Maggie McKay (Host): Dementia. It's something that affects almost everyone at some stage of our lives, whether we experience it ourselves or a loved one does. So today, we're going to get the facts from Dr. Abraham Thomas, Internal Medicine physician. Welcome to Silver Cross Hospital's I Matter Health podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. I'm your host, Maggie McKay. Thank you so much for joining us today, Dr. Thomas.

Abraham Thomas, MD: Thank you, Maggie. It's a pleasure to be here. Thanks for having me on.

Maggie McKay (Host): Absolutely. So there are different types of dementia. How would you describe the disease and the different types you see and treat?

Abraham Thomas, MD: So, let me first start off by saying that the term dementia is an all encompassing term that refers to a decline in cognitive abilities. That's like thinking, reasoning, analyzing, that over a period of time affects a person's life and their daily activities. Having said that, there are many causes of dementia.

Dementia affects millions of people worldwide. I do want to stress this though, Maggie. Dementia is not a normal process of aging. We have this myth in our heads, oh you know what, as we get older, we get dementia, we get forgetful. That is not true. Think about all the 90-year-olds you know who are perfectly sharp and know what's going on, right?

So it's not part of the normal aging process. I do want to stress that. Having said that, the different types of dementia, the commonest type of dementia is Alzheimer's disease, which we all know. There is a certain genetic component to that, which means it can run in families if we have the gene. The reason for it is that we get these protein plaques that develop in our brain over time.

Interestingly, out of the top 10 leading causes of death in the United States, Alzheimer's is number seven. Which is kind of a big deal. The second most common cause of dementia is vascular dementia, which is where we don't get enough blood supply to our brain. And this is what happens when we say people get older and they get forgetful.

It's because there's a compromise in the circulation. The third commonest kind is something called a Lewy body dementia. This is associated with Parkinson's disease and it's an interesting kind of dementia in the sense that people with this dementia tend to have really vivid dreams and hallucinations in addition to the memory loss.

Then you get down into the other kinds. There's something called a frontotemporal dementia, which is associated with personality changes. And that's where there's sort of this disconnect between the frontal and the parietal temporal lobe in our brain. Now, bear in mind too that people can have mixed dementia.

In other words, you could have Alzheimer's and you could also have vascular. So there's that category. Then there are certain illnesses that can also cause or other conditions that can lead to dementia. You know, the one that we're all aware of now is CTE, which happens in athletes, especially football players.

That can be a cause of dementia, brain injuries. Then you have certain reversible kinds of dementia like thyroid disorders, infections, but those are the broad categories of the types of dementia. 

You mentioned memory loss, one of the most well known symptoms, but that's not always the first symptom, right? What do you see in terms of personality changes before memory loss? What do we look for?

Some of the things, and we tend to miss this, even those of us who supposedly are in the know, but when we have family members with dementia, you know, one of the commonest things is sort of a loss of interest in things that used to interest people before. Some people get sad, they have episodes of depression, some people get frightened, some people have paranoid thoughts, some people have impulsive behaviors.

Abraham Thomas, MD: So someone who's normally really cautious goes out and just spends a whole lot of money and buys this new car, or something like that. Those are all warning signs, and a lot of times these actually precede the actual memory loss that we can see.

Host: So, why do some dementia patients experience personality and behavioral changes before noticeable memory issues?

Abraham Thomas, MD: I think there are many factors to that. I think it depends on the inherent personality of the person. It depends on if they have other coexisting medical conditions like Parkinson's disease. I think it also depends on their living environment, who they live with, do they get along with their spouse, do they get along with their kids, all that kind of stuff.

And then it also depends on the kind of dementia because like we said, some kinds of dementia like Frontotemporal dementia, there are more prominent personality changes in those.

Host: Doctor, what are the most common personality or mood changes that loved ones should be aware of?

