What is the difference between my lifelong “geographic handicap” and a form of dementia? Would I (or any of my family or friends) recognize it? The diagnosis of dementia is not based on a sole symptom; rather, it requires the existence of at least two types of impairment that are significant and interfere with daily life.
Thankfully, I have adjusted to being “temporarily misplaced” (I don’t call it lost) and smiling at you whilst I try to remember your name. It may seem I jest or am insensitive to a grave health issue—but I am very serious about our need to pay attention to ourselves, to those we care for, and to those we care about (including neighbors). I now live in an area where a “silver alert” (missing elder) is an almost daily occurrence.
The table provides a comparison of normal-aging memory changes versus dementia symptoms; this is a tool we can use in practice and provide to our patients and their families.5 However, when changes in memory become so pervasive and severe that they are disrupting work, hobbies, social activities, and family relationships, we must recognize that they are the warning signs of Alzheimer disease.6 After reading multiple reports and guides, and witnessing the disease progression in neighbors, I share the three most significant hallmarks of the disease: impaired judgment, difficulty in recalling new information, and unusual behavior.7
It is important to remember—and to communicate to our patients—that memory loss itself does not meet the criteria for dementia. While some may be quick to fear that diagnosis, other factors that can contribute to cognitive problems are stress, depression, vitamin deficiency, thyroid disease, and even dehydration. All of these can be managed, with a resultant reversal of symptoms of memory loss.8 As always, a good health history, review of symptoms, and physical examination will guide us to an accurate diagnosis and plan of care.
There are multiple resources available for patients and families who receive a diagnosis of dementia or Alzheimer disease. Fear of the diagnosis need not blind us to the early warning signs. As NPs and PAs, despite our busy schedules, we must stop and listen to both the patient and the family, and ask the difficult questions about judgment and behavior in our aging patients.
REFERENCES
1. Doty L. Caregiving topics: early signs of dementia. http://alzonline.phhp.ufl.edu/en/reading/EarlySignsFeb08.pdf. Accessed December 11, 2015.
2. CDC. Older persons’ health. www.cdc.gov/nchs/fastats/older-american-health.htm. Accessed December 11, 2015.
3. Hebert LE, Weuve J, Scherr PA, Evans DL. Alzheimer disease in the United States (2010–2050) estimated using the 2010 census. Neurology. 2013;80:1778-1783.
4. Alzheimer’s Association. 2013 Alzheimer’s disease facts and figures. Alzheimers Dement. 2013;9(2):20-245.
5. Wayne M, White M, Smith M. Understanding dementia. www.helpguide.org/articles/alzheimers-dementia/understanding-dementia.htm. Accessed December 11, 2015.
6. Smith M, Robinson L, Segal R. Age-related memory loss. www.helpguide.org/articles/memory/age-related-memory-loss.htm. Accessed December 11, 2015.
7. A guide to coping with Alzheimer’s disease: a Harvard Medical School Special Health Report. www.health.harvard.edu/special-health-reports/a-guide-to-coping-with-alzheimers-disease. Accessed December 11, 2015.
8. HelpGuide.org. What’s causing your memory loss? www.helpguide.org/harvard/whats-causing-your-memory-loss.htm. Accessed December 11, 2015.