What the heck is dementia? I have a better question.
By David Hart, Ph.D.
For over a decade now, I’ve taught a community health series I call Memory Boosters. Memory Boosters is a 4-part program that addresses brain fitness and neuroplasticity. The course inevitably attracts older adults who are concerned about their memory. Most frequently I hear similar complaints, including “I’m no good with names anymore” or “sometimes I walk into a room and forget what I’m supposed to do there.” These concerns may be best framed in the context of Alzheimer’s disease (AD) – the most common cause of dementia.
Dementia, Alzheimer’s Disease and Memory
A survey conducted by the Kaiser Foundation found that AD is the most feared disease amongst adults 55 and older. The finding is not surprising noting the devastating effects of AD, which is now the 6th leading cause of death in the United States. My students are often searching for reassurance that their memory challenges are not the beginning stages of AD or another dementia. When I begin the discussion on the differences between normal age-related cognitive decline and AD, I’m often queried on the differences between AD and dementia. The question usually goes something like this: what the heck is dementia, anyway?
Dementia: A Clinical Syndrome
The nuanced answer is that dementia is a clinical syndrome – essentially a term to describe a cluster of symptoms and behaviors. It’s not a disease. I know this is confusing to most readers but let me attempt to clarify. In order to be described as exhibiting dementia, the patient must demonstrate an impairment of memory and cognition (i.e., judgement, language, planning, comprehension, orientation, etc.) and those impairments combined interrupt the patient’s day-to-day functioning. Functional impairment might include challenges with balancing a checkbook, navigating the internet, becoming lost in familiar surroundings, or remembering whether or not there’s a pot on the stove. That’s the basic definition of dementia. The harder but better question to answer: what is the physiological cause of dementia?
Alzheimer’s Disease: Reversible vs Irreversible Causes
More than likely, in 50%-75% of all dementia cases, Alzheimer’s disease is the cause. But there are other causes as well, including those that may be reversible. Yes, I wrote reversible. Nearly 8% of identified dementias are caused by treatable medical disorders, including medication side effects, internal infections, dehydration, and other metabolic issues. The probability, though, that dementia symptoms are cause by an irreversible degenerative brain disease, are high. Irreversible causes of dementia include AD, frontotemporal dementia, dementia with Lewy Body, vascular dementia, and dementia caused by traumatic brain injury in addition to numerous others.
Readers are invited to consider how this information might apply to their lives. First, studies have found that individuals who complain frequently about their memories are at greater risk for developing dementia. Because AD is such a feared disease, often older adults avoid discussing symptoms with their physicians. I highly recommend promptly sharing your concerns in an effort to rule out treatable medical disorders. You might find that a new medication is causing your forgetfulness.
If your healthcare team determines that you or your loved one has an irreversible cause of dementia it’s critical to know sooner rather than later in an effort to appropriately plan for the future. Also, if you’ve been “diagnosed” with dementia, I encourage you to ask the simple question: what’s causing my dementia? If your physician is uncertain, advocating for additional evaluation and assessment is recommended (there are advanced diagnostic centers are UCLA and USC).
Although treatments for all dementias are relatively uniform, the symptoms and degenerative progression are different for each. Therefore, planning requires a more tailored approach. Despite limited treatment options, there are a myriad of programs and services throughout the South Bay that can help to maintain a good quality of life over the course of AD or other irreversible dementia. The bottom line: dementia is an umbrella term to describe symptoms and behaviors. But the term itself doesn’t provide the whole answer. What’s causing my dementia? Now that’s one heck of a better question.
Dr. David Hart, Ph.D. at Always Best Care SouthBay
Dr. David Hart, Ph.D. is the Director of Clinical Services at Always Best Care Senior Services and is a faculty member in the Department of Counseling at California State University, Fullerton. Dr. Hart is a trained psychotherapist who specializes in working with older adults generally and people with dementia and their families specifically. He is currently the Chair of the South Bay Dementia Education Consortium, has authored book chapters, and presented on a myriad of topics at local, national, and international conferences. Dr. Hart facilitates several programs in the South Bay, including Caregiving Essentials, a 3-hour workshop for family caregivers caring for a loved one with dementia, and Memory Club, an 8-week psycho-educational support group for people diagnosed with early-stage Alzheimer’s disease, mild cognitive impairment, or another dementia.