The importance of cognitive health often becomes more significant as people age. With all the stereotypes, it is important for us as health professionals to challenge and educate people who classify aging adults as “senile,” or as people unable to learn or remember things. The fact is that most people live cognitively healthy lives well into old age.

While older adults often experience mild cognitive decline, that affect tends to be more annoying than compromising. Ways people can compensate include using lists, notes to self, or other reminders.

Common Questions About Dementia

1. What is it?
2. What are the risk factors?
3. How prevalent is it?
4. Is routine screening recommended?

Dementia Defined

Recent memory loss is not always a symptom of dementia. The American Psychological Association defines dementia as a “clinical syndrome of cognitive deficits involving memory impairments and a disturbance in at least one other area of cognition: aphasia, apraxia, agnosia, disturbance in executive function and changes in function and behavior.”¹

Risk Factors

• Advanced Age
• Mild Cognitive Impairment
• Cardiovascular Disease
• Genetics: Family History, Stroke, ApoE4 allele on chromosome 19
• Environment: Head injury, ETOH abuse²

Prevalence

• Dementia affects 5% of people 65 and older
• Four to five million Americans have Alzheimer’s Disease
• 13.2 million are projected to have Alzheimer’s by 2050³
• There are upwards of 50 types of dementia

Suggested Screening

While routine screening may seem like a valid strategy for professionals to consider, there are no formal recommendations provided in the literature. The AMA and AAFP both recommend that clinicians working with seniors be alert for cognitive and functional decline in older patients or from discussion with families to identify dementia in its early stages.⁴ Listening to older people and their families tell their stories is often the best technique to help professionals identify “red flags” that signal cognitive or functional change. Statements such as “Preparing meals and eating is more of a challenge“, “Mom forgets to pay her bills“, or “Dad forgot his way to my house” may signal changes in cognition and/or function that needs further evaluation.

According to a report to the CDC, dementia is a serious public health issue and despite increasing available interventions that often improve the functioning and quality of life of people with dementia and their families, the disorder is often not diagnosed and goes untreated or is misdiagnosed.⁵

There are several tools used to assess cognition, however, the accuracy varies (e.g., see Table 3) Regardless of the screening method, positive screening needs follow-up with further evaluation by the primary provider or referral to a specialist.

With the many stigmas specific to older adults with mental health disorders, as health professionals, it is important to challenge negative attitudes that may influence older adults and families to neglect their cognitive health changes, resulting in delay in diagnosis and treatment. According to the NIH, rates of cognitive disorders among older adults declined during the decade 1992-2002. Improved treatments for stroke, heart disease, vascular conditions and higher levels of education may be significant factors.⁶ Much can be done to enhance brain health and maximize life as we age.

References

1. American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (4th Ed).

2. Hartford Institute for Geriatric Nursing. Dementia: Nursing Standards of Practice Protocol. Available online February 2008.

3. Ibid. Available online February 2008.

4. U.S. Preventive Services Task Force (USPSTF) recommendations on screening for dementia. Available online March 2008.

5. Chapman, et al. (2006). Dementia and its Implications for Public Health. Centers for Disease Control and Prevention.

6. Study Finds Improved Cognitive Health among Older Americans. US Department of Health and Human Services. Available online: March 2008.

GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

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