Recognizing Dementia:

What’s Normal Aging, And What’s Not?

By Jan Howard

Memory loss is not a normal part of aging, and not everyone who gets older gets a form of dementia, such as Alzheimer’s disease.

Janet Girardat of the Alzheimer’s Association discussed the differences between normal signs of aging and dementia April 15 at the Newtown Senior Center on Riverside Road.

Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life. It accompanies certain illnesses or physical conditions, such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease, among others.

“Dementia is not a normal part of aging,” Ms Girardat said. “It is not caused by stress or hardening of the arteries.”

Dementia is confusion or disorientation regarding normal tasks a person would perform. It could be caused by ministrokes or diseases, such as Alzheimer’s.

There are reversible types of dementia, she said, where something is wrong but can be corrected. Dementia-type symptoms include hearing loss where a person won’t remember what is said because he/she did not hear it. Other forms of reversible dementia include medical conditions, such as thyroid imbalances, and drug interactions. Some senior citizens take eight prescriptions a day, she said.

What is normal and what is not? Differences can be noticed in memory and concentration, mood and behavior, language and speech, and movement/coordination.

Memory And

Concentration

Normal aging would include periodic minor memory lapses or forgetfulness of part of an experience or occasional lapses in attention or concentration. Listening to someone, and losing attention, is normal, Ms Girardat said.

“With Alzheimer’s, the person will never remember that piece of information,” Ms Girardat said.

Early signs of dementia include misplacement of important items, confusion about how to perform simple tasks, trouble with simple arithmetic problems, difficulty making routine decisions, and confusion about the month or season.

Misplacement of important items is an early sign of dementia. “Asked what they are, they won’t know,” she said.

Confusion about performing simple tasks could be dangerous, such as plugging in an iron and leaving it on and causing a fire.

“Trouble with adding and subtracting goes very early in Alzheimer’s patients,” Ms Girardat said. First signs will include their checkbook not being in balance. The person may add when he/she should have subtracted or vice versa.

Persons with dementia are more susceptible to solicitation letters or scams asking for a check. “A person with Alzheimer’s will write those out without thinking,” she said.

Routine decisions will be difficult to make, she noted, such as whether to go out to lunch, what to eat at a restaurant, or what to wear.

Mood And Behavior

It is normal to feel temporary sadness or anxiety based on an appropriate and specific cause, Ms Girardat said.

Unpredictable mood changes is a sign of dementia. It is not normal to be in a constant state of sadness, she said. “That is not a normal part of aging.”

It is also normal to have changing interests and increasingly cautious behavior.

A person with Alzheimer’s, however, loses interest in everything, she noted. “They are withdrawing into themselves, into a comfort zone. They don’t want to leave home.”

They may experience depression, anger, or confusion in response to change.

“They are angry about everything,” Ms Girardat said. There may be personality changes.

Language And Speech

Language and speech are unimpaired in normal aging.

However, persons with more advanced Alzheimer’s disease will have difficulty completing sentences or finding the correct words. “These are warning signs,” Ms Girardat said.

They may talk about something irrelevant to the conversation, though this could also be a sign of a hearing problem.

Movement/Coordination

Persons with normal aging will show increased caution in movement and their reaction times will be slower, Ms Girardat said. “It’s okay to be cautious,” she said.

A person with dementia will have visual impairments. “There is nothing wrong with their eyes,” she noted. “The brain is not able to send interpretations.” Steps would be seen as stripes, and because of that, the person would fall. Color changes in flooring would be seen as a hole.

Coordination would be affected, including slowing of movements, halting gait, and reduced sense of balance, causing the person to shuffle.

Alzheimer’s Disease

Alzheimer’s disease was discovered in 1906. For 50 years nothing was done with the discovery, Ms Girardat said. “The medical community thought senility was normal for aging,” she said. “There is no such thing as senility.”

Increasing age is the greatest risk factor for Alzheimer’s. “The older we get, the higher the risk factor,” Ms Girardat said. One in ten individuals over 65 and nearly half over 85 are affected. Alzheimer’s disease is not a natural part of aging, nor is it limited to older adults. It is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. Rare, inherited forms of the disease can strike individuals as early as the 30s and 40s.

It is the eighth leading cause of death in adults. There is no known cause or cure. A person with Alzheimer’s disease will live an average of eight years and up to as many as 20 years from the onset of symptoms.

The early stage of Alzheimer’s can be from one to four years; the middle stage, when patients can get lost or be incontinent, from three to nine years; and the last stage, when he/she is totally dependent, from one to three years. In the final stages, the patient loses the ability to smile, hold his/her head up, and vocabulary. They forget the social graces, such as saying thank you and please.

“Everything kind of goes, and the body weakens,” she said.

An estimated 4.5 million Americans have Alzheimer’s disease or a related disorder, more than double the number in 1980. In Connecticut alone the number afflicted with the disease is estimated at over 100,000. That number will continue to grow because seniors are the fastest growing population, she noted. “By midcentury, 14 to 16 million people will have Alzheimer’s,” she said.

There is help for Alzheimer’s, Ms Girardat said. It is vital that dementia be diagnosed as soon as possible since some conditions are reversible if treated. If Alzheimer’s or some other disease that causes dementia is diagnosed, treatment is available that helps a patient to maintain cognitive functions longer.

A specialist, such as a neurologist with skills in Alzheimer’s or a geriatric psychiatrist, should be consulted for an assessment.

Is it hereditary? There is a familial component, Ms Girardat said. If a parent had Alzheimer’s disease prior to age 65, the risk factor is higher for inheriting the disease. If the parent is older than 65 when contracting Alzheimer’s, the risk factor is not high. She noted, however, that familial Alzheimer’s is rare.

Women are more likely to have Alzheimer’s than men, Ms Girardat said.

Half of all nursing home residents have Alzheimer’s disease or a related disorder. Very few Alzheimer’s patients are in hospitals, she said. Most live at home, where family and friends provide almost 75 percent of their care. The remainder is paid care costing an average of $12,500 per year, usually out of pocket.

The average lifetime cost of care for an individual with Alzheimer’s disease is $170,000. National direct and indirect costs of caring for individuals with Alzheimer’s disease are at least $100 billion, according to estimates by the Alzheimer’s Association and the National Institute on Aging.

Alzheimer’s is fatal, Ms Girardat said, and because of that qualifies for hospice care at the end stage. “All you have to do is ask for it,” she said.

The Alzheimer’s Association provides a free caregivers’ course, which is free and open to the public. It also provides support groups for caregivers, such as its Phone Angel program, through which a caregiver is linked with another. For information on these and other programs, contact the Connecticut Chapter office at 866-3-MEMORY or 860-956-9560.