Separating Forgetfulness from Dementia in an Age-Conscious Era

With President Biden at 81 years old and former President Trump at 78, the spotlight on aging and cognitive health has become a bigger concern for many Americans. Age naturally raises questions about the difference between normal forgetfulness and dementia.

If elected, President Biden and former President Trump would set a record as the oldest president in office. Both have faced speculation about their cognitive abilities. During the CNN debate, Biden exhibited behaviors that concerned viewers, including slurred speech, garbled answers, and a pause ending with a non sequitur.

As Americans reflect on the ages of their leaders, they also are thinking about their own aging and brain health. A new survey conducted by Cleveland Clinic and Parade reveals that 85% of adults have contemplated their risk of developing brain diseases such as Alzheimer's or dementia.

Jessica Caldwell, PhD, a neuropsychologist at Cleveland Clinic, says the media attention on this issue makes it personal for many people. Some are taking steps to help with prevention.

I think that most adults these days have thought about their brain health for a number of reasons. One of those is just that we hear more about brain health in the media.

Natural Aging or Dementia?

Memory lapses can be common as we age. Forgetting where you put your keys or occasionally struggling to recall a name can be frustrating, but the Mayo Clinic says they're not necessarily signs of dementia.

Age-related forgetfulness typically does not significantly disrupt your daily life. For instance, you might occasionally forget a person's name but remember it later. You might misplace your glasses or need to make lists more frequently to keep track of appointments or tasks.

These memory changes are usually manageable and don't impair your ability to work, live independently, or maintain a social life.

According to the Alzheimer's Association, dementia is a more serious condition characterized by a progressive decline in cognitive function that significantly interferes with daily life. This decline can encompass memory loss, difficulty with problem-solving, language issues, and changes in behavior or personality.

The National Institute on Aging (NIA) puts it this way:

Older adults may worry about their memory and other thinking abilities, such as taking longer to learn something new. These changes are usually signs of mild forgetfulness — or age-related forgetfulness — and are often a normal part of aging.

However, more serious memory problems could be due to mild cognitive impairment, dementia such as Alzheimer's disease, or other factors beyond normal aging.

Recognizing the Signs of Dementia

While occasional forgetfulness is normal, certain red flags can indicate potential dementia. The Alzheimer's Association outlines some key signs to watch for:

• Memory loss that disrupts daily life: This memory loss includes forgetting important dates or appointments, repeatedly asking the same questions, or becoming lost in familiar places.
• Difficulty with problem-solving: Struggling with once routine tasks, such as balancing a checkbook or following a recipe.
• Challenges with planning and performing familiar tasks: Difficulty managing finances, organizing oneself for activities, or withdrawing from hobbies and social activities.
• Confusion with time and place: Losing track of the day, month, or year or becoming disoriented in familiar surroundings.
• Trouble understanding visual images and spatial relationships: Difficulty reading, judging distances, or following directions.
• Problems with speaking or writing: Difficulty finding the right words, using incorrect words, or struggling to hold a conversation.
• Misplacing things and losing the ability to retrace steps: Frequently misplaced items, inability to find their way back after leaving something somewhere, or poor judgment in decisions.
• Withdrawal from social activities: Withdrawal equals to a reduced interest in socializing, neglecting personal hygiene, or personality changes such as becoming withdrawn, suspicious, or irritable.

Diagnosis and Treatment Options

If you're worried about your cognitive health or that of a loved one, the National Institute on Aging (NIA) recommends consulting a doctor for a comprehensive evaluation.

Most of us will never hold a major position of power like a presidential candidate, but it is crucial for families to recognize the signs of cognitive decline and encourage testing. Early detection can lead to better management and care, ensuring that loved ones receive the support they need.

Dr. Sanjay Gupta, CNN's chief medical correspondent and associate chief of neurosurgery at Grady Memorial Hospital, has expressed concerns about President Biden's cognitive health. Gupta suggests that President Biden should undergo neurological testing, citing issues such as confused rambling, sudden loss of concentration mid-sentence, halting speech, and a lack of facial animation, which sometimes results in a flat, open-mouthed expression.

The consensus from the doctors reaching out to me, however, was that the president should be encouraged to undergo detailed cognitive and movement disorder testing, and those results should be made available to the public.

This process may include reviewing medical history, conducting cognitive tests, and potentially performing brain scans to identify the cause of memory issues.

Here's a breakdown:

1. Medical History and Family Background: Doctors will ask about memory problems, changes in behavior, and past medical conditions. They'll also inquire about a family history of dementia.
2. Physical and Neurological Exams: This checks overall health, reflexes, and nervous system function.
3. Cognitive Assessments: These tests evaluate memory, thinking, language, and problem-solving skills.
4. Brain Imaging (Optional): CT scans or MRIs can sometimes reveal abnormalities that support a dementia diagnosis.
5. Lab Tests: Blood tests rule out other conditions that might mimic dementia symptoms, like vitamin deficiencies or thyroid problems.

It's important to note that pinpointing the exact type of dementia can be tricky because symptoms can overlap.

