Sep 24, 2021

Interviewer: With aging loved ones in our lives, we always kind of in the background of our mind are worried about them developing some sort of a cognitive disorder like Alzheimer's and dementia. But it gets a little tricky because general memory trouble is also a pretty common effect of aging. So the trick is how do we as loved ones recognize cognitive impairment and when it's just our loved one having a senior moment?

Dr. Michelle Sorweid is a geriatric physician and a cognitive disorder specialist with the Aging Brain Program at University of Utah Health.

Dr. Sorweid, say an older parent or loved one seems to be forgetting things. Maybe they use the wrong words for things fairly consistently, tell the same story every time I see them. Are these things that I should be worried about, or is that just part of getting older?

Dr. Sorweid: If someone came up to me and asked, "What should I be looking for in my loved one?" things that are commonly noticed are short-term memory changes, so repeating details of things that you know you've talked about before, especially if they're really important topics, but maybe not necessarily. And then there is a really common presentation where people might not recognize these changes in themselves. It's probably going to be others, like loved ones or coworkers or even acquaintances, that notice these changes.

Interviewer: Let's start with, first of all, as an onlooker, what are the different types of cognitive impairments that I should be aware of, and how do those kind of show up? Or are there too many really to talk about? Can you narrow that down for somebody?

Dr. Sorweid: There are quite a few. There are over 100 different causes of memory and thinking changes. But I would say a lot of them have many overlapping characteristics.

The one thing that I want to definitely make sure people are aware of that's less commonly known is that short-term memory isn't the only presenting symptom. Sometimes we might see things like personality changes or even severe depression or what seems like severe depression. So kind of lack of interest in their day-to-day activities, things they used to enjoy. Those can be signs that something is changing in the brain.

You mentioned word-finding difficulties, whether it's substituting words that don't make sense or describing words instead of using the word they want to use, especially things like common words. We all have "senior moments," but really those becoming more and more frequent or, like I said, using words that maybe don't quite fit.

Interviewer: Do you find that some patients kind of ignore these symptoms, first of all, as we already talked about, because it's just kind of attributed to "Oh, just getting older"? But maybe because there's a little bit of a fear of what they might find out?

Dr. Sorweid: Absolutely. I think there are a number of reasons people tend to not want to seek help. There are a lot of cultures specifically that have a stigma against people with memory and thinking changes. I know spending a lot of time with Hispanic communities throughout the world, the word "dementia" in Spanish means crazy. And so we try not to use that word specifically for certain communities.

But yes, there are a lot of reasons why people might not seek help. Again, the lack of cures for a lot of these diseases. But I think the one thing that patients and families may not realize all the time is that part of this disease process oftentimes includes lack of insight or not being aware of one's own deficits. And so that's really difficult to navigate as a family member of someone you know is having changes and they insist that they're not and that things are fine. It might be tricky getting them to even see a provider to figure out what's going on.

So we encourage our families and patients to seek this type of screening assessment or visit as maybe just seeking a baseline and finding out where things are at. That way, if there are changes down the line, we have a comparison.

Interviewer: And as a family member, if I understand correctly, a primary care physician actually has access to some screening tools. So one could accompany an older adult to an annual type physical or health checkup and request that these screenings be done if, I guess, they're having difficulty convincing the individual. Or is that the kind of trickery you wouldn't recommend?

Dr. Sorweid: No, I would really encourage family members to present to physician visits with their loved ones and provider visits. So that is something I would definitely encourage.

And then spending time with them in their own home can be really helpful and eye-opening and seeing what's going on day to day, what's going on with their medications and how they're managing them. What does their home even look like? That can be really eye-opening.

But yeah, seeking help from their primary care provider can be really helpful and asking for something like an annual wellness visit, which is covered by Medicare.

Interviewer: Back to the afraid to acknowledge it because for fear of finding out that they might have a cognitive impairment that really not a lot can be done about. I understand that a lot of causes could also be physical, that if you take care of the physical, then the cognitive issues clear up as well. Talk about some of those physical symptoms that might present that would go hand in hand with cognitive issues.

