Diagnosis and treatment may effectively manage symptoms and offer hope
Any person of a certain age who forgets words or loses his or her car keys may think they are in the beginning stages of dementia – but it could be normal aging.
Many people experience mild cognitive impairment (MCI), changes in memory and thinking that have not made a huge impact on their daily life and function. Anjali Patel, DO, a cognitive neurologist, says, “About 12 to 15% of people with MCI will develop Alzheimer’s disease (AD) or another form of dementia; some people stay the same, and others get better.”
The most common form of dementia is Alzheimer’s disease (AD), but more exist: Lewy body, vascular, frontotemporal, Parkinson’s disease, Huntington’s disease, chronic traumatic encephalopathy (CTE), and some secondary dementias that occur because of disorders that damage the brain. Some conditions that look like dementia develop from nutritional deficiencies, hormone dysfunction, side effects of medications or chronic infections, and can be reversed.
A Diagnosis Is the First Step
According to Dr. Patel, most memory problems can be diagnosed by obtaining a thorough history, completing a physical with blood work, and cognitive tests in the office. Generally, an imaging study such as an MRI or CT scan of the brain is obtained. If necessary, additional tests such as neuropsychological memory testing, lumbar puncture or PET scans can be obtained. With an accurate diagnosis, the disease can be better managed with proper treatment.
While researchers are working for a cure, there are interventions that will help manage the disease and possibly prevent secondary dementias. These include keeping blood pressure within normal ranges, controlling cholesterol, treating sleep apnea, following the MIND diet, being physically and socially active, and limiting alcohol intake.
Managing the Symptoms of Alzheimer’s Disease
There are two types of medications that can slow down cognitive decline – cholinesterase inhibitors (i.e., donepezil, rivastigmine and galantamine) and memantine, an NMDA receptor antagonist (i.e., Namenda). They are not a cure and do not prevent the progression of the underlying disease.
“Of those taking cholinesterase inhibitors, about one-third of people improve, one-third stabilize, and one-third have no response. Memantine blocks excessive glutamate release, allowing better function of the impaired brain, and is usually indicated for people with moderate to severe symptoms of dementia,” says Saurabh Sharma, MD.
Cognitive decline often leads to or can be associated with secondary symptoms such as depression and feeling loss of control. “Giving the patient more freedom to make his or her own choices, to participate in once-favorite activities, or even music therapy might alleviate several symptoms of Alzheimer’s disease,” Dr. Sharma notes.
Tips to Stay Healthy
Insomnia has many causes, ranging from anxiety to drinking liquids too close to bedtime. Dr. Sharma recommends trying natural remedies such as melatonin and sound machines or eye shades before relying on medication. He also recommends avoiding drugs such as Benadryl or sedatives. Drug therapies are available if these do not work. For other behavioral symptoms, mood stabilizers, anticonvulsants and neuroleptics can all help. Dr. Sharma says patients should discuss with their doctor about using FDA-approved drugs and avoid supplements for which “reliable research on the efficacy and safety” is not available.
ATLANTIC MEDICAL GROUP
Dr. Patel and Dr. Sharma are part of Atlantic Medical Group, a multispecialty network of health care providers. For more information, visit atlanticmedicalgroup.org. They can be reached at 908-522-2829.