Monthly Archives: April 2018

Screening for Dementia

Say, you are worried about your mother who seems to not remember what you had just told her.
Perhaps your husband has taken the wrong turn a few times on the way to a favorite restaurant.
Maybe in conversation you have searched for a word to explain something. You know it is there, but it’s just out of reach. 

Is this dementia? Alzheimer’s?  You are familiar with the signs, but how do you know for sure?

Let’s put your own mind at ease, first, by looking at what is considered normal aging and what is abnormal. Distinguishing between normal memory loss and dementia symptoms is not an exact science but there are some clues to look for:

Are memory changes typical aging or symptoms of dementia?
Typical aging: Symptoms of dementia:
You or a loved one complain about memory loss but are able to provide detailed examples of forgetfulness Complain of memory loss only if asked; unable to recall specific instances
Occasionally search for words Frequent word-finding pauses, substitutions
May have to pause to remember directions, but don’t get lost in familiar places Get lost in familiar places and takes excessive time to return home
Remember recent important events; conversations are not impaired Notable decline in memory for recent events and ability to converse
Interpersonal social skills are at the same level as they’ve always been Loss of interest in social activities; may behave in socially inappropriate ways
Adapted from: The American Medical Association

It is reassuring to know that three-fourths of people over 50 report that their memory is not as good as it once was, and of those who complain about memory problems only 10% have Alzheimer’s or dementia.

If you have definite concerns there are a few tests or questionnaires that can be helpful in clarifying whether a person may have dementia.
Be aware that these cannot be used as diagnostic tools except by a professional. If, after administering the tests you see a problem, you should take the test and the person to a doctor who is able to give you some insight and direction.

The Clock Drawing Test

Have the person draw a clock by hand on a large piece of paper.
Have the person draw the face of a clock and put the numbers in the correct positions.
Then have them draw the hands to indicate the time like 3:40 – one hand of the clock on 3 and the other on the 8.

 Scoring:  assign the following points for each part of the drawing
1 point for a closed circle
1 point for properly placed numbers
1 point for including all twelve numbers
1 point for properly placed hands

If the person cannot draw the clock or if it looks abnormal they would fall into the category of “probably” suffering from mild cognitive impairment or dementia. Many people that cannot pass this test might be suffering from some other illness. This is why it is necessary to consult your doctor.

MIni-Cog Test for Dementia and Alzheimer’s

First, name three objects and then ask the person being tested to repeat them back to you (for example, chair, house, apple). If the person cannot repeat the three objects after a few tries (cannot learn them), please consult a physician immediately.
If the person is successful give them another task for about ten minutes or the clock drawing test.
Next, ask the person to repeat the words/objects from the first part of the test.
If the person is unable to repeat any of the words, they might be categorized as mildly cognitively impaired or suffering from dementia.

The Sage Test
This is a more comprehensive test that you can download developed by Wexler Medical Clinic at Ohio State University.  SAGE

MCI/Alzheimer’s Questionnaire QUESTIONNAIRE 

NEXT: The diagnostic tools doctors use.


How do you prevent dementia or Alzheimer’s? Let me tell you, first of all, there is no magic pill. Doctors and scientists are working very hard to find a cure or identify factors that lead to the condition, but there is no miracle drug or procedure that will stop its progression–so far.

The ‘anti-aging’ tag on a label is a well-used ploy to sell, as are a plethora of products that purport to increase your memory or slow down the aging process. Equally persistent are ads for  products with formulas fabricated to increase your mental acuity. Most are based on incidental research and contain plant byproducts or vitamins, some of which are truly essential to good health, but not the panacea they claim.  It is always a good idea, though, to check the ingredients, especially those that refer to the brain.

While there is no guarantee that you will develop dementia, there are steps you can take that may decrease your chances. It is not surprising to recognize that the prescription for protecting your brain is the same as maintaining a healthy body. 

The Mediterranean diet based on a high intake of fruits and vegetables, whole grains and fats from fish, nuts and olive and vegetable oils has been found to slow cognitive decline.
     • In longitudinal studies those who followed the Mediterranean diet performed better on cognitive tests and than the control group, and were able to cut their risk for Alzheimer’s disease by half.

     • A study commissioned by the National Institute on aging found that people who consumed fish once or more per week had a 60% lower risk of developing Alzheimer’s disease as compared to those who did not.
     • High intake of fruits and vegetables, rich in free radical-fighting antioxidants, help prevent oxidative damage to the brain. Inflammation and damage from these free radicals most likely play a part in brain changes usually found in those with Alzheimer’s disease.
     • Use of olive oil, and eating fish rich in monounsaturated fats and omega-3, help quell inflammation throughout the body, including the brain.