Dr. Sorweid: Absolutely. So we know that there are a lot of things that we can treat and intervene upon as far as preventing further decline or treating symptoms related to memory and thinking changes, so things like high blood pressure, diabetes, high cholesterol, abnormal heart rhythms, sleep apnea. So there are a lot of different changes that we know make an impact on memory and thinking, on the brain.

Interviewer: Do you find that patients are afraid that they're going to find out that they or their loved one have Alzheimer's? I mean, is that the inevitable outcome if you start noticing some cognitive decline?

Dr. Sorweid: Not all memory and thinking changes equate to Alzheimer's disease. Not all memory and thinking changes equate to a dementia process. That's certainly a possibility, but the earlier we know what's happening, the more we can make an impact on someone's quality of life.

There are oftentimes things we can do to really improve someone's day-to-day, such as harmful medications that either are over the counter or may have been prescribed by a provider just lacking that training with older adults. There are mood disorders that can be treated and improved. I have some patients who've come to see me that thought they were developing a dementia process and it turns out they were just severely depressed. And so we were able to help them in that respect.

Interviewer: So it's really important for loved ones or acquaintances or friends to bring this up with that individual. Do you find that the individual is pretty open then to seeking help, or not so much? And if so, how can you help them get help?

Dr. Sorweid: Yeah, not always because of what we call lack of insight, which is very common in older adults with memory and thinking changes. They may not recognize what's going on in the brain. The brain is kind of playing some tricks on them. They may not recognize what's happening in and of themselves. So they therefore might not be as likely to seek help or be amenable to someone else saying they need to.

So I think I would try to take the approach of, "This is just an assessment to see what your baseline is there, and if there are changes down the line, then we have this baseline." It's a part of just your general health, just like getting the flu vaccine or getting screened for depression or a mammogram.

Interviewer: And then if somebody does come in and they have the assessment, which you can just get at your primary care physician as they have access to these tools, and it comes back, then what would potentially be the next steps at that point?

Dr. Sorweid: So asking for that assessment from your primary care provider through the Medicare annual wellness visit, which is covered by Medicare every year, is a really good first step. And then if your primary care provider isn't as comfortable about taking next steps, for example, certain blood work or MRI or additional testing, then that would be the time that you could request a referral to us for additional workup.

Interviewer: And the sooner that you address cognitive issues, the better. Explain why that is.

Dr. Sorweid: It's really difficult to fight fires when the fires have already started. It makes it harder for us to make a large impact on families and patients when things have kind of escalated to the point where we're, again, just fighting that fire. So the earlier we know something is happening, the more impact we can make as far as quality of life, slowing decline, avoiding harmful medications, assessing sleep, and treating any sleep disorders. There's so much we can do early on.

Interviewer: And tell me a story about somebody who recognized cognitive impairment in a loved one and did something about it. How did it, in your opinion, change the course of that individual's life?

Dr. Sorweid: I do specifically remember a patient who was in the hospital for severe memory changes and also some harmful thoughts about herself. And when she was discharged, they told her she had dementia. When she came to see us, we discovered that she was actually just severely depressed. And she was actually doing really well functionally after receiving treatment for her depression. She did not have the type of dementia they suggested. She had severe depression.

So there's a lot we can do if someone has true memory and thinking changes early on. Again, I have so many examples of giving them the right diagnosis and helping families understand what's to come. There are a lot of conditions that can affect both mental and physical well-being. And so even if it's as simple as getting the patient the appropriate targeted physical therapy, or an assistive device like a walker or a cane to help them with their motor symptoms that might be related to one of these conditions, that can really make a large impact in their quality of life.

It's hard because of the stigma that goes along with these cognitive disorders. Like I said, there aren't a lot of cures for these conditions, but there's so much positive impact we can make that doesn't necessarily include medication.

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