Putting together the pieces of dementia

| Keeping our brains fit as we age |

BRAINS AGE. As people get older, they may start forgetting appointments, or lose track of days and months. For a while, they may put on a good show. “They’ll tell you what they think,” says Dr. Jeffrey Reddout, a neuropsychologist at Winter Haven Hospital’s (WHH) neurorehabilitation program. “Sometimes they fill in the blank with what makes sense, but not necessarily what’s true.”

Not everyone experiences memory loss or intellectual impairment that affects their everyday lives. When it happens, the results can be devastating. So it’s wise to get help early when treatments are most effective. Sometimes, the loss is reversible.

“Depression can look like dementia,” points out Dr. Hasan Mousli, a neurologist practicing in eastern Polk County. When depression is treated, dementia may go away. Whenever forgetfulness is a concern, a thorough checkup is advised. Changing habits may be a good idea. Dr. Mousli says conditions that reduce blood flow to the brain can age it by 10 years. These can include weight problems, lack of exercise, diabetes, hypertension, high cholesterol, and sleep apnea. “A stroke by itself can lead to dementia or make it worse,” Dr. Mousli points out.

Dementia is an umbrella term that refers to a variety of conditions involving loss of memory and intellectual functioning that affects everyday life. Alzheimer’s is the most common form of the disease.

In Polk County, there were an estimated 14,922 cases of Alzheimer’s in 2014 among 623,327 residents, according to the Florida Department of Elder Affairs and Alzheimer’s Association. That means one in 41.8 persons in Polk has Alzheimer’s, compared to one in 40.19 statewide and one in 61.43 nationally.

The number of cases in Polk is expected to climb to an estimated 22,152 cases by 2025. Statewide, the number is expected to rise from an estimated 485,000 to 720,000; nationally, the projection is an increase from an estimated 5.2 million to 6.8 million.

Most people with Alzheimer’s also have one or more other medical conditions; more than one in seven live alone, according to the Alzheimer’s Association.

Memory loss can be connected with the following ailments and diseases:

• Strokes
• Brain tumors
• Infection
• Thyroid imbalances
• Alcohol
• Over-the-counter night-time medications
• General anesthesia
• Chemotherapy

Vitamins D and B-12 appear to play a role; the right level is important. Dr. Herminio Cuervo, a Lakeland neurologist and a Polk County Medical Association member, says it’s critical to prevent deficiencies in these vitamins. “I routinely see people in my office with low vitamin D who have memory problems,” he asserts.

“Dementia, memory loss, is not one thing. … You have to make a diagnosis,” Dr. Mousli adds.

“If you’re going to get it, you’re going to get it. There are things you can do to stack the deck in your favor. Your body will be better able to manage,” asserts Dr. Aryn Harrison Bush, co-director of the Neurophysiology of Aging Laboratory at the University of South Florida in Tampa. “Everybody should be concerned. Based on the statistics, no one is immune.”

She says it’s likely that the “vast majority of us” have susceptibility, although we may not have the rare familial mutation associated with dementia. “There is some evidence by managing your diet, and by managing your cardiovascular or your chronic health conditions — all of these things — you can help delay or possibly prevent the onset of a neurodegenerative cause of dementia.”

A study published in The Lancet on March 11 found improvement in cognitive functioning was possible through multi-pronged intervention including diet, exercise, cognitive training, and vascular risk monitoring. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) targeted at-risk elderly people.

The good news is, things good for your overall health are also good for brain health. The most important ones are exercise and socialization, according to Barbara Herrington, a certified care manager and owner of All About Aging, a Winter Haven firm serving Polk and Highlands counties. Exercise improves oxygenated blood flow to the brain. “Anything we can do to keep our brains from being lazy is important,” she explains. “When people become isolated and withdrawn, they lose the conversational ability. They become depressed. That’s the beginning of a cascading effect that is not good.”

We need to challenge our brains by learning new things; things that give a reward are good as well. That may be learning a language, keeping up with technology, or even doing online training at www.brainhq.com or www.lumosity.com. “It can be as simple as jigsaw puzzles. When it (the puzzle piece) fits, the brain says ‘Way to go, you are so smart,’ ” she says.

Also recommended are meditation and other forms of stress management — and a good night’s sleep.

What makes you more at risk for dementia? “The biggest risk is age. The older we get, the more likely we are to get it. Women get it more than men. Is it because we live longer? Could be,” Herrington says.

“In general, level of education makes a big difference if dementia happens,” Dr. Mousli says. “Those with more education are going to do better.” It’s determined not by college degrees, but by whether the person is an “active learner,” he says. “Every time you think, you build muscles in the brain,” he explains.

If you or a loved one is concerned about memory loss, check with a primary healthcare provider, and learn more through the local Alzheimer’s Association new program on brain health: Healthy Habits for a Healthier You. The workshop is aimed at helping you age well, and includes current research findings and what we can do to improve or maintain overall health, says Stefanie Thompson, director of Early Stage Programs for the Alzheimer’s Association-Florida Gulf Coast Chapter. The workshop covers cognitive ability, physical health and exercise, diet and nutrition and social engagement. A meeting is scheduled from 3 to 4 p.m. on May 7 at The Estates at Carpenters, 1001 Carpenters Way, M Building, second-floor Media Room, Lakeland. You can reserve a place by calling (863) 292-9210 or emailing Thompson at thompsons@alzflgulf.org.

You also can contact WHH’s outpatient neurorehabilitation program at (863) 292-4061 for comprehensive testing. “It’s okay to start with us,” Dr. Reddout says. “A lot of times, if people are having questions, it’s a good idea to get checked out.” Sometimes testing uncovers a mild cognitive impairment, rather than dementia; sometimes they find “the worried well,” he says. Testing may consist of five to six hours of clinical evaluation involving memory, intellectual function, concentration and processing speed. “There is no blood test or straight diagnostic,” he explains. The tests can help determine if a patient should be allowed to drive, handle his or her own finances, live alone, or is competent to make his or her own decisions.

Testing is helpful because a patient can mask the problem well for short periods of time, which may delay diagnosis and treatment. “If people are in a familiar situation it may not show up at all,” he says.

Outpatient evaluation, education, and treatment also are available at the Winter Haven Hospital Center for Behavioral Health — Memory Clinic.

While she acknowledges it’s a “tough disease,” Dr. Harrison Bush says scientists are “working tirelessly” on a solution. “There are promising treatments that are being explored,” says the board member for the Alzheimer’s Association-Gulf Coast Chapter. “Everyone should have a vested interest, and we, as scientists, do.”

Gene therapy and brain stimulation, even an antiepileptic drug, offer hope for the future. “There’s just so much research going on,” she observes, “and there is some promise.”


article by CHERYL ROGERS

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