Where did I put those keys?

I completely forgot about that appointment I had!

What was the name of that person I met last week?

These experiences are common enough. But when is it time to worry? How do you know when these types of memory problems are the sign of something more serious?

All people experience declines in their memory and in their ability to retrieve the correct word as they age. However, in some cases, declining memory can be the beginning of dementia.

What is dementia?

Dementia is a class of diseases involving chemical and structural changes in the brain that cause symptoms such as intellectual decline and social dysfunction. These deficits can become severe enough to interfere with daily functioning. The most common dementia is Alzheimer's disease, although there are many others, each with its own symptom profile. To be diagnosed with dementia, you need to have decline in two intellectual ability areas: memory, language, motor skills, and/or judgment and planning (also known as executive functioning). Personality changes can also occur with some types of dementia.

While the early stages of the disease may seem like ordinary forgetfulness at first, over time, dementia sufferers decline in all areas of functioning until they are no longer able to care for themselves. The advanced stages of dementia are characterized by increasing physical and mental disability.

Types of Dementia

There are a number of different types of dementias each with a different symptom profile. A partial list includes:

Alzheimer's is the most common and usually begins with memory and language dysfunction.

Vascular dementia is the result of damage to the arteries supplying your brain or heart. Symptoms may appear suddenly or gradually and are dependant upon the location of damage.

Fronto-temporal dementia affects the frontal and temporal lobes of the brain and often first manifests as changes in personality, lack of inhibition, and poor decision making.

Lewy-Body dementia has similar symptoms to Alzheimer's disease but with alternating periods of clear thinking and confusion. Hallucinations are also a common symptom of this type of dementia.

There are also dementias associated with diseases such as Huntington's and Parkinson's.

Risk Factors of Dementia

What puts you at risk for dementia? The number one risk factor is age. Most cases of dementia occur in people over the age of 65. As the American population ages, there will be more individuals with dementia. Although estimates vary, one recent study suggested that there are now 3.8 million individuals in the United States with dementia, 2.5 million of those with Alzheimer's disease.

Although most cases of dementia occur in individuals over the age of 65, dementia can occur in rare cases in younger people as well. These cases of "early-onset" dementia usually have a genetic component and thus run in families. But genes are not the sole cause of dementia. Inheriting the apolipoprotein E*4 (APOE4) gene puts you at higher risk for Alzheimer's disease. However, even people who have inherited a copy of the APOE4 from both parents are not guaranteed to develop dementia (but they do have a higher chance of getting Alzheimer's disease than the general population). Clearly, there are other contributing factors.

Physical health can also influence the likelihood of developing dementia. Individuals with uncontrolled high blood pressure and stroke history may develop vascular dementia. Likewise, those with atherosclerosis, diabetes, smokers, and alcoholics all have an increased likelihood of developing different types of dementia.

How do you test for dementia?

A comprehensive assessment for dementia includes a medical history, physical exam, and usually an exam by a neurologist as well. Your physician or neurologist will often recommend a neuropsychological evaluation of cognitive functioning. These examinations consist of tests that measure an individual's memory, attention and concentration, language ability, motor skills, and executive functions. Psychological factors that often co-occur, such as depression, are also evaluated. A typical neuropsychological evaluation takes 4 to 8 hours, often administered over more than one day. Depending upon the suspected cause of the dementia, brain scans such as CT scans and MRI are sometimes recommended as well.

Treatment for dementia

Although relatively uncommon, some types of dementia are reversible. For example, the cognitive abilities of individuals with meningitis (an infection of the lining of the brain) improve once the infection has cleared. For the more common types of dementia, like Alzheimer's disease, there is no cure. However, there are medications that can slow the rate of cognitive decline as well as medications that can alleviate certain symptoms. For example, with increased disorientation many patients become understandably agitated. Agitation can be treated with both medication and behavioral techniques to keep the patient safe, comfortable, calm, and content. Lastly, caregiving for a patient with dementia can be very stressful. Caregivers need to take care of themselves often benefit from periods of respite care and contact with others who are facing similar issues.

Memory Problems That Are Not Consistent With Normal Aging:

Confusion about the time and place

Forgetting how to do tasks of daily living (basic hygiene, writing checks, etc.)

Frequently getting lost while driving

Trouble learning new information or things

Frequently repeating phrases or stories

Significant difficulty with finding the right word when speaking or writing

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