Dementia: When Should I Start Worrying?
Cognitive decline prevention for seniors
"Someone is trying to break in,” my panicked mother relayed to me over the phone. From 3,000 miles away, I pleaded for her to call the police as I was unaware of her new reality. She then brushed off the potential danger. There was no intruder.
In another call, she reported people sleeping in the large weeping willow tree in the backyard of our family home. And then there was the film crew and their large production truck parked out front. “The house across the street is going to be featured in Better Homes & Gardens,” she declared.
Her stories were vivid and detailed. They were visual hallucinations and the first indicators something was wrong. This otherwise healthy, physically and socially active 83-year-old was diagnosed with dementia with Lewy bodies (DLB) in 2008. Nearly five years later, she moved into an assisted living facility. She turned 100 last year. It truly is the long goodbye.
DLB is the second-most common form of degenerative dementia behind Alzheimer’s disease. Hallucinations are more prominent in DLB than in Alzheimer’s, while memory loss is an early feature of Alzheimer’s disease. Some memory loss is normal as we age. So when someone begins misplacing their keys, forgetting someone’s name or repeating the same stories, many families struggle to determine if it’s just part of aging or something more serious.
An estimated 7.2 million Americans 65 and older are living with Alzheimer’s, according to the Alzheimer’s Association’s most recent report. A 2023 study analyzing Medicare data found the average age at diagnosis for dementia is 83.
Dementias are often grouped by their commonalities: underlying causes, specific brain regions affected, progression of symptoms and presence of associated neurological or behavioral features. Besides DLB and Alzheimer’s disease, which are characterized by the accumulation of amyloid plaques and tau tangles in the brain, there is vascular dementia, frontotemporal dementia and dementia caused by co-pathologies.
When memory issues start interfering with daily life—repeating the same question, struggling to follow a conversation, getting lost in familiar places or showing poor judgment—it may be time to speak with your doctor, says Jie Pan, MD, a neurologist with the Torrance Memorial Lundquist Neurosciences Institute.
The institute offers comprehensive care for dementia, including diagnosis, treatment and support services. It also offers resources and support for patients and their families.
A distinction of normal aging is the self-awareness of forgetfulness. “Dementia patients will usually lack the awareness,” says Dr. Pan. “It’s usually a family member who notices it. Typically, memory concerns associated with normal aging will be reported by the patient and not the family. Normal aging is also not associated with loss of functional capacity and tends to remain stable with time.”
Dementia affects more than just memory. It can affect different domains, including language, visual-spatial cognition and executive function, such as trouble completing familiar tasks or learning new ones.
Lifestyle choices, like smoking, can increase one’s risk of developing dementia. Health conditions such as depression, cardiovascular disease, high blood pressure, high cholesterol and uncontrolled diabetes can increase the risk. Untreated hearing loss in midlife has also been associated with an increased risk of dementia.
Maintaining good sleep hygiene, eating a brain-healthy diet, engaging in regular exercise and social activities, learning new skills and maintaining mental health can lower one’s risk. Good sleep hygiene means getting the right amount of sleep, says Dr. Pan.
Researchers found people over 65 who consistently sleep more than nine hours every night had twice the risk of developing dementia within the next 10 years. The reported sweet spot is between seven and nine hours. “You don’t want too much or too little,” Dr. Pan points out.
Dr. Pan recommends the Mediterranean, DASH (Dietary Approaches to Stop Hypertension) or MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets. MIND, which combines aspects of both the Mediterranean and the DASH diets, focuses on foods rich in nutrients—whole grains, green leafy vegetables, berries, poultry, fish, beans and olive oil. These foods protect and nourish the brain and reduce the risk of cognitive decline and neurodegenerative diseases. It’s also ideal to limit red meat, fast food, fried food, butter, cheese and sweets.
One’s education level and intellect can be a factor in brain health. Dr. Pan notes people with higher educational levels have a higher cognitive reserve, which is the brain’s ability to maintain cognitive function despite damage or degeneration, and are better able to compensate early on. “The signs of dementia might be subtle in this population and therefore difficult to notice initially.”
There are emerging therapies, such as anti-amyloid monoclonal antibody IV treatments, that aim to slow progression in the early stages of Alzheimer’s, though the long-term effectiveness and safety are still being studied. Blood biomarkers and other biomarker tests may be an available option in appropriate clinical contexts.
Early detection matters. Getting help sooner can improve quality of life and open the door to better treatment options.
Jie Pan, MD, practices at Torrance Memorial Physician Network Neurology, 23560 Crenshaw Blvd., Suite 101 in Torrance. She can be reached at 310-517-7021.
