While dementia remains challenging for the medical field, early detection, lifestyle choices, and caregiver support can make a tangible difference in a person’s experience of the disease.
That’s the news longtime physician and cardiologist, Dr. Edward Hoffer, gave a room of older residents in a presentation at the Mattapoisett Library recently. More importantly, Dr. Hoffer said, preventative steps that individuals can take, like regular exercise, social connection, and proper nutrition, may offer the best hope for preserving brain health as we age.
Dr. Hoffer’s Sept. 23 talk covered the full spectrum of dementia knowledge from symptoms, testing, diagnosis, treatment, caregiving, and prevention. Dr. Hoffer, a Harvard-trained cardiologist and author of Prescription for Bankruptcy, practiced medicine for 40 years and is now helping artificial intelligence in medicine studies at Massachusetts General Hospital.
In his remarks, he addressed several concerns people have early on, especially noting that the clearest distinguishing factor between memory gaps related to normal aging and those from dementia can best be determined through the passage of time. Dementia, he said, always gets progressively worse.
“It’s not a light switch being turned off it’s a steady, gradual worsening,” Dr. Hoffer said.
It’s an important distinction because early symptoms of dementia aren’t always dramatic. Difficulty driving unfamiliar routes, repeating questions, or losing the ability to make good judgement calls can indicate trouble.
“A simple question I would ask patients is, ‘You’re walking along the street, you see an envelope on the ground, you pick it up, it’s an address, it’s got a stamp on it, what would you do?’”
If the person has trouble coming up with a solution – like dropping the envelope in a mailbox – it could be an early symptom of dementia.
Diagnosis of dementia is often delayed by two to three years, according to Dr. Hoffer.
“Part of it is doctors sometimes don’t like to make the diagnosis because they’re uncomfortable. They know they haven’t got a whole lot to offer,” he said. “Patients don’t want to hear it. So it sometimes is delayed and that is a problem.”
However, if a family has concerns, they can ask for a quick screening test that a primary care doctor can do in their office.
At other times, a dementia diagnosis could be due to other factors. Some conditions can mimic signs of dementia and can be missed in older adults, Dr. Hoffer said. For example, an underactive thyroid can cause dementia-like symptoms in both young and older people, but is more easily spotted in the young person.
“If you are 30 and you have an underactive thyroid, it’s generally something the doctor can tell very easily. Your voice is deep, your skin gets dry, your hair gets brittle, and you usually will have a goiter,” he said. “As you get older, it becomes much more subtle. And one of the ways that an underactive thyroid can show up is simply impaired cognition.”
Other physical conditions that can bring on symptoms of dementia and yet are treatable, Hoffer said, include a vitamin B12 deficiency and some medications. He recommends visiting one’s PCP to review all medications.
“If you have a primary care doctor, once a year, you ought to have them look at everything you’re taking, and that includes over-the-counter stuff and things that other people prescribe,” he said.
Dr. Hoffer also recommended searching the Beer’s List online for a list of medications that older adults should not take. For example, he said, some of the older antihistamines can impair thinking.
Switching to treatment options, Dr. Hoffer suggested the options are slim. “Spoiler alert,” he said. “We haven’t got a great treatment.”
He spent more time on prevention measures, which he said, are absolutely worth exploring, as there is no cure for dementia now, nor anything he sees on the short-term horizon.
“What we have are drugs that will slow the progression and this is not nothing,” he said. “I mean if you know the progression of Alzheimer’s disease is that a year and a half from the diagnosis you are going to be in a nursing home (then) if you can stretch that to two years or two and a half years, that is a useful thing to do.”
There are more good supported options for preventing dementia, Dr. Hoffer stressed. “There are all kinds of things that we can do to prevent this disease, this awful disease.”
Vascular diseases have specific risk factors for dementia, so it’s important to seek treatment for those.
“Treat high blood pressure, treat diabetes, and don’t smoke for heaven’s sake,” he added. “These will not only be good for your heart; they will be good for your brain.”
Exercise is at the top of the prevention list. “There’s almost unanimous consensus among the medical community and the neurologic community that exercise is the single one best thing we can do to help our brain,” said Dr. Hoffer. “It has been clearly shown that regular exercise slows cognitive decline.”
You don’t have to go to the gym every day. Get out and walk if you can.
A United Kingdom study tracked how people did their errands. Did they walk, bicycle, or drive to the bank, shopping, or theater?
“And those who walked or bicycled had 20% less dementia than those who got in their car for everything,” he said.
When it comes to diet and nutrition, there is a lot of discussion about its effectiveness, but no real consensus. However, Dr. Hoffer did advise avoiding processed meats, limiting alcohol intake, and possibly eating more eggs.
“Hot dogs, salami, cold cuts, stay away from them,” he said.
“Eggs, which many of us have been taught to stay away from for cholesterol reasons, are in fact not so bad for cholesterol, and they’re pretty good for your brain,” he continued.
Also stay cognitively and socially active. “Whether you like to do Sudoku or crossword puzzles or play bridge or chess or anything, anything that keeps the brain moving is very, very good,” said Dr. Hoffer.
A natural tendency to withdraw after a dementia diagnosis should be resisted.
“It’s the worst thing you can do,” Dr. Hoffer said. “You definitely want to stay social.. Get together with friends, get together with family, stay social, do things together, and also try new things.”
“Doing new things helps your brain.”
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