     • Yes, it’s true, dark chocolate is good for your brain. In a study cited in the May 2016 edition of Appetite, participants were given a battery of tests that assessed cognitive function and then compared the scores with the amount of chocolate they typically ate weekly. The results showed that the cognitive scores rose with the amount of chocolate consumed.  

Vitamins and Minerals
If you eat a varied diet you should get most of the vitamins and minerals you need. In older adults it is important that they receive enough of the following:

    Vitamin D: 600I U ages 50-70; 800 IU over age 70; not to exceed 4,000 IU
    Vitamin B6: Men 1.7 mg a day; Women 1.5 mg a day
    Vitamin B12: 2.4 mcg a day
    Folate: 400 mcg a day
    Calcium: Women 51 and older 1,200 mg a day; Men 51-70 1,00 mg a day; Men 71 and older       1,200 mg a day

Reference:Office of Dietary Supplements National Institutes of Health

Physical activity is needed for an over-all healthy body, but it is also essential to keep an adequate amount of blood flowing to the brain.
     • Regular exercise promotes better mental functioning by improving cerebral blood flow which aids in the prevention of cognitive decline. It also has the added benefit of releasing endorphins which make you feel better mentally.
    • 75 minutes of intense physical activity or 150 minutes of moderate physical activity a week is recommended. This does not always mean you must go to the gym. Participating in a sport or walking several times a week is as effective.

     • Not surprisingly, a high BMI (body weight index) increases your chance to develop dementia, especially vascular dementia or Alzheimer’s. Research on people in midlife, shows that for someone with a BMI between 25 and 29.9 the chance for dementia increases twofold, and for the obese person (BMI greater than 30) chances for dementia are four times greater. This could be a more powerful motivator than losing weight for a slimmer profile!

Getting a good night’s rest is very important.
     • Doctors recommend six to seven hours of sleep a night for good mental functioning. This can be a real concern as we grow older and our sleep patterns  change. It is not unusual for seniors to have problems getting to sleep or waking often at night.
     • Certain studies have shown that participants who reported less that six hours of sleep a night, on average, and described their sleep as restless, had a greater buildup of plaque in the body than those who had a longer, restful sleep.
     • Sleep is when our brain consolidates and firms up new information. During this deep sleep, slow-brain-wave period, short term memories are transported from the hippocampus to the prefrontal cortex for long term storage. This probably explains why staying up most of the night to cram for a final wasn’t a good idea!

     • There are many effective, natural ways to improve your sleep; however, precautions must be taken with the use of sleeping pills. The American Geriatrics Society (AGS) recommends against the use of  sedatives such as diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) for the treatment of insomnia in older adults because of the risk of interruption of the sleep cycle and risk of cognitive impairment. Short term memory loss has also been associated with antihistamines (Benadryl) found in some sleep aides such as Tylenol PM.

Stress takes a heavy toll on the body.
     • High levels of stress cause the release of cortisol. Research has found when cortisol levels rise, cognitive performance declines. It is thought that chronic stress leads to malfunctions in the brain pathway that regulates cortisol levels and in turn affects brain cells.
     • Studies conducted on treatment of high blood pressure appeared to offer a side benefit. The Journal of Hypertension, June 2013, reported that medication for high blood pressure not only reduces a risk for stroke or heart attack, but may also help to prevent dementia, especially vascular dementia.

     • There are many ways to reduce stress, among them exercise and meditation, but ultimately it needs to be something tailored to the individual.
     • Smoking and excessive consumption of alcohol to relieve stress would, obviously, not be wise choices. An alcoholic drink a day, especially red wine, however, not only may help the heart but increase blood flow to the brain and prevent small strokes.

Mental Stimulation and Social Engagement
Keeping mentally active and socially engaged supports mental health and ultimately your brain cells.
     • Reading, playing board games, puzzles, dancing, playing a musical instrument or pursuing a hobby are ways to keep active which have been shown to lessen the chance for dementia. A five-year study of seniors 75 or older who kept active and mentally stimulated  were found to be less likely to develop dementia compared to a control group.
     • A Mayo Clinic study looked at inactivity by comparing the time spent watching television. They found that participants who spent an average of more than seven hours of TV a day were more likely to suffer memory loss than those who watched less.

     • There are commercial products on the market, principally computer programs that are promoted to stimulate mental acuity; research has shown, so far no notable differences between these programs and self selected activities such as games, puzzles, etc.
     • Talking with and interacting with people is also important for good mental health. It keeps the brain stimulated and your memory stronger. 

Another significant way you can help yourself is to not stress about what may or may not happen in the future and keep a positive attitude.

References: John Hopkins White Papers Memory: Your annual guide to alzheimer’s disease and dementia, Peter Rabins,M.D. M.P.H.  and Scientific American Memory:Your annual guide to prevention, diagnosis and treatment and treatment, Peter V. Rabins, M.D.