Explainer: Know the difference between a normal aging brain and early signs of dementia

Alzheimer’s disease and related dementias are a major public health problem. Many of these diseases can be prevented, and while there are promising treatments on the horizon, there is no cure for these diseases and little focus on preventing them.

Dr. Lisa Renzi-Hammond is the director of the Institute of Gerontology at UGA’s College of Public Health and co-director of the Cognitive Aging Research and Education (CARE) Center.  She studies the aging brain, and works to help educate individuals on how to keep their brains healthy – and what to do if you suspect Alzheimer’s.

What are some of the early signs of dementia vs. normal signs of aging?

When we think about cognitive aging, we usually think about relatively small changes in some aspects of cognition, like memory or attention, without changes in a person’s ability to continue to manage daily life, like paying bills, enjoying time with loved ones, and managing medications. When we think about diseases like Alzheimer’s disease, we think of changes in cognitive function that are debilitating and get significantly worse over time.

In early stages of the disease, we often see memory loss as one of the early symptoms. You might notice someone with Alzheimer’s disease forgetting the names of people they meet, getting confused about dates, misplacing objects, and getting “turned around” while driving. These sorts of things happen to all of us to some extent, but they happen frequently for people in this early stage, and these changes tend to be noticed by friends and family.

If someone is showing early signs of dementia, what are the next steps?

If you are the person showing early signs of dementia, step 1 is simply facing it. Talk to your doctor about your memory loss or confusion. If a loved one is showing signs, talking to them about the changes you have observed can be a challenge, but it’s so important. We often see families where an adult son or daughter notices changes in a parent but hesitates to mention it, because the other parent refuses to have the conversation. There are advantages to getting diagnosed early, so despite the challenges, the conversations are important.

Once you have an appointment for yourself or your loved one, make sure that more than one person attends the medical visit. If you are the patient, bring a loved one who has also observed the changes you want to discuss with your doctor. Ideally, your doctor or your loved one’s doctor should be performing an annual wellness exam (if you or your loved one is eligible for Medicare) and checking on cognitive health through that exam every year. If the cognitive screening portion of the exam hasn’t happened, ask your doctor to make sure to include it.

It’s important to trust yourself or your loved ones. We have interviewed doctors all over the state, many of whom believe that the early signs of Alzheimer’s disease or other dementias are just normal aging. You know your body and your loved ones best. If you notice cognitive changes happening, don’t hesitate to get a second opinion, and always remember, not all cognitive function changes are Alzheimer’s disease. We tend to think the worst, but there are lots of other things that can cause us to have cognitive function changes, like nutrient deficiencies, other easily treatable diseases, and drugs that interact negatively with each other. Unless you talk to your doctor, you won’t be able to rule out those other issues.

Are there any precautions that people can take to avoid getting dementia?

Brains are much like the rest of the body; when we are healthy, they tend to be healthy. The same strategies that work to keep the rest of you healthy also help your brain. For example, exercise boosts blood flow to the brain, and eating a healthy diet keeps the blood vessels that serve your brain healthy while providing your brain with the raw material it needs to repair damage and function optimally. Brains use sleep time to consolidate new memory and repair damage. Learning new things causes brains to continuously adapt and change. We often make the mistake of thinking that brains produce cognition (like learning, memory, planning, reasoning) only and forget that healthy emotional responses to our world also come from healthy brains. Social stimulation boosts our moods and reduces stress, which is detrimental for both cognitive and emotional wellbeing.

How does your research and the CARE Center work to understand and take action on this issue?

When we take a hard look at where we live, where we age, and how effectively we are served by our healthcare system, we realize that many of Georgia’s older adults live in rural communities that lack access to the sorts of specialty care physicians who diagnose Alzheimer’s disease using neuropsychological assessment, neuroimaging technologies, labs, and other diagnostic tools that are more commonly found in urban areas.

The CARE Center was founded to change the way we approach Alzheimer’s disease and related dementias. We see through a public health lens, rather than a purely medical lens, which means that our major focuses are education, improving access to diagnostic and clinical services, and support for those caring for persons living with these diseases.

Are there particular individuals who are more susceptible to dementia, and are there ways to help with this?

The biggest risk factor for Alzheimer’s disease and related dementias is simply age, so all older adults should be thinking about their cognitive health. That said, older people with lower educational attainment and less access to preventive healthcare are particularly at risk, as are those with co-morbid conditions like cardiovascular diseases.

Alzheimer’s disease is profoundly underdiagnosed – it appears on death certificates in only a fraction of those who receive a diagnosis, and only a fraction of those with the disease get a diagnosis in the first place. Persons who are medically underserved are far less likely by default to receive a diagnosis, so when we use incidence and prevalence data to tell who is at greater risk for the disease, we are missing a large segment of the population who doesn’t appear in those figures, because they never receive a diagnosis in the first place. That said, the data we do have shows that Black and African American adults and Hispanic adults are more likely to have the disease, despite being less likely to have access to diagnosis.

The U.S. is getting older. What will be the best ways to address dementia or other neurodegenerative diseases going forward?

It will take work on many fronts. First, all of the interventions we currently have aimed at improving the public’s health can also help us prevent Alzheimer’s disease. When we tackle cardiovascular health, mental health, nutrition, physical activity, smoking cessation, etc., we promote healthier brains at reduced risk for these diseases. Sadly, there is less federal funding for prevention research than for pharmaceutical-based “cures.” We need to prioritize lifespan health rather than disease management.

When it comes to identifying who is at risk for the disease, cognitive screening should be a part of primary care, starting in middle age. We know that a fraction of older people who are eligible for Medicare actually receive their annual wellness visit, and of those patients who attend that visit, only a fraction of those visits include the complete cognitive screening.

We also simply need to get creative. Alzheimer’s disease is a labor and technology-intensive diagnosis. Until our understanding of the disease improves and until we have reliable rapid diagnostics, we need to ease bottlenecks in diagnosis. Bringing technology to our communities, creating digital health solutions, and focusing on workforce development will all help ease bottlenecks in diagnosis.

Finally, we have to get more doctors on board with diagnosing Alzheimer’s. In the words of one of our primary care physicians practicing in rural Georgia, “Why bother diagnosing it? It’ll just stress out the family, and there is nothing for it anyway.” While there may not be a cure, for many Georgians, a diagnosis is a stepping stone to support, money for caregiving expenses, resources, and respite. Consequently, one of CARE’s deliverables in all our communities is a set of resources for healthcare providers to share with patients, so that when they give a diagnosis, they can feel more confident that the diagnosis is helpful, rather than merely stressful.

Story produced by Chancey Phillips.

Posted on November 21, 2022.