As the years go by, your body changes. Your skin thins, and wrinkles appear. Your joints stiffen and creak when you change position. Your hair may gray. These are all normal facets of aging. Mentally, you might experience some changes, too—it’s common to occasionally forget where you placed your glasses, have trouble conjuring up the right word to use in conversation, or mistakenly call your grandson by your son’s name.
What’s not normal: Forgetting how to complete basic tasks, getting lost in familiar places, or repeating the same anecdotes again and again. This debilitating lapse in intellectual skills may be indicators of dementia.
It was that last sign—redundancy—that piqued the attention of Tracy Rinehart of Annapolis in 2010 when spending time with her mother, Linda Watkins. “I would notice she was telling me the same story over and over, and then she would make a joke about it, like ‘Oh my gosh, I am losing my mind,’” Rinehart recalls. “It was little signs that you didn’t take seriously at all.”
As time ticked on, her mother—whom Rinehart describes as “one of those larger-than-life people” who “was in control of everything all the time”—started to change. Little signs of memory problems grew into waving red flags until there was an event that they simply couldn’t ignore. In late 2012, Watkins drove to watch Rinehart’s sister run the Richmond marathon and, after the race, she couldn’t find her car in the parking garage. Watkins decided it had been stolen and simply got a rental car to drive home.
Watkins neglected to mention the incident to Rinehart or his sister until she came to visit for Thanksgiving. Once Rinehart’s sister heard the story, she went to the parking garage—and found the car, still sitting there two weeks later. “This was the first time that we really noticed that she started to get really angry about this,” Rinehart notes. “Instead of being grateful, she was angry that we followed up on it, angry that we questioned her, angry that her story wasn’t right.”
That’s not a normal part of aging, either—unusual personality changes, such as anger, depression, or confusion. All added up, Watkins was clearly displaying symptoms of dementia. Sadly, Rinehart’s experience with her mother isn’t uncommon—worldwide, some 50 million people have dementia, according to the World Health Organization, and that number is projected to reach 152 million by 2050.
Despite the prevalence of dementia, there’s still so much scientists don’t know about it. There’s no cure. There’s no proven way to prevent it. In many cases, no one knows what causes it—all that’s 100 percent known is that dementia can be devastating for the people it affects and their loved ones.
Understanding Dementia
Dementia is not a disease itself, but rather an umbrella term to describe the general symptoms of cognitive impairment. Just like “heart disease” can refer to arrhythmias or coronary artery disease, “dementia” is related to a variety of diseases, including:
Alzheimer’s disease: The most common form of dementia, accounting for between 60 to 70 percent of all cases. The disease can be early onset, occurring before age 55—which is quite rare, just 1 percent of cases, and caused by a genetic mutation—or late onset, occurring after age 60. The first sign of Alzheimer’s is often memory loss.
Vascular dementia: Makes up 5 to 10 percent of cases. The first signs typically include poor judgment, difficulty planning, or issues with making decisions.
Dementia with Lewy Bodies (DLB): Also known as Lewy body dementia, DLB accounts for another 5 to 10 percent of dementia cases. Signs of DLB can be similar to Parkinson’s disease, including rigid muscles and tremors.
Frontotemporal dementia: A form of dementia in which the frontal and temporal lobes of the brain shrink, causing dramatic changes in their personalities. It tends to begin between ages 40 and 65, which is markedly younger than other forms of dementia.
Mixed dementia: It’s possible to be affected by more than one type of dementia—the most common combination is Alzheimer’s disease and vascular dementia.
Other diseases that are linked to dementia include Huntington’s disease, which is caused by a genetic defect; Creutzfeldt-Jakob disease, a rare condition that causes proteins in the brain to start folding into abnormal shapes; Parkinson’s disease, which occurs when neurons in the brain gradually break down and die; and traumatic brain injury (TBI), caused by singular or repetitive head traumas.
