Guarding Your Brain Against Dementia

As we go to press, we’re happy to share breaking news about the future of Alzheimer’s
treatment. On July 6, 2023, the FDA approved the drug Leqembi. The drug targets a protein in the brain called beta-amyloid, long known by scientists to be one of the underlying causes of Alzheimer’s disease.

Although Leqembi is not offered as a cure, clinical trials establish that the drug, which is given via IV every two weeks, will slow the progression of the disease. Check with your doctor and the Centers for Medicare & Medicaid Services (CMS, www.cms.gov) to see if Leqembi is covered by your Medicare plan, which may cover up to 80 per cent of the cost.

Like Madea, we all laugh about having “senior moments,” and it seems funny until you find yourself driving on an unfamiliar freeway with no idea where you’re going. Or maybe the names of people you’ve known forever begin to slip from immediate access. There’s that woman, you grew up together, she’s the one who cut off your braids when she sat behind you in second grade, you were a bridesmaid at her third wedding, and her name is…starts with a N…Norma, Neicey, Nene, Noelle, Nichelle, Naomi…

If you or a loved one has been diagnosed with Alzheimer’s or another dementia, you are not alone. The Alzheimer’s Association is the trusted resource for reliable information, education, referral and support to millions of people affected by the disease.

• Call the 24/7 Helpline: 800.272.3900.
• Locate your local Alzheimer’s Association.
• Whether you’re living with memory loss or caring for someone who is, ALZNavigator™, an online interactive tool, will guide you to your next steps.

And because June is the month dedicated to Dementia Awareness, here’s our easy intro to recognizing changes in your brain, and ideas for keeping your brain “plastic.”  Plastic doesn’t mean what you think it means. When talking about your brain tissue, it means flexible, responsive, and adaptable, the very qualities that make human beings a successful species. Preserving and nurturing brain plasticity as we age is now understood to be a major factor in keeping full cognitive function.

WHAT EXACTLY IS ALZHEIMER’S? IS IT THE SAME AS DEMENTIA?

First, let’s define terms. Dementia is a general term used to describe a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life. It isn’t a specific disease, but several diseases can cause dementia. Though dementia generally involves memory loss, memory loss has different causes. Having memory loss alone doesn’t mean you have dementia, although it’s often one of the early signs of the condition. Alzheimer’s disease is the most common cause of a progressive dementia in older adults, but there are a number of other causes of dementia. Depending on the cause, some dementia symptoms might be reversible, according to the Mayo Clinic. Toxic proteins in the brain are the likely source of most dementia. As we age, the composition of many of our tissues changes. This happens with our melanocytes, the structures in our melanated skin that create glorious, protective pigment. In later life, they clump together and stop producing melanin consistently, resulting in splotches and dark patches. Beginning in our 40s, a similar process occurs in the eye, causing cataracts.  Large clumps called “tangles” of the protein called tau form in brain cells and spread throughout the brain, attacking the synapses or “messenger” cells that enable us to reason, associate, make decisions, learn, and remember, resulting in various forms of dementia. Today, medicine is seeking ways to stop, prevent and reverse the spread of tau tangles in the brain.

HOW WILL I KNOW IF I’VE GOT DEMENTIA?

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Cognitive changes

• Memory loss, which is usually noticed by someone else
• Difficulty communicating or finding words (“Aphasia” is a severe form of this kind of cognition-loss)
• Difficulty with visual and spatial abilities, such as getting lost while driving
• Difficulty reasoning or problem-solving, making simple decisions (like choosing fruit at the market)
• Difficulty handling complex tasks, then simpler tasks (people with advanced dementia may literally forget how to bathe, groom, dress themselves, and may neglect basic housekeeping, hygiene, and cherished pets)
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Confusion and disorientation

Psychological changes

• Personality changes, often becoming aggressive and combative
• Depression
• Anxiety, sometimes escalating into panic attacks
• Inappropriate behavior, including loss of sexual inhibitions and social “filter”
• Paranoia (elderly people with dementia will often accuse caregivers of stealing from them)
• Agitation (manifesting as insomnia, meltdowns, outbursts of rage)
• Hallucinations (often signaled by the person conversing with someone who’s invisible to others)

Often, we notice these changes in others before we notice them in ourselves. Common warning signs we may observe in others include that someone with Alzheimer’s may repeat the same statements and questions over and over, forget recent conversations, appointments and events, misplace items, often putting them in places that don’t make sense (like putting your purse in the fridge), getting lost in places that they’ve been to a million times, forgetting the names of everyday objects and familiar people, and losing the ability to join and follow in conversations (although if this is happening, first rule out hearing loss as a possible cause).

All of these experiences can make an individual experiencing a form of dementia feel isolated, lonely, and even frightened. Also, a decline in cognitive abilities can endanger well-being in more tangible ways. Forgetting to pay bills and take medications are common examples. Sometimes someone with dementia will use appliances, like a stove or iron, and not remember to turn off the power, etc. People with these conditions also may literally wander out of their homes wearing their pajamas.

CAN DEMENTIA BE REVERSED?