Abraham Thomas, MD: What I have found and what I have learned in treating people with dementia is one of the earliest signs is a loss of interest in things that used to interest you before. I have patients who are avid readers but all of a sudden they'll come to the office and say, you know, I just don't feel like reading anymore. 

Just doesn't interest me. Or I start reading a book and I just can't complete it. Or other people will say, I have trouble balancing my checkbook. Or I used to pay my bills and you used to be automatic for me, but now it's kind of a struggle for me. It takes me a long time. Or another really common symptom is impulsive behavior like we talked about. Then irritability. Some people just get crabby. These are all things to watch out for. The difficult thing about this, Maggie, is that we can always write these off as having a bad day. But they could be signs of something much more ominous.

Host: Any other signs or symptoms that we should be on the lookout for?

Abraham Thomas, MD: Paranoid behavior is a big one because, I have, I've had family members who have had issues where all of a sudden they think that the neighbor is spying on them or they think that, there's someone driving by their house all the time. And those are things that, you know, and then anger, just of uncharacteristic anger. That's also something to watch out for.

Host: So how can caregivers and doctors distinguish early dementia related personality changes from other mental health conditions like depression or anxiety?

Abraham Thomas, MD: That's a great question, and you know, it's something that I struggle with myself, and I've been doing this for close to 30 years. I think the thing to do is just be aware of what it possibly could be. Don't ignore persistent personality changes like that and try to be in contact with your primary care provider.

Make sure you keep up with regular appointments and discuss this with the primary care provider. If we decide that there might be an issue, then we go on into further testing. You know, there's really no specific blood test or radiological test that we can do that will tell us that if someone has dementia, but you know, there are neuropsychological tests where we send people to a trained psychologist who actually will put them through the testing that tests all the different functions of the brain and can come up with a diagnosis of dementia.

Host: So how do these early personality changes affect family dynamics? What advice do you have for caregivers navigating this stage? Because that's rough.

Abraham Thomas, MD: That is really tough Maggie, you know I think one of the biggest issues that I have seen is that it's hard for caregivers not to take things personally. We should always remember that the person who has dementia, when they say stuff, they've kind of lost their filter. So they say stuff that can hurt because you can really only be hurt by people who you love, right?

So, number one, it's really hard not to take things personally and caregivers, family members, always have this feeling of inadequacy. You know, am I doing enough for my loved one? There's always a lot of guilt associated with it. You know, there's a lot of anxiety, there's a lot of stress, and a lot of people have financial hardships because, you know, they have to take financial care of people who have dementia.

So it is really tough for family members and what I always tell people is that, you know, try to develop good coping skills in the sense that try to carve out some time for yourself. And try to do it without feeling guilty. I have patients, caregivers, who will say, you know what, I really wanted to go to the mall and go shopping, but I'm scared to leave mom by herself, and I don't want to. So, figure out a way, you know, maybe get some help from a sibling, maybe hire temporary help, try to do stuff like that that will allow you to get some time to yourself. There are a lot of support groups out there. The Alzheimer's organization has a great website that will put you in touch with support groups in the area that you live in, and that's always a good resource to be aware of.

Host: That's a great idea so you don't feel so isolated. You can be with other people who understand what you're going through. Because I guess unless you're in it, people can't understand.

Abraham Thomas, MD: Exactly.

Host: Dr. Thomas, are there any treatments, lifestyle changes, or therapies that can help slow the progression or ease personality related symptoms?

Abraham Thomas, MD: Yes. So there are medications that you could discuss with your provider or your neurologist. You know, there are certain medications that are specifically used to slow down memory loss. There's really no cure as of now. And a lot of times the medications that are available do not necessarily help us recover memory that we have lost already.

They slow down further loss of memory. So there are medications in answer to your question. There are medications that can help with symptoms of depression. There are medications that can help with agitation. However, more important than the medications, diet, you know, making sure you have you know, the affected person tries to have a healthy diet, tries to get some form of exercise, even if it's just walking. Socialization, trying to have the person meet with people, you know, sometimes all it takes is a phone call.

