Dementia is a brain disorder that affects memory and other abilities like language and thinking. According to the World Health Organization, "Currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year." Dementia can affect daily life and recognizing the early signs is key to getting a diagnosis quickly and starting treatment. Dr. J. Wes Ulm, Harvard and MIT-trained MD, Ph.D. with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting and education explained to us what to know about dementia and symptoms to watch out for. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
What To Know About Dementia
Dr. Ulm says, "Dementia is a source of great concern for American adults, as various forms of this neurological condition are indeed quite prevalent, and it's important to be on the lookout for potential signs so as to spot them for early intervention. First, a couple caveats. The term "dementia" in itself is quite broad-based and pertains to a variety of different physiological disturbances contributing to memory loss or dysfunction, so it's important to keep in mind that there are many potential causes with diverse remedies. Although dementia is often associated with Alzheimer's disease for the general public — in large part due to the enduring historical importance of the early monographs by Alois Alzheimer, the German physician who first identified it — in fact it's a multifaceted condition with potential connections to many other diagnosable illnesses. It can, in fact, be associated with slowly developing but treatable conditions like Vitamin B12 deficiency, alcoholism, NPH (normal pressure hydrocephalus) or PTSD, but also with vascular dementia (the second most common type of dementia) owing to an ischemic stroke or multiple TIAs (transient ischemic attacks), as well as other diagnoses like frontotemporal dementia (Pick's Disease), DLB (Dementia with Lewy Bodies), and rarer conditions like Huntington's Disease, CJD (Creutzfeldt-Jakob Disease), PSP (Progressive Supranuclear Palsy), or CBS (Corticobasal Syndrome)."
Dementia and Infectious Diseases
Dr. Ulm explains, "It should also be noted that some infectious diseases can also manifest with dementia chronically, most notably HIV in the form of HAND (HIV-associated neurocognitive disorder), but also potentially COVID-19 itself, based on early indications of neurological effects of long COVID. This in turn leads to the second important caveat: While dementia is no doubt quite distressing, it's also often nonspecific and quite variable in its presentation. Likewise, while it can sometimes signify a progressive condition, its wide variation and intricate pathogenesis mean that, especially with recent research and bench-to-bedside therapeutic advances, medical professionals are better equipped than ever to help patients preserve and regain cognitive function. Moreover, as noted, many of the conditions causing it are treatable and essentially curable with prompt intervention. That's why the following signs of dementia are important to spot, and to respond to, as early as possible. There are others besides the ones on this list, but the following five signs and symptoms are particularly informative as hallmarks to seek medical attention."
According to Dr. Ulm, "Memory loss, chiefly of short-term memory (particularly working memory), even as longer-term memory and procedural memory (how to do things with which one is well-acquainted) appear to be better-preserved. The very word "dementia" derives from a Latin root related to the concept of forgetting ("dimenticare" is the word in Italian for "to forget"), and thus memory issues are one of the prime diagnostic identifiers of clinical dementia. This is of course one of the classic hallmarks of Alzheimer's Disease (AD) in particular, owing to the pathophysiology of the disease in which harmful biochemical products — predominantly substances called amyloid plaques and NFTs (neurofibrillary tangles) — build up in and around cells, and give rise to varying levels of damage to an important structure called the hippocampus, which functions as a kind of manager for the processing of short-term memory. Patients with this presentation will often have difficulty remembering where they placed their keys or medications, or repeat the same questions or statements uttered minutes before, even as they can easily recall conversations from decades ago (or e.g. how to play the piano or violin, an example of procedural memory). While severe and new-onset short-term memory deficits can sometimes be telltale, however, it's important to bear in mind that memory lapses are not always (and usually are not, in fact) indicative of frank dementia. The modern American lifestyle in general — with relatively high stress, long hours at work, significant demands on time, the "always-on" connectivity of electronic devices and media, job insecurity, fatigue, and now COVID on top of encounters with the usual menu of colds and flu — is especially conducive to conditions that tax our memory and attentional resources, and cognitive reserves in general. We can all feel scatterbrained and overwhelmed at times, so it's important to keep an eye out for memory deficits that are significant and sustained, and differ markedly from an individual's baseline."
Issues With Engaging and Conservations
Dr. Ulm shares, "Issues with following or joining conversations, and engaging productively in discussions. This is another telltale indicator of potential dementia, and manifests specifically in varying degrees of aphasia or dysphasia — two somewhat fluid terms used to describe difficulties in producing or comprehending language — often with specific manifestations such as anomia, i.e. straining to remember and use the right word for an object or concept. Again, all of us have occasional conversational slip-ups or a foot-in-mouth incident here and there; the key is to look for cases in which there is a considerable, sustained deviation from an individual's baseline, and difficulty in holding discussions and chit chat about even mundane, everyday matters."
Difficulties with ADLs (Activities Of Daily Living)
"ADL challenges are among the hallmarks of both the diagnosis and management of dementia, and one of the reasons for calling on e.g. a homecare specialist to assist the patient," says Dr. Ulm. "ADLs include basic things like brushing one's teeth, driving a car, and preparing meals. If these tasks abruptly begin to feel taxing for an individual to carry out, this can be another of the indicators to take a potentially affected member to a medical consultation."
Changes In Personality Or Mood
Dr. Ulm says, "Even though dementia is most commonly associated with alterations of cognition and cognitive capacity (particularly of memory, as well as attention and processing of language or calculation), many forms of dementia also present with mood or personality shifts, and in fact such manifestations can often help diagnostically in determining the underlying cause. Frontotemporal dementia, for instance, is classically linked with profound alterations in mood, behavior, and personality, sometimes with frank depression, anxiety, or unwarranted suspicion about others in a person's environment. Once again, the key is to be on the lookout for significant changes from an individual's baseline, without an obvious external stressor to explain the shift. In addition to being a diagnostic hallmark, such changes are also important in clinical management, as they can warrant counseling and treatment by a psychiatrist or other mental health professional for a diagnosable mood disorder."
Getting Lost in Familiar Places
"This is another classic sign of dementia, especially if it is new-onset and frequent, and involves difficulty in finding one's way or retracing a path that is generally well-known to the patient, such as a route from home to a grocery store nearby," Dr. Ulm explains. "The specific presentation can be quite variable, with some patients experiencing significant disorientation in time and place, while others may present more subtly, with modest but recurring confusion in charting out basic routes to get where they need to go. Whatever the case, a pattern may be evident with difficulty in providing or following directions and navigating otherwise well-trod paths, and this can be another trigger to schedule an appointment for the potentially affected individual with a medical professional."
Wes Ulm, MD, Ph.D., is a physician-researcher, musician (J. Wes Ulm and Kant's Konundrum), and novelist, and earned a dual MD/Ph.D. degree from Harvard Medical School and MIT. He is part of the Heroes of the COVID Crisis series in relation to his ongoing efforts in the drug discovery and public health arena.