国产精品 experts say it鈥檚 never too late, nor too early, to adopt healthy habits that delay the onset of dementia.
Forgetting names and misplacing items happen to us all, more so as we age.
But when should you be concerned that these small acts of forgetfulness are part of a larger cognitive decline that may indicate dementia?
, co-director of 国产精品 Sydney鈥檚聽, says there鈥檚 no single test that can say conclusively whether someone has the beginnings of dementia 鈥 but diagnosis begins with a visit to a GP. There the GP might test their short-term memory with some word, number and drawing exercises, after which they may then refer the patient on to a specialist.
But Prof. Brodaty says sometimes the most reliable indicator is to ask someone who lives with the patient.
鈥淭he diagnosis is usually a combination of getting a history from the patient and a history from someone who lives with them,鈥 he says.
鈥淭hat's probably the most useful thing 鈥 someone who lives with you 24/7 is a much more accurate rapporteur than someone like me doing a one hour assessment in a clinic.鈥
Major changes in memory
We all have our forgetful moments. But when major memory lapses start becoming consistent and start impacting one鈥檚 day-to-day life, it could be an indicator of cognitive decline.
鈥淲e have to distinguish between what is cognitive decline and what's physical decline,鈥 says聽, with Centre for Healthy Brain Ageing.
鈥淎s we age, we get more frail, and It may be difficult to walk longer distances, or to have the range of motion to drive a car.
鈥淏ut that's unrelated to cognitive decline and this is where dementia or cognitive impairment comes in. A person with dementia at some point will not be able to do the things they once could do without thinking, such as drive a car, because they get confused and are no longer able to process the sensory information required to do this.鈥
Read more:聽
Prof. Brodaty says some cognitive decline is part of normal ageing.
鈥淎s we age, we become slower in our processing speed. We鈥檙e not as good at remembering things, particularly when they鈥檙e not able to be logically sorted and connected.
鈥淭here鈥檚 a test called the Rey Auditory Verbal Learning test where you鈥檙e given a list of 15 words five times in a different order and we normally see a learning curve as people remember more and more. A 20-year-old will do better than a 40-year-old who鈥檒l do better than a 60-year-old who鈥檒l do better than an 80-year-old.鈥
But it鈥檚 not all bad for older folk; some things improve with age.
鈥淎s we age our vocabulary improves, our judgment improves, our ability to organise things improves. In tests where we can sort, say 10 grocery items into different categories, we do just as well as the younger person because we can use those strategies to compensate. There is also evidence that we become wiser as we get older.鈥
According to聽, it鈥檚 when people encounter difficulties with the following on a regular basis that there could be some underlying cognitive cause worth investigating:
- Trouble remembering recent events
- Trouble finding the right word
- Trouble remembering the day and date
- Forgetting where things are usually kept
- Difficulty adjusting to changes in routine
- Trouble understanding written content or a story on television
- Difficulty following conversations in groups
- Problems handling finances
- Difficulty with everyday activities
- Losing interest in activities that were previously enjoyable
It may not be dementia
One strong reason why it鈥檚 worth seeking advice about problems with memory is because some conditions can cause similar symptoms, and if caught early enough, are reversible.
鈥淰itamin B12 deficiency, low thyroid, some infections and some sorts of cancer can present as dementia. As a psychogeriatrician, I always check for these but they occur very rarely in my practice because they鈥檝e usually been screened for by blood tests by the time the patient sees me,鈥 says Prof. Brodaty.
Other conditions with similar symptoms that may be reversible dementia include normal pressure hydrocephalus (a build-up of cerebrospinal fluid in the brain) and infections such as syphilis. Urinary tract infection, certain medications, stress, and depression can mimic dementia and need to be ruled out.
Read more:聽
A/Prof. Reppermund says depression in an older person can sometimes look like dementia at first glance.
鈥淭here is the term聽pseudodementia, which refers to major depression in older people that may interfere significantly with their cognitive function, for example their concentration and their memory. And that's treatable,鈥 she says.
