Did your dad just forget or is it a sign of something more serious?

medium120313961Forgot your keys in the car? Can’t remember the name of your favourite niece? Missed a scheduled lunch date with a longtime friend? Before you start panicking that this ‘brain fog’ would eventually go down the dreaded dementia road, take a deep breath. Forgetfulness is perhaps the most natural part of ageing, and doctors say not all memory loss ends up as dementia.According to the Alzheimer Society of Canada, almost 40% of us will experience some form of memory loss after we turn 65. “But chances are still unlikely that we have dementia. For the most part, our memory loss is mild enough to live our daily lives without interruption,” it says. The World Health Organisation says only 5-8% of people aged 60 and above will live with dementia. However, incidence increases with age — about 5% of those aged 71 to 79 have dementia, and about 37% of those about 90 live with it.But how do you know if it’s just age catching up with you or a deeper neurological malaise? If forgetfulness disrupts daily routine, comes in the way of finishing familiar tasks, and makes loved ones sit up and take notice, those are warning signs. “With age, there’s a natural decline in attention span, multi-tasking ability and recall of information stored in the brain. This decline does not compromise autonomy,” says Dr Anu Gupta, associate professor of neurology at the All India Institute of Medical Sciences (AIIMS), New Delhi. But in dementia, this impairment is more pronounced than what is expected for one’s age, education, and it begins to affect a person’s functionality. For instance, forgetting why you came into a room is normal but if the room itself feels unfamiliar, then that could be a sign. medium120313086Dementia, she says, can be due to many causes, but the most common in India are Alzheimer’s disease and vascular disease of the brain. “Hence, physicians take note of a patient’s history, carry out cognitive tests, compare results to age and education based normal, look at functionality, and only then make a clinical diagnosis of dementia,” she adds.Charan Ranganath, psychology professor at the University of California, Davis says the biggest reason for forgetfulness in our everyday life is multitasking. “We’re checking our phones, being distracted by noises on the street…these really degrade our capability to remember. And when under stress, we often have trouble forming new memories,” he told the South China Morning Post.PERSONALITY CHANGE A SIGNBut dementia is a completely different ballgame, changing one’s personality in unexpected ways. Dr Gupta recalls a case where a 52-year-old man was brought to her by his family after a significant decline in health and demeanour. The patient was a psychology graduate who used to work at a university, run a social organisation and even manage a grocery shop part time. But after a business debacle five-six years ago, he stopped doing all of that. He gradually lost interest in his favourite hobbies and avoided relatives at family functions by pretending to have a headache. “Initially, his family thought this was due to stress and loss in business, till he started losing words. He would keep asking what he was supposed to do, despite repeated answers. Within a year or two, he completely lost his memories, speech and understanding.” Families don’t even realise the memory loss is serious. Dr Gupta says she has seen similar cases where family members have attributed forgetfulness and behavioural changes to ageing, stress and retirement, failing to recognise it could be the onset of dementia until it’s too late.BLOOD TESTS MAY BE FUTUREWhat makes it even more tricky is that there is no single test to diagnose people living with Alzheimer’s or other causes of dementia. “We mostly diagnose patients on the basis of clinical exams. If their forgetfulness progresses and impairs daily activities, and the person is found negative for other common treatable causes such as vitamin B12 deficiency and thyroid dysfunction, we consider them for dementia,” says Dr Kameshwar Prasad, head of neurology at Fortis Hospital, Vasant Kunj.In case of Alzheimer’s disease, there’s high deposition of a protein called amyloid in the brain, he says, adding, “Developed countries like the US and UK can use PET scans to detect the protein. But currently, this test is not available in India as it requires high-tech labs. Some blood-based biomarkers have also been identified to diagnose Alzheimer’s, but they are still at the early, developmental stage.” According to sources, AIIMS Delhi is planning a project to validate the benefits of such a test.Between natural ageing and dementia, there’s another stage known as mild cognitive impairment (MCI), says Dr Gupta. “At this stage, the person is able to function independently but needs effort. All patients with MCI do not progress to dementia,” she adds. ShowQuotesTREATMENT OPTIONSDespite evidence to classify different types of dementia, there’s a huge gap in treatment options, says Dr Shamsher Dwivedee, a senior neurologist at Max Healthcare. “We have therapeutic agents to slow down progression of Alzheimer’s — the most common cause of dementia — if diagnosed early. We advise lifestyle changes and cognitive behavioural therapy, also referred to as brain exercise, to manage the condition. It’s labour-intensive and expensive, since there are very few trained cognitive behavioural therapists available in the country,” he adds. WHAT CAN WE DO TO PREVENT IT?The bane for dementia is advancing age, which we cannot change. But studies have shown other risk factors that could be eliminated to reduce half of the dementia cases worldwide. The Lancet Commission recommends providing kids with quality education and being cognitively active in midlife, reducing harmful noise exposure, treating high LDL (bad cholesterol) and depression, improving social connectedness, and smoking bans among others. According to Gill Livingston, professor at University College London and lead author of the Lancet commission, a healthy lifestyle with regular exercise, not smoking, and avoiding excess alcohol can not only lower dementia risk but may also push back dementia onset. “So, if people do develop dementia, they are likely to live less years with it. This has huge quality-of-life implications for individuals as well as cost-saving benefits for societies,” he says.