Is it dementia? Diagnosis of memory issues isn't always easy

by Paul Arco
OSF Healthcare
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ROCKFORD -- Actor Chris Hemsworth recently made headlines when he announced that he's taking time off from acting after undergoing testing that resulted in an alarming discovery: he has a greater risk of developing Alzheimer's disease at some point in his lifetime.

The 39-year-old Hemsworth made the discovery after undergoing tests as part of his documentary series Limitless, where Hemsworth tests his body and searches for ways to live longer.

While having a predisposition for Alzheimer's is not a diagnosis, it can help someone take the appropriate preventative measures. Hemsworth has said he is going to spend time focusing on stress and sleep management, nutrition and fitness.

According to the Alzheimer's Association, Alzheimer's is the most common cause of dementia, making up 60-80% of dementia cases. Dementia is not a normal part of aging, and is caused by damage to brain cells that can lead to memory problems, confusion and communication issues.

"With dementia, it's a short term, memory-deficit, but usually long term is intact," said Andrea Shewalter, a nurse practitioner with OSF HealthCare Illinois Neurological Institute (INI). "People will forget what they ate for breakfast that day and they may forget having a specific conversation with a family member that morning or the day before, but they'll be able to tell you what they did 25 years ago and be able to reminisce with stories like that."

Typically it's a loved one who notices the initial troubling signs of dementia such as memory loss, problem-solving difficulties or issues with daily tasks such as paying bills, taking medication or preparing meals, so it's the patients who are accompanied by family members to an appointment who are most likely exhibiting the greatest symptoms of dementia.

Shewalter adds that anyone is a candidate for testing. And if you have a loved one who has been diagnosed with dementia you do not need to wait to develop symptoms to look into testing options for yourself.

"When patients come in we refer them for a neuro psychological evaluation, where the psychologist reviews the 12 different domains of the brain through different systems and assessments," she says. "And they can come up with a potential diagnosis and are able to tell us what part of the brain is having a deficit or what deficit of the brain is occurring."

But arriving at a dementia diagnosis isn't always easy. Physicians have to recognize a pattern of loss of skills and function and determine what a person is still able to do. And it usually takes more than one test to come up with the diagnosis. Tests include cognitive and neuropsychological tests, neurological evaluation, brain scans, lab tests and sometimes psychiatric evaluation.

"I would refer anyone for neuropsychological testing, where they can help determine what areas of the brain are being affected," says Shewalter. "And then we usually send the patient for imaging to make sure that there's nothing from a pathological standpoint that's going on in the brain. Is there a brain tumor? Is there Lyme's disease? Is there some sort of disease that is affecting this? We can also look at the structures of the brain to be able to tell if there a lot of shrinkage for their age. Is the brain compensating due to the atrophy or the shrinkage of the brain?"

... we recommend the exercise, the increase in socialization, and the brain healthy diet ...

In the early stages of dementia, Shewalter has several recommendations for patients to remain as independent as possible, including doing crossword puzzles, playing cards and crafting – anything that involves hand and eye coordination.

She also encourages socialization – getting out in the public and being around people as much as possible. While there is no conclusive evidence, there is still benefit to taking care of yourself as much as possible. That includes a healthy brain diet and a high intensity exercise program of 150 minutes each week. Finally, get your financial affairs and power of attorney in order, especially if memory loss progresses to the point where you can't make decisions for yourself.

"We try to treat dementia as naturally as possible," adds Shewalter. "That's why we recommend the exercise, the increase in socialization, and the brain healthy diet, because it is what you make of it. If you just sit in a house and don't use your brain or challenge your brain and let the world go by, you often have generally worse outcomes than if you were to face this head on. Do the steps that we naturally recommend to decrease the rate at which your memory declines."

In addition to taking preventative measures and staying active, having a support system in place early on is especially important for someone with any dementia diagnosis.

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