Published on: February 16, 2012
by Travis Giddings for Daily Rx:
One of your parents, perhaps a friend, begins to withdraw from social activities, change their sleep habits, becomes irritable, has memory problems and trouble concentrating. Before you assume the worst, there are several under-diagnosed causes of the same symptoms that are important to rule out first, because they are treatable.
The mind is a complex system, and figuring out what’s wrong is not as easy as you might think. Rebecca Wood of the Alzheimer’s Research Trust says, “Similarities in symptoms between dementia and depression can mean the two are sometimes confused at time of diagnosis, but we don’t know if they are biologically linked.”
A lot of things can impact quality of life for the elderly, including poor nutrition, any number of other medical problems, grief from the death of a spouse, or a close friend, any of which could push them into an episode of depression, but watching the passage of time take its toll on their friends and relatives makes the elderly particularly susceptible.
This means that all medical causes should be explored before assigning a diagnosis of dementia, because depression is frequently overlooked.
Things to rule out
Most importantly, many medications can cause all kinds of problems, including subtle problems in thinking, fatigue and a sense of fogginess.
If someone you know has been slightly off and has had a recent change in their prescriptions, accompany them to their pharmacist and ask them to make sure there are no potential drug interactions, and see if some of the side effects could be the cause. Many times your doctor can change your prescription to an alternative drug.
Common culprits are drugs for blood pressure and drugs to lower cholesterol. Additionally, liver and kidney function decrease with age so common medications can reach and remain at high levels, causing severe sedation and drowsiness, or other toxic effects without a change in dosing.
Always carefully read the list of side effects that comes with your medications, and talk to your pharmacist if you are having problems.
Vitamin B12 deficiency, as well as other nutritional problems, are more common in the elderly. Over time those symptoms can cause a wide array of effects that could be mistaken for a neurological deficiency. Even with a healthy diet, some people lose the ability to absorb vitamin B12 over time. Diagnosis requires a simple blood test, and treatment is just a shot of vitamins.
Decreased thyroid function, known as hypothyroidism, has many subtle effects that can be hard to notice initially and gradually worsen over time. Fatigue, weight gain, deeper voice changes, and problems thinking are typical symptoms of long term untreated hypothyroidism. With some estimates ranging from 10 to 20 percent of the elderly having lower levels of thyroid hormones than normal, it is a common problem, and should be ruled out early. Diagnosis is straightforward, and treatment with prescribed thyroxine is cheap and easy.
Not as commonly recognized but just as important, is mistaking depression for dementia. In cases of moderate to severe depression, lack of interest in new things, slow speech, confusion, memory problems and sluggish thinking can occur, which can reverse after treatment.
If depression is the only issue it is entirely treatable, but it’s important to remember it’s common for both to happen together. While depression is not a simple thing to treat, a good mental health professional can frequently improve the symptoms of depression in the elderly.
Over half of elderly people who are hospitalized, recently had a major surgery, or diagnosed with cancer fit profiles of severe depression, which can be mistaken for dementia.
The complications from diabetes, especially if not treated aggressively, can cause all kinds of problems with memory, thinking ability, and motor skills due to damage from high levels of sugar in the blood building up on neurons. The process is roughly similar to cholesterol buildup on arteries in the heart.
Kidney function should be regularly checked in people who have existing conditions, especially those on dialysis or with other conditions that can affect the kidney, including diabetes, because a buildup of toxic products in the blood known as uremia can cause severe problems in the brain.
Heart and lung disease
Oxygenation of the brain, whether from a series of tiny strokes or impaired heart function, should also be explored. Possible solutions range from taking a baby aspirin every day, or beginning to use oxygenation masks for severe lung conditions such as emphysema. Long-term smokers are especially vulnerable, as several types of lung cancer secrete products that alter the blood chemistry.
On a similar note, people with problems with atherosclerosis and build up of cholesterol in their arteries, especially in the carotid arteries of the neck, can have problems getting enough oxygen to their brain. Other people with heart problems can have similar problems because their heart cannot work hard enough. Sometimes a pacemaker is set too slow. If you suspect this is a problem, you might check with your cardiologist for a work up.
The other side of the equation is prevention. Keeping your mind occupied is a major boost to health, and whether you prefer to enjoy a few hobbies on the side, or just never stopped learning, some studies show that use it or lose it doesn’t just apply to physical fitness.
One of the most powerful effects on state of mind is living environment. Where one lives is tied to identity and for many people, it’s where they have spent a majority of their life. Losing your home is a blow to the psyche with many subtle effects.
If you’re in charge of taking care of a family member, remember that assisted living and nursing homes are not all created equal, and options should be carefully explored before making any decisions.
Many people with normal mental function, especially if seriously ill, may briefly lose their mind and become disoriented if they find themselves in a strange place such as a hospital or nursing home, and this condition, known as delirium, is temporary and should not be confused with dementia.
For anyone having trouble with their memory, there are a few important things to rule out first. Ask your doctor about what else could be causing problems.
Although it’s great to celebrate the big achievements, it’s also important to celebrate the small wins.
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