Neurocognitive Disorders and Dementia

What is dementia?  Many people use the phrase “dementia or Alzheimer’s disease.”  In reality, dementia is just a general term for changes in thinking that are significant enough to interfere with daily life.  There are numerous causes or types of dementia – Alzheimer’s disease is just one type (and is the leading cause).  Other common causes are vascular disease, Parkinson’s disease, Frontotemporal dementia (FTD), and various other medical conditions.  While many causes of dementia are permanent and worsen over time, there are some dementia-causing conditions that can be improved or reversed, including depression (also referred to as pseudo-dementia), side effects of medication, and hydrocephalus, among others.

At its core, dementia is caused by damage to brain cells in various regions of the brain.  This damage causes the cells to be unable to communicate properly with each other, resulting in changes to thinking and behavior.   Like many other brain-related conditions, neurocognitive disorders occur on a continuum or spectrum:

Normal aging

Very mild decline in mental function as compared to one’s past abilities.  This is difficult to define as it is different for every person, but may include occasionally misplacing an item, having more difficulty learning new things, or having a shorter attention span.

Mild Cognitive Impairment (MCI)

Cognitive changes that are serious enough to be noticed by friends and family members, but not significant enough to affect the person’s ability to engage in everyday activities.  For example, a person may have more difficulty remembering directions to a place they have been once or twice, but with the aid of GPS, they are still able to drive safely and arrive at their destination.   They may also need to set reminders to pay bills on time or take medication regularly, but they are able to manage these processes independently (e.g., can go to the pharmacy and organize their medications without any errors).  Approximately 5-20% of people over 65 have MCI; having MCI increases the risk of developing dementia, but some people with MCI may never get worse, and some may get better with lifestyle changes (e.g., better sleep, reducing alcohol/tobacco use, etc.).

Dementia
Cognitive changes that are serious enough to cause problems with everyday activities.  Dementia ranges from Mild to Severe, depending on the level of assistance the person needs:
  1. Mild dementia may cause regular lapses in memory (e.g., forgetting names of grandchildren), having trouble in social situations, or getting lost in a familiar place.

  2. Moderate dementia typically includes confusion about where they are or what day it is, having an increased tendency to wander or get lost, and demonstrating behavior or personality changes (e.g., more impulsivity, suspiciousness/paranoia, or compulsive behaviors).  Patients with moderate dementia typically need regular assistance and care from loved ones, though they should still be encouraged to do as many tasks as they can independently.

  3. Severe dementia involves a loss of awareness of day-to-day life and surroundings, difficulty communicating, and requiring round-the-clock care.

Treatment options are highly dependent on the type of dementia, which is why proper evaluation is so important.  There are some medications that may help slow the progression of memory concerns, but these medications may not be effective for all types of dementia.  Nearly all types of dementia can be positively impacted by healthy living habits – eating a healthy, well-balanced diet (e.g., Mediterranean or MIND diets), exercising regularly, and engaging in brain-boosting activities (e.g., playing word-games, reading, or learning a new skill).  A typical evaluation includes an interview with the patient.  Participation from a close family member or friend is strongly encouraged – this should be someone who knows the patient well and sees them on a regular basis.  Evaluation also includes formal neurocognitive testing, which helps the provider assess the patient’s strengths and weaknesses.  Every type of dementia has a unique cognitive pattern that identifies it; testing allows the provider to compare your cognitive profile to the profiles of various disease processes to help form a diagnosis.  The evaluation concludes with a discussion about next steps, including treatment options and creating a plan of care for the patient and their family.

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Before scheduling a full evaluation, Dr. Sedlak offers free, 15-minute phone consultations to answer your questions and ensure she can meet your needs.  You can book a consultation online by clicking on button below and following the instructions to book an appointment.  This Patient Portal Help Guide also provides step-by-step instructions. 

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