Is It a Quirky Behavior or Alzheimer’s?

When time is running out

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You witness an elderly parent forgetting their grandchild’s name and wonder if it is time for you to find a locked facility with a pleasant-sounding name.

Many people fear they or a loved one will join the 6.7 million Americans 65 or older (10% of the US population) who are diagnosed with Alzheimer’s. [i] And if this isn’t scary enough, the percentage increases to 33% for those 75 or older.[ii] These rising numbers have led the World Health Organization to speculate that dementia is becoming an epidemic.

In the United States, neurologists have the primary responsibility for the diagnosis of dementia. Unfortunately, the average time between a referral to a neurologist and an appointment is 18.6 months. As the number of people developing dementia increases, the gap between service demand and supply is expected to widen.[iii] It is unreasonable—and some would argue unethical—for a person to wait one-and-a-half years for a critical diagnosis. Is there anything you can do while you wait? Absolutely!

You can utilize “probability statistics.” Probability is how likely something is to happen. Here, we are looking at the likelihood that dementia will develop based on the behaviors we observe. We can form the probability by looking at five different elements. This probability exercise should not substitute for comprehensive testing. Rather, it is a stopgap method for enabling you to use facts rather than hopes for making decisions that will affect your future. The five are:

1. Types of cognitive events
2. Frequency of occurrence
3. Strangeness
4. Context
5. Memory

Types of Cognitive Events

There are nine types of worrisome cognitive events that result from information processing errors.[iv] The only one that should immediately send up a red flag is disorientation. Other types may suggest dementia after their frequency, severity, and context have been examined.

1. Forgetting names and numbers
2. Repeating stories and asking the same question multiple times
3. Misplacing objects
4. Substituting words
5. Sequencing problems
6. Difficulty completing tasks
7. Conflating memories
8. Difficulty understanding
9. Disorientation

When only a few types of worrisome events occur (e.g., forgetting keys, substituting words, etc.) this would suggest normal cognition rather than dementia. However, the presence of multiple types of worrisome events suggests a widespread cognitive problem (e.g., Alzheimer’s or other forms of dementia).

Frequency

As the brain ages, it may lose some of its younger processing abilities.[v] One change is the frequency of a worrisome cognitive event. For example, you are not concerned when your partner, who was always on time, now is late a few times a month. But if she is late three or four times a week, you might be concerned.

You also want to be aware if there is a trend: decreasing, static, or increasing. The greater an increasing trend, the greater the probability that the behavior is related to dementia.

Strangeness

Sometimes, the cognitive event involves an error similar to what should have been done or said. For example, repeatedly losing one’s keys in places like coat pockets, under papers on the dining room table, or in the front door lock should not give you concern. All are similar enough that we could consider them “related.” However, if the keys were placed in the refrigerator or in the washing machine, the probability of a dementia-related behavior increases.

Context

Context refers to what happens before and during a cognitive event. For example, a client forgot the location of his favorite restaurant—a place he routinely frequented. I was concerned about his disorientation until he told me about an argument he had just before leaving for the restaurant, new glasses, a blaring radio, and a fog-shrouded street sign. Context that can explain a worrisome cognitive event reduces the probability that it stems from dementia.

Memory

Memory is often cited as the most critical element in diagnosing dementia.[vi] It is important, but not sufficient for a diagnosis. Additionally, the type of memory identified is important. There are five types:

1. sensory
2. short-term
3. long-term
4. sequential
5. working (executive function)

Problems in working or executive function have a high probability of predicting dementia, whereas problems in all others are less predictive. Working memory refers to how the mind pulls together various types of memories and uses them to execute an action. For example, If I want to make an omelet, my brain will need to gather information and rules from each type of memory and pull everything together for me to cook a tasty breakfast.

Dementia Essential Reads

Does Herpes Put You at Higher Risk for Alzheimer's Disease?

The First-Ever Alzheimer's Patient

Takeaway

Probabilities can never be as satisfying as “absolutely knowing,” but they can guide you as to whether you should move now or wait, put a non-refundable deposit down on a cruise, or give up your extended care health policy. Use the summary below as stop-gap measures you may wish to use for decisions that can’t wait one-and-a-half years for an appointment.

Probability of dementia increases when:

• A person is over 60 years of age, and chances are even greater if they are over 80
• More types of concerning cognitive events are present than only a few
• There's a presence of disorientation without any explanation
• There's a higher frequency of worrisome cognitive events
• Strangeness of cognitive events is high
• Context does not provide an explanation for a worrisome cognitive event
• Working memory is defective