Some disorders cause dementia symptoms but can be treated or reversed, such as normal pressure hydrocephalus, caused by a buildup of fluid in the brain; Wernicke-Korsakoff syndrome, a result of a severe shortage of vitamin B-1 (thiamine) that most commonly occurs in people who are long-term heavy drinkers; and certain metabolic and endocrine abnormalities, like thyroid problems, low blood sugar, or problems absorbing vitamin B-12.
Spotting the Signs
It’s not always easy to spot early signs of dementia because they’re so subtle and can be quickly chalked up to age. “Dementia is very slow in its progress,” notes Lil Banchero, RN, senior director of Anne Arundel Medical Center’s Institute for Healthy Aging. “People don’t always catch it right away.”
Family members are often the ones who suspect something isn’t right—but even then, the person experiencing cognitive decline may go out of their way to hide or excuse what’s happening to them. Nine years ago, Liz Glass and her twin sister began noticing symptoms of dementia in their mother, Rodney Klein, but like Rinehart’s mom, she would get angry or defensive if her daughters questioned her. “In retrospect, she knew something was going on and was trying to cover it,” the Annapolis resident says.
When they eventually brought Klein to the doctor to get checked out, the twins realized that their mother’s condition was significantly worse than they realized. “Her doctor asked her such simple questions, like what year it is—and our mother had no idea. Our jaws were on the table. She was very good at hiding it,” Glass recalls.
Although memory problems don’t always mean dementia, they shouldn’t be ignored. Early indications that are frequently overlooked, according to the World Health Organization, include forgetfulness, losing track of time, and becoming lost in familiar places—say, getting lost on the way home from the grocery store. Eventually, they might start forgetting people’s names, struggle to communicate their thoughts, and experience personality changes, becoming depressed, confused, or angry.
For Odenton resident Belen Rios, the first evidence that her grandmother might have dementia was those personality changes. “My grandmother was the sweetest person, so when she started to hide things because ‘people would steal from her,’ that was the first red flag,” she says. “Also, we noticed that she was being careless about her personal hygiene.”
A Hope for a Cure
The sad truth is that there’s no cure for any type of dementia. There are only medications and strategies to mitigate memory problems and alleviate accompanying concerns, such as depression, irritability, anxiety, and sleep disturbances. “We haven’t had any new drugs for over 15 years,” Banchero remarks. “It’s been a real tough nut to crack. What we have to depend on is lifestyle behaviors.”
However, research is ongoing. Scientists are studying next-generation drugs that can target plaques, or abnormal clusters of protein fragments called beta-amyloid, that build up in the brain, a hallmark of diseases like Alzheimer’s. There’s also research into biomarkers of dementia, which refers to something that can indicate the presence of a disease—for example, a fasting blood sugar level of 126 mg/dL or above is a biomarker for diabetes. Currently, there are no biomarkers for dementia, but several are being studied, such as levels of beta-amyloids and tangles of the protein tau in cerebrospinal fluid, as well as brain changes that are detectable by imaging. Detecting biomarkers for dementia could help medical professionals treat the correlating disease before it does serious brain damage.
Just like there’s no cure for dementia, there’s no guaranteed way to prevent it either. However, there are risk factors that can be mitigated. Research published just this year in the scientific journal Neurology concluded that there are five lifestyle choices that can be linked to Alzheimer’s disease, and by making at least four out of five of those choices may result in a 60 percent reduced risk for Alzheimer’s. Those lifestyle choices are probably familiar to you, as they’re pretty standard when it comes to healthy living:
However, as of now, “the biggest risk factor is that you’re 50 or older,” Banchero shares, stating that it’s also important to continue to have “a purpose,” whether it’s going to work, volunteering, or caring for another person, such as a grandchild.
And there’s some recent promising news. A New York Times article dated August 3rd of this year reported that researches at Harvard University have concluded that the dementia epidemic is declining overall within the United States and Europe (but not in Asia, South America, or Africa), based on assessments of seven large-scale studies. The exact reason: although they’re not specifically certain, the researchers note that lifestyle choices and education could be contributing factors, because the genetic risk factors have not changed.