Convincing someone to get assessed
The fact that some conditions appear to look like dementia could be a strong reason to urge someone close to you to visit the GP. But as Prof. Brodaty points out, no-one can be forced to get assessed for dementia.
鈥淚f a person refuses to get assessed, and they've gone downhill, and they鈥檙e no longer able to look after themselves, then you can make an application for an intervention order with what used to be called the Guardianship Tribunal and is now called聽聽,鈥 he says.
The NSW Civil & Administrative Tribunal consists of a legal representative, a presiding member, a health professional and a community member. They hear cases to determine whether or not somebody has decision-making capacity, whether it's caused by a disability such as dementia, and whether there's a need for intervention.
鈥淏ut unless somebody is in danger, or is not able to care for themselves properly, you can't force someone to do anything different,鈥 says Prof. Brodaty.
A/Prof Reppermund agrees that it may be difficult to convince someone to be assessed, but you can certainly put forward a case for it in a positive and respectful way.
鈥淵ou can approach them and say, 鈥業鈥檝e noticed that your memory may not be working as well as it used to be for you, and I鈥檓 a bit worried. Have you noticed that as well?鈥 So just make them aware and think about whether there is a problem or not. Most of the time they would have seen their own warning signs already. But they may not be open yet to go to a doctor because it鈥檚 scary.鈥
Life goes on
And even if the diagnosis is dementia, there鈥檚 no reason for them to think they鈥檝e moved through a one-way door.
鈥淚t is really important for people to see that once you have a diagnosis of dementia, you're still the same person,鈥 A/Prof. Reppermund says.
鈥淵ou have a diagnosis so you can plan for it. But that doesn't mean that from yesterday to today, you are a different person. I think stigma still exists today, that somehow your life ends as soon as you get a diagnosis of dementia.鈥
In fact, says A/Prof. Reppermund, a diagnosis 鈥 which could be for one of more than 100 different types of dementia 鈥 can actually come as a relief.
鈥淚t鈥檚 not necessarily a loss,鈥 she says, 鈥渢o know what you finally have a name for your symptoms. You can now understand and learn more about the particular type of dementia you have, what to expect and what are the next steps, how to plan for the future, for your finances, and be more confident to tackle the next years of your life.鈥
People can live positively with dementia for many years, adds Prof. Brodaty, who helped set up聽聽that offers advice on how to take their lives forward.
Read more:聽
Can dementia be prevented?
Prof. Brodaty says while there is no cure for most types of dementia and no known way to prevent it, we can certainly delay the onset of it, hopefully to the day we die.
鈥淲e just ran聽聽aged 55 to 77. And we showed that by doing exercise, observing good nutrition such as the Mediterranean diet, being socially connected, and doing brain training exercises as well as treating depression and anxiety 鈥 we improved cognition in people, over three years, compared to a control group.鈥
A/Prof. Reppermund says while there are certain dementias which have genetic links, dementia is most probably acquired by a mix of neurobiological and environmental factors.
鈥淭here are certain risk factors that make it more or less likely to develop cognitive decline and dementia, including physical and social inactivity. Being inactive, not engaging in social activities, a poor diet and too much alcohol are all risk factors.鈥
Even then, Prof. Brodaty says, 鈥渋t鈥檚 never too late to start, and never too early to start鈥 making changes that maintain and protect your brain health into old age.
Are you, or do you know someone living with dementia? Are you interested in helping progress research into preventing dementia? If so, you may be interested in participating in the following studies (click links for further information):
- 聽鈥 researchers are looking for people in Sydney living with dementia or mild cognitive impairment and aged 60 years or above to try out a tool that measures the ability to complete daily tasks such as shopping and finances.
- 聽鈥 researchers are looking for people aged 70-90 years without dementia who live in the local government areas of Randwick, Botany, Waverley and Woollahra.
For all other ageing related studies, visit the聽.
