Dementia & Memory Disorders: When Certain Behavior Signals Something Serious

We all occasionally draw a blank on a password or forget where we left our keys. Developing some minor memory issues can be a part of normal aging. But when do these “senior moments” signal something more serious, like Alzheimer’s disease?

Dementia and memory disorders are the specialty of Patricio Espinosa, M.D., chief of neurology at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health South Florida.

According to Dr. Espinosa, not all memory disorders are related to dementia. It takes an evaluation by a neurologist to make an accurate diagnosis.

Actually, we think that we can prevent dementia by treating cardiovascular disease and high blood pressure. There has been data that shows that if you treat hypertension, not only do you prevent a stroke, but also you prevent harm to the brain.

Patricio Espinosa, M.D., chief of neurology at Marcus Neuroscience Institute

“Part of the workup that we do is to make sure somebody doesn’t have a reversible cause of memory loss, such as hypothyroidism, vitamin b12 deficiency, autoimmune disorders such as vasculitis and others,” he explains. “We want to make sure when we diagnose somebody with a dementing illness that we have the right diagnosis and that we’re not missing something that can be treatable and reversible.”

Dr. Espinosa was the guest on a recent episode of Baptist Health’s Resource Live program, hosted by Jonathan Fialkow, M.D., chief of cardiology at Miami Cardiac & Vascular Institute and chief population health officer for Baptist Health.

Check out the Q&A below for insights into dementia treatments, prevention strategies and a warning about the use of prescription sleep medications.

Dr. Fialkow:
“Can you explain what dementia is from a medical standpoint?”

Dr. Espinosa:
“Dementia is a general word that basically describes cognitive changes over time. The number one cause of dementia is Alzheimer’s, which occupies about 75 percent to 80 percent of the cases of patients with dementia. Then we have other causes of dementia, such as dementia with Lewy bodies, frontotemporal dementia, dementia pugilistica. Another one that is very common, actually here in South Florida, is dementia due to stroke — we call it vascular dementia.”

Dr. Fialkow:
“What would be signs that something a loved one is experiencing warrants further attention, versus what could be considered normal parts of aging and normal parts of people’s behavior?”

Dr. Espinosa:
“So what we look for definitely is for a change. A change in the cognition. We all forget some little things here and there. However, let’s say somebody becomes very repetitive, they tend to ask the same question over and over again. Also, most people normally know today’s date or the year or the season, some basic orientation facts. When we start seeing a change in that normal cognitive behavior is when we have to be concerned and seek medical attention.”

Dr. Jonathan Fialkow:

“What processes do you go through to evaluate someone?”

Dr. Espinosa:

“It’s very important for the memory assessment to bring somebody that knows you or has experienced what the memory problems are. Once we do that, we collect a lot of information about the history.

We’ll also look at medical conditions, medications, social history. There’s a dementia actually related to alcohol. We also ask about the family history. We know that some patients have a higher risk of having dementia if they have close relatives with dementia illness. “

Dr. Fialkow: “What is the role of brain imaging studies in the diagnosis?”

Dr. Espinosa:
“We’ll typically order brain imaging, preferably an MRI of the brain. There may be a tumor or a mass maybe pushing on their brain (which can) mimic dementia. Here at Marcus Neuroscience Institute, we have an MRI with a software that helps us measure the volume of the memory centers and compare them to a norm. In that way, we can tell objectively if the thinning of the brain is normal for somebody’s age.”

Dr. Fialkow:
“You mentioned that Alzheimer’s disease is the number one cause of dementia. What do we know about it?”

Dr. Espinosa:

“We know that the main risk factor for Alzheimer’s is aging. And we know based on epidemiological studies that at age 65, about 10 percent of the population will have this condition. As we continue aging, when you get to your ninth decade of life, it’s estimated that actually 50% of people will have this condition.

“The classic Alzheimer’s is characterized by forgetfulness where patients will have problems remembering things that they did in the morning or the day before or in the last week or two. However, at the same time, you ask them who were their classmates from elementary school, they may name 10, or they may name an event that happened 20 or 30 years ago.”

Dr. Jonathan Fialkow:
“What medical treatments are available for patients with Alzheimer’s?”

Dr. Espinosa:
“Currently, we have two treatments approved for Alzheimer’s. There are two classes of medications that we use. One is called acetylcholinesterase inhibitors. One is very well used in practice called donepezil; the other one is called rivastigmine. And, also, NMDA receptor antagonist, which is Memantine. Data have shown (these medications) to decrease the speed of decline of the memory loss. Unfortunately, to date, there’s no medication that can revert, or for that matter, improve the symptoms.

“And I would like also to highlight the fact that, unfortunately, there are all these advertisements about all these vitamins, supplements. I don’t want to say any names in particular, but all those things have not been shown to be effective, have not been shown to decrease the risk of Alzheimer’s or to treat any memory problem for that matter. So, I will tell all of our patients not to take any supplement unless it’s prescribed by a clinician.”

Dr. Fialkow:
“What can we do to keep our brain agile to try to avoid these types of clinical outcomes of dementia?”

Dr. Espinosa:
“Actually, we think that we can prevent dementia by treating cardiovascular disease and high blood pressure. There has been data that shows that if you treat hypertension, not only you prevent a stroke, but also you prevent harm to the brain. And that can be not only protective, but it can also prevent these disorders. So, there’s so much strong data that tell us that if we control hypertension, hyperlipidemia, diabetes, we don’t smoke, all of these things that are good and important for the overall health of the heart, of the brain, of the kidney, of your lungs is going to have a positive impact in the brain.

“So, what you, Jonathan, do as a cardiologist, we preach the same thing in neurology because we think that it’s very important to have a healthy body. You have to have your weight under control, you have to exercise every day, at least 30 minutes of walking. There’s data about the Mediterranean diet, which has been also shown to have a protective effect and preventive of dementia and memory loss.”

Dr. Fialkow:
“Sleep is such an important component of our body’s health. Is there a relationship between sleep disorders or proper sleep patterns and the risk of dementia?”

Dr. Espinosa:
“Yes. Some patients can have some sleep disorders even before they develop the memory illness, such as REM sleep disturbance, which is a very typical thing. But, too, patients getting enough rest is very important. I would like to highlight that we in the memory disorders world are working very hard for our patients to avoid taking benzodiazepines and medications that work like benzodiazepines, such as Ambien. They have been shown to actually increase the risk of memory loss. Moreover, studies have shown that sleep hygiene, which is to have a good (sleep habits), is as effective as taking a benzodiazepine at night. Healthy and normal sleep is without a medication.”

Dr. Fialkow:
“What about exercising your brain? It’s a term we use quite often. Is that really beneficial?”

Dr. Espinosa:
“We encourage our patients to do activities, engage in things, to do exercise, to be part of all of these activities that will involve some critical thinking. All of these work. Unfortunately, there’s not one thing better than the other. Nothing has been shown to be 100% effective, but what we’d recommend is patients to be engaged. Engage in life, enjoy life, read, watch, go with people, be in activities, be a part of your community, help others. All of these things are very important.”