Because when we have dementia, we're so isolated in our minds that maybe just a phone call with the grandkids or the kids, doing crossword puzzles, doing sudoku, trying to get enough sleep. Lack of sleep is a huge thing, and it's easy for me to sit here and say get enough sleep, but once we get into good sleep habits and good sleep hygiene, that helps too.

The other thing that helps is to avoid medications and substances that can worsen symptoms of dementia. Alcohol is a big one. Then antihistamines, you know, we pop Benadryl and sinus pills all the time. These can actually aggravate or worsen the symptoms of dementia. Avoid sedatives. Another big thing I've noticed is that we need to make sure that the person's eyes and ears are functioning well.

A lot of times people with dementia can't see. They have cataracts but they don't know that they can't see and they can't express that to you and that can further lead to feelings of isolation because they can't see or they can't see as well as they used to. My mom, used to read and she stopped reading and we're like, why don't you read?

We finally figured out that she had cataracts and she couldn't really read. So even though she had dementia, the cataracts were also making that worse. Hearing, if they can't hear you that further leads to isolation, leads to anger, because then you get mad, you think they're not listening to you, and then it just creates this vicious cycle.

So simple things like that, get their eyes checked, get their hearing checked, avoid medications like that, try to make sure they socialize. I think those are important lifestyle changes that would help.

Host: I think socializing is a huge one.

Abraham Thomas, MD: Absolutely.

Host: Just from experience. Is dementia reserved mostly for the elderly? What's the age range?

Abraham Thomas, MD: No.

Host: Really?

Abraham Thomas, MD: No. There are people who actually develop dementia much earlier in life. And that again, like the one dementia we talked about in the beginning, the frontotemporal dementia, that can occur much earlier in life than dementias that are due to traumatic brain injuries or chronic brain injuries like football players, who have just constantly had head trauma over their playing career. Those causes can lead to early dementia.

Host: At what point should families look for medical evaluation if they notice personality shifts, even if memory seems intact?

Abraham Thomas, MD: My personal opinion is that if anything seems out of character, that seems consistent and cannot be explained; you got to get it looked into right away. If someone who is normally very even keeled and doesn't really get angry all of a sudden is irritable. Yeah, it's okay if we're irritable for a day, two days, if there's a reason. But if we're persistently irritable, probably got to be looked into. If things like I said, if someone who is used to reading all of a sudden stops and doesn't seem interested in that anymore.

I think that's got to be looked into. And it's always important to bring stuff like this to the attention of your physician or your primary care provider because remember that the primary care provider only sees you for that moment in time, and probably sees you like once every six months. So it's always a good idea for if you're concerned about a family member who might exhibit symptoms like this, always a good idea to come in with the person or maybe call ahead and tell the primary care provider, hey, listen, I'm worried about these things. Maybe you should look into these things.

Host: Because I imagine people get resistance from say their parents or their older spouse, who maybe don't want to go to the doctor. So that's a good idea to call ahead and say, we're coming in for this.

Abraham Thomas, MD: Absolutely.

Host: In closing, anything else, Doctor, that we did not talk about?

Abraham Thomas, MD: No, I think we've pretty much covered it, but I think it's important to remember that this is a condition that's more prevalent than we think it is, and we tend to write off a lot of the symptoms saying, oh, they're getting older or, like I said earlier, they're just having a bad day, but, sometimes these things need to be looked into and there are things that we can do to sort of slow down the progression of this illness.

Host: Well, thank you so much for sharing your expertise and making the time today. This has been so educational. I really appreciate your time.

Abraham Thomas, MD: You're very welcome, Maggie. Thank you for having me on.

Host: Of course. Again, that's Dr. Abraham Thomas. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening to this edition of Silver Cross Hospital's I Matter Health Podcast. To learn more, please visit silver cross.org. That's silver cross.org.