Transcription:
Is it Normal Aging or Alzheimer’s Disease?

Melanie Cole (Host):Is the memory loss you're experiencing a common part of aging, or could it be a sign of a memory disorder like Alzheimer's disease? My guest is Dr. Roberto Fernandez Romero. He's a neurologist at UVA Health System's Memory and Aging Care Clinic. Welcome to the show, Dr. Fernandez. What are some of the normal changes to your brain's function that you can expect? We have age-related dementia, and sometimes we forget little things, but what are some of the things that we can expect to happen as a normal part of aging?

Dr.Roberto Romero (Guest): Just like the rest of our body, our brains experience significant changes as we get older. However, not all of these changes have to be negative. Actually, there are many brain functions that can benefit from life experiences and the things that we tend to practice and do on a regular basis so they can actually improve with age. Things like vocabulary, for example, or just general knowledge can be better or get better with age because we tend to accumulate those memories and experiences over time. They can also shape the way we react in certain situations, and so we sometimes tend to be better at responding in certain circumstances. That's something that many people call wisdom, which is something that comes with age. However, there are many other brain functions that do get affected negatively with age. These are cognitive functions that typically rely on things like quick thinking or fast reaction or mental flexibility, and also things like attention, which can be sustained attention, just keeping focused on something in particular, or divided attention, which is focusing on different things at the same time. These are things that require a lot of brain activity and require sharp connections between different parts of the brain, and those can get affected with age. It is not uncommon for older individuals to have more difficulty with things like multitasking, for example, that requires the ability to divide our attention between different tasks or problem solving or quick decision making, which are things that are not so much dependent on our life experience and practice but, rather, our ability to respond quickly. Likewise, the reaction times that require, for example, a motor action in response to a stimulus are things that we see typically that tend to decline with age. Perhaps the best example of this would be driving a vehicle, which requires your ability to respond quickly in certain circumstances.

Melanie: We do notice, Dr. Fernandez, that older people, their response time in driving gets a little bit less. We worry about them having their licenses longer, and that's part of that brain function. But what are some of the signs? If you lose where your keys are, that's one thing. What are some of the red flags that might signal that somebody is sort of entering that first phase of Alzheimer's that might send them to see someone such as yourself?

Dr.Romero: Yes. The important thing to keep in mind is that there are subtle things that happen with age, with memory, like you mentioned just losing your keys every once in a while or things like forgetting a word now and then. But when these things become frequent enough that they are actually interfering with the way you do things, or when family members or friends or caregivers start noticing that these memory lapses or these changes in behavior are affecting your day-to-day activities, that's when you should start getting concerned. Things like difficulty, other than memory problems is the first thing we would think about with Alzheimer's disease. This can be having trouble remembering recent conversations, or if people start repeating themselves or asking the same questions over and over again. That should always be a red flag. Misplacing things around the house every now and then is okay. But if you're constantly misplacing your glasses or your keys and have to search for them and cannot find them, then that can be also concerning. But there are other signs that are not necessarily related to memory that is important to keep in mind because we typically don't tend to associate those with Alzheimer's but they are actually very frequent, and those are things like getting lost or disoriented in familiar places when driving, having trouble finding their way around, or things like having difficulties finding words in casual conversation all the time, or even things like having trouble balancing the checkbook. Those are the things that are concerning and we should keep in mind.

Melanie: Are there personality changes that go along with this that we might notice mood changes, personality changes?

Dr.Romero: Yes. There are personality changes. It is not uncommon actually to see patients with early dementia who also have depression. However, depression by itself can mimic dementia. It's always a fine line between which one is causing the symptoms. But we also have to keep in mind, particularly with younger people—so people below the age of 65—there are other types of dementia that have more significant behavioral problems as opposed to memory problems. Even though these are less common or rather rare conditions, they still happen, and they can often be misdiagnosed because people are not looking for dementias in that age.

Melanie: In younger people. That's true. Now, what can UVA's Memory and Aging Care Clinic do to help patients? What's the treatment? If you bring somebody in, they've got mild Alzheimer's, they're in their first stages and you've noticed those personality changes—getting lost, trouble paying bills and handling money, normal daily tasks, any of these things that you've said signal a red flag that would send them in to see you—there's no cure, right? There's nothing we can do to stop the progression? But can we slow it? What can we do about it, Dr. Fernandez?

Dr.Romero: Yes, you're absolutely right in the sense that we currently and unfortunately don't have a cure. There's not necessarily even a medication that we can give to significantly slow down the progression. However, there are advances coming up all the time and there are new therapeutic experimental treatments that are promising. So, making an early diagnosis is still very important. But also, you have to realize that the treatment and care of patients with dementia doesn't just stop with medications and treatments like that, but it also involves giving the support to the families and caregivers and the patients. That includes education so that people know how to cope with the condition and also are aware of how to plan ahead for the future. For the University of Virginia, we are very fortunate. We have the Memory and Aging Care Center, which has a highly specialized multidisciplinary of team of professionals, and that includes neurologists, neuropsychologists, nurses, nurse practitioners, social worker, and even a representative from the Alzheimer's Association. We all work together as a team to give a more comprehensive care to these patients. Also, as an academic center, we have, aside from the expertise to make a diagnosis and begin the appropriate treatment, a significant amount of cutting-edge diagnostic tools that can be particularly helpful in those rare dementias and disorders that I mentioned briefly before.

Melanie: In just the last 30 seconds, Dr. Fernandez, wrap it up. Give hope to the people listening and your best advice about Alzheimer's disease.

Dr.Romero: The best advice is to, first of all, to seek treatment early because, again, there are medications that can help with the symptoms. Also, there's support that can be given to caregivers and families, and also to understand that most of the time, Alzheimer's is a condition that progresses slowly over time. Since we're not necessarily all about memory, there are still many brain functions and qualities that will be preserved for a long time, and so it's important to keep an open mind and be optimistic about the future.

Melanie: Thank you so much. You're listening to UVA Health System Radio. This is Melanie Cole. Thanks for listening.