In the United States alone, there are presently at least five million people living with some form of dementia. The number of cases rises as the population ages, and one in every six females and one in every ten males in the United States who live to be at least 55 will be diagnosed with some form of age-related dementia.
Of these, around 70 percent are attributable to Alzheimer’s Disease. The rest are due to vascular and other types of dementia, with a few cases being “reversible.” The exact number of such reversible dementia cases remains controversial, with studies showing anywhere from 1.5 to 20 percent, with the large variability thought to be primarily due to contributory health differences in the populations studied. All dementias are not the same but all affect memory to some degree.
There are three basic types of memory related issues recognized in the medical community.
Normal age-related memory decline is common and is not dementia. This is basically characterized by somewhat slowed speed of information processing and subtle impairment in various types of sustained concentration. You might not feel “as quick on your feet” mentally. IQ tests are therefore adjusted for this decline as a function of aging.
Mild Cognitive Impairment, however, is a stage of memory decline that, while not quite dementia, is a cause for some concern. MCI is characterized by problems in thinking, memory, judgment and language (abnormal difficulty finding words), noticeable by you and others, but does not rise to a level that interferes with your daily life.
You may have no difficulty with daily activities if you have MCI but learning new activities or routines may be difficult. This is a situation that often occurs before further development into full dementia, although some people with MCI do not progress, and others will become better.
The most common risk factors for MCI are increasing age, a gene called APOE e4 linked to a higher risk of developing Alzheimer’s, smoking, hypertension, high serum cholesterol, diabetes, obesity, depression, sedentary lifestyle, and lack of social interaction. If you experience MCI, you may also notice anxiety, depression, apathy, or irritability and aggression.
Individuals with MCI have a significant risk of developing dementia, but not a certainty. Approximately 10-15 percent of those with MCI will go on to develop dementia each year. The exact prevalence of MCI is difficult to pin down as it depends on the precise definitions and subtypes of MCI being studied. If there is a chance that you have risk factors for a reversible dementia or signs of MCI, this is the best time for diagnosis and early intervention.
According to the Mayo Clinic, about one-to-two percent of older adults develop full dementia each year. But almost everyone notes times when they enter a room only to totally forget what they’ve come for. We all lose car keys, forget the names of movies or people, forget addresses and passwords, etc. When is it normal aging? When is it MCI? When is it time to call it dementia? Who decides? Can your family doctor tell? Should you see a psychiatrist? A neurologist? Can anything be done about it if it is MCI or dementia?
The very simplistic diagnostic requirements for dementia, per the most recent Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association are: A. Evidence of significant decline from a previous level of performance in one or more – learning and memory; language; executive function; complex attention; perceptual-motor skills; social cognition. B. The cognitive deficits interfere with independence in everyday activities. At a minimum, assistance is required in activities of daily living such as paying bills or managing medication. C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depression, schizophrenia.).
Sounds simple. But it’s not simple to the average person. In fact, it’s rarely simple for a psychiatrist or neurologist.
What are executive function, complex attention, perceptual-motor skills, and social cognition? How are they measured? How is it determined whether any such ability represents a significant decline from a previous level of performance? The short answer is, the psychiatrist or neurologist has no real way of measuring present performance in these areas against any previous performance because those abilities were never tested and quantified in the past.
It’s really a common sense approach, often relying on estimates of prior levels of function based on previous levels of education, occupation, social history, and family members. More data-based measurement and quantification of these abilities, along with providing an explanation of exactly what some of these abilities are, is most usually the realm of the clinical neuropsychologist, a type of psychologist who specializes in the diagnosis of dementia and other cognitive issues by means of standardized psychometric testing. Arkansas has 20 board certified neuropsychologists, so getting a referral for testing shouldn’t be a problem.
In short, you will need to see a variety of doctors to get a solid diagnosis of any memory problem other than normal age-related memory decline. At least 70 percent of true dementia is of the Alzheimer’s type. It’s almost always age-related. Although some dementias are genetic, they comprise only a tiny percent.
Of the genetic dementias, the onset is earlier, usually in the mid-50s. By comparison, other, non-genetic dementias begin slowly, with brain changes occurring 20-25 years before signs begin to show.
By age 70, your chance of developing dementia is about 20 percent, and approximately 33 percent by age 80. But that’s without implementation of strategies to prolong or avoid dementia which, as mentioned, are both real and accessible.