Memory and Aging

Fellowship-level expertise to help patients with dementia and Alzheimer's disease

The term “dementia” describes a group of symptoms affecting memory, cognition, and social abilities severely enough to interfere with daily functioning. There is a certain amount of memory loss that is a normal part of aging, so just having memory issues does not mean you have dementia. It is when these memory issues are combined with impaired judgment, language problems, or the inability to perform common daily activities such as paying bills or driving that dementia may be diagnosed.

Serving adults aged 60 and older, Memory and Aging Services at Erlanger is an outpatient clinic focused on diagnosing and treating mild cognitive impairment and dementia. Our goal is to preserve the dignity and maximize the abilities of each individual, helping them cope with stressful issues such as grief, loneliness, illness and disability, changing roles and status, and family conflicts.

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Symptoms
Types
Risk Factors
Diagnosis
Treatment
Outcomes
Prevention
Memory and Aging Services at Erlanger
Patient Questionnaires

Symptoms

Most people have some memory problems as they age. There is a difference between normal aging and dementia or Alzheimer’s. You may want to see a doctor,(bring a family member or friend with you), if you recognize symptoms including:

• Difficulty performing familiar tasks
• Problems with  language
• Time and place disorientation
• Poor judgment
• Problems  with abstract thinking
• Frequently misplacing things of high value
• Uncharacteristic changes in mood
• Personality changes
• Loss of initiative

Types of Dementia

Dementia involves damage to the nerve cells in the brain. Symptoms vary depending on the location, severity, and progression of the damage. Some memory loss is caused by a reaction to medications or nutritional deficiencies, and can be reversed with treatment. Alzheimer's disease is the most common cause of dementia. Most people develop Alzheimer’s symptoms after age 65, but some people may have early-onset forms of the disease. The exact cause of Alzheimer's disease isn't known, but research shows that plaques made up of a protein called beta-amyloid and tangles made up of tau protein are involved. Family history often plays an important role, though gene mutations are rare.

Vascular dementia, the second most common type of dementia, is caused by brain damage due to reduced or blocked blood supply to the brain. Blood vessel problems may be related to a variety of factors, such as stroke, hypertension, diabetes, or heart conditions. Symptoms of vascular dementia are often more variable and less predictable than Alzheimer’s disease

Dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) dementia are similar brain conditions that result from microscopic Lewy bodies that are made up of a protein called alpha-synuclein. Whether a patient with Lewy bodies has PD or DLB depends on which area of the brain is predominantly affected by the Lewy bodies. DLB patients tend to experience fluctuating attention, visual hallucinations, and a sleep condition known as rapid eye movement (REM) sleep behavior disorder that involves acting out dreams.

Frontotemporal dementias tend to occur at a younger age than does Alzheimer's disease, generally between the ages of 50 and 70. This is a group of diseases characterized by the breakdown of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior, and language. There are several different genes and protein changes involved in this group of dementias.

Other disorders linked to dementia include:

• Huntington's disease
• Traumatic brain injury
• Creutzfeldt-Jakob disease
• Amyotrophic lateral sclerosis (ALS)
• Multiple sclerosis

Conditions that mimic dementia and could possibly be reversed include:

• Alcohol and drug abuse
• Nutritional deficiencies
• Endocrine abnormalities such as thyroid conditions
• Reactions to medications
• Sleep apnea
• Anoxia/hypoxia (lack of oxygen)
• Normal pressure hydrocephalus
• Untreated syphilis
• Meningitis and encephalitis
• Subdural hematomas
• Brain tumors

Risk Factors

Risk factors that can't be changed include:

• Age
• Family history
• Down syndrome

Risk factors you may be able to control include:

• Heavy alcohol use
• Sleep apnea and poor sleep hygeine
• Atherosclerosis and cardiovascular disease
• Blood pressure
• Diabetes
• Depression
• Low vitamin B12 levels
• Thyroid problems
• Lack of exercise
• Diets high in ultra-processed foods
• Smoking
• Social isolation
• Hearing loss

Diagnosis

Memory loss and other dementia symptoms can have many causes and associated conditions, so diagnosing dementia is a complex process. That’s why Erlanger offers a special clinic for these patients. Designed for adults aged 60 and older, Memory and Aging Services at Erlanger focuses on diagnosing and treating cognitive disorders associated with aging, as well as addressing the needs of families and caregivers. Our goals are to preserve the dignity and maximize the independence of the individual; help the patient cope with loss of independence, changing roles, and related family conflicts; and help caregivers set expectations and manage stress.

Some of our dementia tests include:

• Cognitive screening – Measures thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.
• Neurological evaluation – Evaluates movement, senses, balance, reflexes and other areas.
• Brain scans – CT or MRI scans to check for evidence of stroke or bleeding and to rule out the possibility of a tumor.
• Laboratory tests – Rule out medical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.
• Behavioral screening – Evaluate for depression or another psychological condition thatmay be causing symptoms.
• Biomarker testing – Advanced testing for Alzheimer’s and Lewy body diseases

Treatment

Medical management of dementia may help slow disease progression or address symptoms:

• Anti-amyloid therapies such as lecanemab and donanemab
• Cholinesterase inhibitors – drugs including donepezil, rivastigmine, and galantamine work by boosting levels of a chemical messenger, acetylcholine, involved in memory and attention.
• Memantine – regulates the activity of glutamate, another one of the chemical messengers involved in brain functions, such as learning and memory.
• Other medications to address associated symptoms, such as mood changes./li>

Outcomes

Treatment for age-related cognitive decline involves medication, therapies, and lifestyle modifications. While these treatments can help address symptoms, or even slow disease progression, dementia is not reversible or curable. Patients and family members usually need to prepare for the progression of disease and plan for additional care.

Prevention

There is no sure way to prevent dementia, but research shows there are steps you can take that may delay dementia or lessen its affects. For example:

• Stay socially active – Keeping social connections stimulates intellectual and emotional flexibility. This means being able to hear people around you – get yourself checked for hearing loss and wear hearing aids if recommended.
• Stay physically active – Exercise has been shown to help with cardiovascular health, which may also affect brain health.
• Keep your mind active – Lifelong learning can include reading, traveling, learning new languages, or auditing classes at your local college or university.
• Get a natural night’s sleep and treat sleep apnea. Avoid sleep aids such diphenhydramine.
• Quit smoking – Smoking negatively affects the entire cardiovascular and cerebrovascular system.
• Lower your blood pressure – Talk to your doctor about medication, dietary and lifestyle changes to lower blood pressure.
• Maintain a healthy diet – A diet rich in fruits, vegetables and omega-3 fatty acids promotes overall health and may lower your risk of developing dementia.

Memory and Aging Services at Erlanger

Erlanger offers fellowship-level expertise in helping patients with dementia and Alzheimer's disease. We specialize in behavioral neurology, Lewy body disease, neurodegenerative diseases, and clinical geriatric neurology.

Patient Questionnaires

• New Patient Form
• Follow-up Patient Form