This is unknown at the present time. However, some treatable medical conditions can cause dementia-like symptoms, so it’s important to determine the cause. 

Believe it or not, something as basic as a vitamin B-12 deficiency or an ordinary urinary tract infection (UTI) when accompanied by urgency and fever may present literally delirious behaviors that mimic dementia in seniors. The moodiness and indecision which often accompanies an underactive thyroid gland may also seem like dementia. Kidney disease is another potential condition which can produce dementia-like symptoms. When the kidneys aren’t functioning well, a uremic toxin called indoxyl sulfate may accumulate in the body, causing hallucinations. Even mild dehydration — older folks often don’t drink enough fluids — can lead to electrolyte imbalance that can cause dementia-like confusion and irrational behavior. For individuals with Chronic Obstructive Pulmonary disease (COPD, formerly called emphysema) lack of oxygen to the brain can cause a person to ramble incoherently, as if intoxicated. And so on.

The takeaway: See a doctor if you or a loved one has memory problems or other dementia symptoms. The symptoms may be the result of a treatable condition. Or, they may indeed signal loss of brain function that needs to be correctly identified and addressed.

WILL I GET ALZHEIMER’S OR ANOTHER FORM OF DEMENTIA?

Highly possible. Older Black Americans are twice as likely as white people in the same age group to experience Alzheimer’s or other forms of dementia, according to Alzheimer’s Association. The causes may be socio-economic and cultural, since this agency reports that only 20% of Black Americans say that they have no barriers to excellent health care and support regarding dementia care. Half of the Black people surveyed by this agency say that they have experienced discrimination while seeking care for a person living with Alzheimer’s, and only 48% of Blacks report being confident that they can access culturally competent care. Black people often report believing that memory loss is a natural and inevitable part of aging, and are less likely than other ethnic and racial groups to see medical attention for dementia symptoms. Read more about the disparities in dementia-related health care HERE.

WHAT CAN I DO?

For Yourself: 

Genetics play a role in your risk-factors, but current science also concludes that lifestyle choices including not smoking and getting regular exercise do help the brain stay agile and alert. Obesity and hypertension appear to have correlations with dementia onset, so monitor your numbers closely.

To store and retrieve new information, the brain relies on a neurotransmitter called acetylcholine, which plays an essential role in forming neural connections. As we age, production of this key neurotransmitter decreases, limiting the brain’s ability to create new short-term memories. This is why you might be able to easily recall people or events from decades ago, but it can be a struggle to remember where you parked your car or where you left your keys. 

Many companies now market supplements which enhance production of this and other neurotransmitters. Simply, the jury is out as to whether or not these over-the- counter treatments are effective. They may be harmless, and they most assuredly are not the silver bullet.

Let’s get back to brain plasticity. This is an emerging science that holds tremendous potential for keeping the aging brain “connected.” Current studies now suggest that certain activities including singing, doing puzzles like math problems, word jumbles in the newspaper, Sudoku, and even familiar group games like mah jongg and bridge can keep neurons firing and build brain fitness. Physical activities requiring motor skills coordination, like line-dancing and basic calisthenics, may also be helpful in toning your brain as well as your boot-tay.

Experts agree that mastering a new skill may be the best workout for the aging brain, Specifically, learning a new language or learning to play a musical instrument appear to build brain plasticity in potentially dramatic ways. Learning a new language is easy online with apps like Duolingo, Babbel, Rosetta Stone and oodles of others. And it’s even more fun when you gain enough fluency to converse in casual groups either online or in person with others who are also learning.

If you feel that you are losing your ability to think clearly, make simple decisions or remember important things, or if those around you comment on your apparent confusion,  memory loss or decline in mental facility (for instance, your showing up for a party or other appointment three hours early when the time was clearly written out, confirmed and repeated, or the fact that you can’t “see” or locate the bagel shop in the shopping center you’ve visited for years…), DON’T be offended and defensive. DO schedule a thorough cognitive exam pronto. 

For Others:

Keep the person safe, meaning that you monitor their whereabouts and count and prepare their medications in advance, order their needed prescriptions, and schedule medical and dental appointments as well as transportation if necessary. 

Observe the person closely regarding driving a car. Surrendering a driver’s license is never a welcome decision, but it’s an aspect of cognitive decline that absolutely must be addressed for the safety of the individual and the community. And, a person who has difficulty driving may also become bewildered by the bus-schedule they once knew by heart. 

Also monitor and arrange for support with housekeeping, and keep them on-track with haircuts, manicures, pedicures. The regularity of consistent, comfortable, familiar activities may help calm agitation.

As you create a secure living arrangement for the affected person, schedule a thorough medical exam when symptoms (or even suspected symptoms) present themselves. Tests to consider include a PET scan which will show patterns of brain activity, and whether the amyloid or tau protein hallmarks of Alzheimer’s have been deposited in the brain.

Consider volunteering with the Alzheimer’s Association, a national organization committed to engaging underrepresented and underserved communities and responding with resources and education to address the disproportionate impact of Alzheimer’s and dementia.