The two most common cognitive assessment tests are:

1. Mini-Mental State Exam (MMSE): This brief, widely used test takes about 10 minutes. It assesses orientation (time, place, person), registration (repeating information), attention and calculation, recall, language, and visuospatial skills (like drawing a clock). While helpful for initial screening, it may be less sensitive for detecting mild cognitive decline.
2. Montreal Cognitive Assessment (MoCA): This test takes about 15 minutes and is more comprehensive than the MMSE. It includes similar areas as the MMSE but also assesses tasks like visuospatial executive function (e.g., following a trail), abstraction, and naming. The MoCA is better at detecting mild cognitive impairment.

The choice of test depends on the situation and the healthcare professional's judgment.

No Cure - But Treatment is Available

While there is currently no cure for dementia, there are treatment options available. Mayo Clinic says there are medications that treat symptoms at different stages of Alzheimer's disease — mild, moderate, and severe; some may slow the progression of the disease.

These medicines are not approved or recommended for treating mild cognitive impairment (MCI). MCI involves small but noticeable changes in memory and thinking abilities. The most common cause of MCI is Alzheimer's disease.

MCI due to Alzheimer's can represent a transitional stage between normal age-related memory changes and Alzheimer's disease dementia. However, some people with MCI do not have Alzheimer's disease and may have other underlying causes for their condition.

John Rowe, a professor of health policy and aging at the Columbia University Mailman School of Public Health, noted in an article in STAT that approximately 10% to 20% of people aged 65 and older develop MCI. Among those, about 10% to 15% progress to dementia, often Alzheimer's disease.

But most of them will not. And in fact some of them actually improve with age as they get used to dealing with this. And they use memory tricks and, and aids and things like that in order to cope with those problems.

Additionally, healthy lifestyle choices like maintaining a balanced diet, regular exercise, and staying mentally stimulated can potentially benefit cognitive health and overall well-being.

Talking to a Doctor

The Cleveland Clinic-Parade survey revealed that while some people are taking proactive steps to help prevent brain-related issues, they are less proactive when addressing actual memory or cognitive problems. This indicates a gap between preventive measures and seeking help for existing concerns.

Dr. Caldwell says 36% of adults under 50 agree they're too afraid to talk to a doctor, especially if they are younger.

There are many treatable reasons why you might have an attention problem or a memory problem when you're young, and there's no reason not to go and have an evaluation with your doctor so that if it's something that's easily reversible then you can get it addressed.

Interestingly, the survey also highlights some misconceptions about Alzheimer's and dementia. For instance, 44% of adults aged 18 to 34 mistakenly believe that having a relative with Alzheimer's guarantees they will get it too. However, Alzheimer's is not always inherited. Additionally, both men and women surveyed assumed the opposite gender was more at risk for Alzheimer's.

The true case is that more women than men are diagnosed with Alzheimer's disease currently. And in order to get that awareness out, I think we need to talk about it. These are important conversations that we need to have in many different ways.

Family History and Dementia

While a family history of dementia can be concerning, it doesn't guarantee someone will develop the condition. Genetics do play a role, with certain genes like APOE-e4 increasing the risk. However, these genes aren't the sole determinant. Age remains the biggest risk factor, and researchers believe a combination of genes and lifestyle factors likely influence whether someone develops dementia.

Women are slightly more likely than men to develop Alzheimer's disease, though the reasons for this are still being investigated. Hormones or lifespan differences may contribute, according to experts. It's important to note that this doesn't mean men are immune, and dementia can affect people of all genders.

However, the connection is strong enough that there are insurance companies that will not consider an individual for Long-Term Care Insurance coverage if they have two or more first-degree relatives that had been diagnosed with Alzheimer's or dementia. While this is not the case for every insurance company, it does show the additional risk involved due to family history.

Planning Now is Best

Planning for the future often includes saving for retirement. But what about the possibility of needing long-term care? The future decline in your health, body, and mind caused by aging significantly affects your family and finances. A plan like Long-Term Care Insurance will help ensure you have quality care when you need long-term care.

Longevity has many challenges; aging is the primary risk factor for memory loss. Health insurance and Medicare only pay for short-term skilled care, leaving the responsibility of long-term care on you, your finances, and your family.

Long-Term Care Insurance can help you access quality care at home, in assisted living, in memory care, and in a nursing home. It can also provide peace of mind, knowing care costs won't deplete your retirement savings.

Caring for a loved one with dementia or other cognitive decline can be incredibly demanding. While family members often step up to be caregivers because they have no other choice, they may not have the training or experience needed. Long-Term Care Insurance can ensure your loved one receives the quality care they deserve while relieving the burden on your family.

However, LTC Insurance is medically underwritten, so you must obtain coverage before your health declines. As mentioned above, some insurance companies will consider family history as part of the underwriting process.

Most people acquire an LTC policy in their 40s or 50s when premiums are lower, and health is generally better. Plus, some family history may have yet to happen. Seek help from an experienced Long-Term Care Insurance specialist to help you navigate the many options.