How to know the difference between dementia and distraction

We all forget things. And the older we get, the more we stress about it.

We can’t remember the name of the actor in last night’s movie. (We can’t remember the name of last night’s movie...)

We lose glasses, only to find them on our heads.

We lose our car keys, only to find them in our hands.

And finally we begin to ask, “Could this be dementia?”

Robert S. Tan, MD, MBA, associate professor of geriatrics in the Department of Family and Community Medicine at the University of Texas Medical School at Houston, reassures that virtually everyone experiences some degree of age-related memory loss. “But, if you have a loved one or friend who seems to be forgetting more than usual, the [defining point] is loss of functionality.”

He continues that when a person can no longer do the required chores at work or home, cannot write checks effectively, and cannot get from one place to another appropriately, then that person may be suffering from dementia.

The dementia patient sometimes asks the same questions repeatedly, and becomes disoriented about time, people and places. This person neglects personal safety, hygiene and nutrition, but different people lose these abilities at different rates.

It is easy to confuse distraction with dementia in this fast-paced, multi-tasking society of ours. But the occasional oversight of forgetting to sign your check or retelling a family story again, is quite different from suddenly not remembering how to write a check or retelling the family story twice in the same hour.

Differences between Alzheimer’s and other dementia

Alzheimer’s is a form of dementia, but can differ in significant ways. Alzheimer’s progresses fairly uniformly, but is a slow disease, starting with mild memory problems and ending with severe brain damage. However, the speed of these changes can vary from person to person.

According to the Alzheimer’s Disease Education and Referral Center of the National Institute on Aging, patients with Alzheimer’s live from 8-10 years after diagnosis, though the disease can last up to 20 years. It affects about three percent of men and women ages 65-74, and almost half of those over 85.

Multi-infarct: Second most common form

Tan explains that the second most common dementia is called multi-infarct dementia, and it can wax and wane in its effect on patients— they become better or worse over time. “This form of dementia,” explains Tan, “can be caused by a series of mini-strokes that damage or destroy brain tissue.”

Multi-infarct dementia usually affects people between the ages of 60 and 75. Its most important risk factor for is high blood pressure and diabetes.

Conditions that mimic dementia

Medication can also contribute to memory loss. “Some blood pressure medications like beta-blockers are notorious for causing memory loss,” Tan says, Also on the list as “amnesics” are narcotic pain medication such as codeine and sedatives such as valium-like drugs. “Stopping the offending medication may bring the patient back to baseline,” Tan says.

Depression can mimic dementia, as can post-traumatic stress. With treatment, the dementia symptoms reverse. This is called “pseudo dementia.”

Rumor would have it that menopause can cause dementia. Tan denies that this is the case, but says menopause can cause a mild memory loss. He says that some professionals believe low testosterone in men may lead to mood and memory changes, though there is no proof that such symptoms are permanent.

Early dementia

When a younger person experiences dementia, it is called mild cognitive impairment (MCI), and is believed to be a precursor to Alzheimer’s disease. MCI can occur some 10 years earlier than other dementias. People in their 50s can begin to show symptoms.

It is thought that each year about 15 percent of these patients advance from MCI to full-blown Alzheimer’s disease.

Tan reports that studies are being done, using such drugs as Aricept to attempt to slow down the progress of MCI. There is no research as yet to show that the disorder can be reversed.

Studies underway for dementia cure

James J. Knierim, PhD, assistant professor in the Department of Neurobiology and Anatomy at the medical school, researches memory. He experiments with the hippocampus of rats.

Since the hippocampus is one of the first parts of the brain that is affected by Alzheimer’s disease in humans, Knierim hopes to solve some mental mysteries by studying how rats react in similar circumstances.

“In the early stages of Alzheimer’s,” Knierim explains, “people get lost and can’t find their way home. This has direct relevance to what we know about rat behavior. There is a special function of the rat hippocampus involved in spatial learning and navigation. The rat uses its hippocampus to learn and remember where its home nest is, where its food sources are, and how to travel back and forth in its environment.”

He adds that an evidence paper was recently published by another laboratory in the journal Nature, showing that the electrical activity of hippocampal neurons in humans who engage in a navigational computer game mimicked the type of activity that he studies in rats.

“Our hope is that these studies will eventually help guide research toward a cure or some type of therapy for people who begin showing signs of dementia.

UPDATED: 11-13-2003

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