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Normal Aging or Early Signs of Alzheimer's?

By Dr. Linda Sasser


I began doing presentations on brain health and memory several years ago, mainly to educate the “worried well” about behaviors that might indicate cognitive decline and about lifestyle practices that would help maintain brain function. Most people with Alzheimer’s are 65 or older. After age 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly one-third.

We all experience incremental changes in memory function as we age, beginning in our 20’s. Some people will notice and be bothered by these changes more than others, and wonder if they are an early sign of the cognitive decline associated with Alzheimer’s. For most of us, however, difficulty retrieving information such as people’s names or even certain words is just a normal cognitive change which occurs more frequently with age. Another typical change is a decline in attention, and also the ability to multitask (shift attention between two things). Vocabulary, judgment, and problem solving generally remain strong throughout life.

Difficulty remembering tasks or appointments, where you have put things, or details from recent conversations may indicate cognitive decline if they happen daily or weekly and interfere with one’s routine. Other indicators of Alzheimer’s disease or another dementia include getting lost in familiar places or difficulty finding the way home from the grocery store. An uncharacteristic change in personality or general mood may also indicate cognitive impairment. For example, a typically laid-back person who is slow to anger and cool under pressure may suddenly exhibit an explosive personality, getting easily angered and saying mean things.

People with Mild Cognitive Impairment (MCI) — a clinical syndrome describing people who experience cognitive deficits noticeable to themselves or others that can be documented in objective cognitive testing — may have a hard time remembering details of conversations they had just a day or week earlier. They may have difficulty remembering appointments and may need to write down reminders to keep track of normal daily tasks. They misplace items (keys, sunglasses) much more often than most people. They may ask the same questions over and over and repeat the same stories. However, older adults with MCI can still perform daily tasks such as working, driving, eating and showering independently.

MCI can result from factors other than Alzheimer’s. For example, people with obstructive sleep apnea (OSA), a condition that causes people to stop breathing for brief periods during sleep, can experience MCI. The cognitive abilities of these patients can be improved with proper treatment of the OSA. Some medications, such as those for treating urinary incontinence, over-the-counter sleep medications, and the drug Ativan (used to treat anxiety), can contribute to MCI. Illnesses such as urinary tract infections and thyroid problems can also affect cognitive abilities. A physician should rule out depression and/or anxiety as causes of memory difficulty.

On the other hand, if the MCI is due to a neurodegenerative disease like Alzheimer’s, physicians can begin managing people’s symptoms early on, and prepare patients and their families for care planning. Clinicians may use a PET scan, which shows patterns of metabolism in the brain, to determine whether the patient’s MCI is due to Alzheimer’s. They can also conduct a lumbar puncture to analyze levels of beta-amyloid and tau, biomarkers of Alzheimer’s. A battery of neurocognitive tests can help improve the accuracy of a diagnosis, and scientists are developing additional tools like blood tests and retinal scans.

If a patient’s MCI is due to Alzheimer’s, it will most likely progress to dementia of the Alzheimer’s type. However, the amount of time it takes for patients to lose their abilities to carry out daily activities independently varies from person to person.

Since there is no approved medication for MCI, patients should focus on lifestyle practices keep their brains as healthy as possible. These include exercising for 30 minutes a day, setting a good sleep routine, and managing mental health. It is also crucial to eat a healthy diet low in saturated fat and include fish with fatty acid like salmon, along with food with antioxidants like blueberries and cranberries. Staying hydrated can also be helpful for brain function, as can limiting intake of alcohol and avoiding smoking.

Regarding taking a baseline cognitive test and then repeating it periodically to detect changes, Dr. William Burke, Director of the Stead Family Memory Center at the Banner Alzheimer’s Institute, believes that is not as effective as asking someone close to you if they have noticed changes. He says that clinically significant differences in one’s cognitive function will be apparent to loved ones, who should then encourage the person to see a physician.

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