed, or can give the family a baseline to compare and look for changes from year to year.
Especially challenging for families is the senior who has had an underlying, often undiagnosed, mental health problem, and is additionally now having dementia issues. This can result in increased behavioral disturbances and paranoia, and makes finding the most appropriate care critical.
Most care managers are experienced in working with these very complex situations, and should be able to help find the best home care providers, or the most appropriate facilities for those with behavioral disturbances. The last thing a dementia patient needs is to be moved from place to place because they aren’t getting what they need; or worse still, being removed from a facility that is unable to manage their unique needs.
In addition to the basic planning for future care, if you are a dementia patient it is important to begin planning along the trajectory of the disease. This is why understanding the type of dementia is critical, since each is different. Long before the dementia takes full hold, it is important to work with a professional team, including not only doctors and care managers, but the family lawyer and CPA.
Springing Care is the term used for decision-making that you make now to be used at some point in the future. In other words, you make choices now when you may not be able to in the future. By identifying everything from your core values (such as end of life plans and religious preferences) through life comforts (how/where do you want to live, what foods/music do you like), your wishes and desires can be documented and preserved for the time when you are no longer able to make decisions.
Care for Persons with Dementia
Innovative services are constantly becoming available, and more is being learned all the time. Lifeline, for example, now offers hands-free technology that recognizes a fall, indoors or outdoors, and can also include GPS to locate someone who is lost.
In the Netherlands, the entire town of Hogeway is a nursing home for dementia patients1. They live in a small community (with one guarded entrance and exit) AgingLifeNetwork.com ©2017 Aging Life Network Page 4 built like a town around a city square. No money is exchanged, but residents can select their own snacks at the grocery store or go to the post office to send and receive letters. The environment strives to be as normal as possible, but everyone working there, from “gardener” to “cashier,” is skilled in working with people with dementia, and the results have been very encouraging.
When a family has someone living at home alone with dementia, they naturally are concerned for their safety, but it is also much easier for someone with dementia to remain for as long as possible in a familiar environment. A care manager can fully evaluate when the person needs care, and often it is not 24/7. Each case must be evaluated separately. Often dementia patients do well in the morning through late afternoon/early evening. When that is the case, care in the early morning transitions the person to start their day, returning to help with dinner and bedtime.
With individualized care planning and management, dementia care can be made easier for both patients and families.
Details the difference between dementia and mild cognitive impairment, and how to manage care.