Making Tough Decisions
It’s a challenge for someone to come to terms with a dementia diagnosis. It’s also a challenge to see a loved one, such as a parent or grandparent, slipping away from the effects of a disease. “As soon as the diagnosis came out, my sister and I said to our mother, ‘we promise that we’re going to take care of you and you’re going to be okay,’” Glass remembers.
At first, Glass’ mother had someone who lived with her to provide 24-hour care, which was only possible because her mother had long-term care insurance, meaning there were no out-of-pocket costs for the family. Eventually, however, they had to make the tough decision to move Klein to a memory care facility. “Her needs became too comprehensive for a caregiver at home to take care of her,” Glass says. “We never, ever wanted to do this, but we had to.”
Although some families are able to manage care for a dementia patient through the end of their life, others simply aren’t able to because of the progression of the disease—and it affects everyone differently, Banchero says. “Some dementia patients can become very physical, and sometimes it becomes unsafe for them to be at home,” she explains. “It depends on individually how the person is progressing in the disease and what the family can handle.”
When looking for a memory care facility, Banchero recommends visiting it and looking for some key indicators: How well is it staffed? How do they socialize the residents? Can families come and go as they please? (The answer to that should be yes, Banchero says.)
Socialization can improve quality of life for a dementia patient, even if they don’t seem to have an awareness of whom they’re socializing with. When Klein was first moved into a facility, “it was really great because she made friends,” Glass says. “We called it her ‘squad,’ and none of them knew each other’s names, but they hung out all day.”
In December, however, Klein moved onto a new floor because of continued cognitive decline, and in March, the COVID-19 pandemic shut down all forms of socialization—including visits from family members. Glass wasn’t able to see her mother for 14 weeks, and even then, she was restricted to 30-minute outdoor visits. “She used to know who we were, she used to recognize us,” Glass says. “But after 14 weeks, the first time we went to see her, she didn’t know who we were. It’s a complete and utter nightmare.”
She’s learned a lot in watching her mother suffer from dementia and advises others who are just starting to go through it that a shift in perspective is necessary. “Don’t have any expectations that they’re ever going to parent you again, because they’re not,” she recommends. In addition, remember that they don’t have control over what’s going on, so try to avoid getting frustrated. “The best I can say is to be supportive and try to meet them where they’re at,” Glass says. “There’s nothing you can do to change it.”
The MIND Diet
Research suggests that certain foods have a positive effect on your brain. The MIND Diet combines two well-regarded eating methods and combines them to focus on what can benefit cognition. There are no strict rules to the MIND diet, but rather a set of 10 types of food that you should eat more of and five categories that you should minimize. You don’t even have to follow the diet perfectly for it to have a potential benefit—a 2016 study published in Alzheimer’s and Dementia found that even moderate adherence may help reduce the risk of Alzheimer’s disease.
Eat more of these foods:
- Leafy green vegetables: 6 or more servings a week of kale, spinach, lettuce, chard, and others.
- All other vegetables: Eat at least one other vegetable—ideally non-starchy—per day, in addition to green leafy vegetables.
- Berries: At least two servings a week.
- Nuts: At least five servings a week.
- Olive oil: Use as your main cooking oil.
- Whole grains: At least three servings daily.
- Fish: At least one serving a week, ideally of fatty fish such as salmon, sardines, trout, tuna, and mackerel
- Beans: At least four servings of beans, lentils and soybeans a week
- Poultry: At least two servings a week.
- Wine: One glass of red or white wine daily
Eat less of these foods:
- Butter and margarine: Less than 1 tablespoon daily. Use olive oil instead.
- Cheese: Less than 1 ounce a week.
- Red meat: No more than three servings a week of beef, pork, lamb, and products made from these meats.
- Fried food: Less than once per week.
- Pastries and sweets, including ice cream, cookies, brownies, snack cakes, donuts, candy, and more: No more than four times a week.
