At just 59, Susan was becoming concerned about her memory. One day at breakfast she noticed her toast was sitting on the table rather than on her plate. And no, she didn’t have a dog that dragged it there.
Another time her sweater was in the wrong drawer. Sometimes, she says, her mind just goes blank, “like a vacant parking lot.” While these incidents might seem minor, they were enough to send her scurrying to a geriatrician for memory testing.
Her doctor administered the Standardized Mini-Mental State Examination (SMMSE, or MMSE), a series of questions that has been used to help determine cognitive functioning since 1975. With 30 as a perfect score, people in the early stages of Alzheimer’s or another form of dementia usually score between 19-24, indicating some cognitive deficits.
Susan scored 30 out of 30 on the test. But a number of her relatives have had Alzheimer’s disease, so given her family history, she’s extra mindful of any changes she perceives in her mental health.
A Quiet Deterioration
She’s smart to be vigilant: scientists acknowledge that brain changes can begin up to 20 years before Alzheimer’s symptoms appear. However, Alzheimer’s disease can’t be positively identified with complete accuracy while someone is alive, which can make diagnosis tricky.
Also, while Alzheimer’s is the most prevalent form of dementia, there are numerous other types of dementia, often with overlapping symptoms, including Lewy body dementia, frontotemporal dementia, vascular dementia, and Parkinson’s disease dementia.
This is why it’s vital for your doctor to test for memory loss, not just if you suspect you have a problem, but as a routine part of your regular medical examination.
Even though the biomarkers for Alzheimer’s — sticky plaques and tangles that accumulate in the brain from abnormally folded proteins, causing inflammation and cellular damage — can only be positively identified on autopsy, your doctor can test for and eliminate other possibilities.
A skilled physician will also recognize when other factors are negatively impacting your mental health.
For instance, in Susan’s case, after administering the SMMSE and making note of everything his patient reported, her doctor asked, “Are you stressed?”
It turns out that over the past few years, she had been a full-time caregiver for a loved one with dementia in her relative’s home, and last year her stress level was “around 19 on a scale of one to 10.” Stress and anxiety can create mental hiccups that mimic memory loss.
So while she has a family history of dementia, Susan may or may not be developing Alzheimer’s herself — and now she has a baseline from which to proceed.
Selecting A Brain Health Doctor
You may decide to visit your primary care physician, or opt for a specialist. Brain health professionals who can test for memory loss include:
- Geriatricians. Primary care physicians with additional training in geriatrics: medical care for diseases and conditions common among older adults.
- Geriatric Psychiatrists. Psychiatrists with additional training in mental health and aging. They may be helpful in ruling out other causes of memory loss, such as depression, and in treating behavioral issues in people with dementia.
- Neurologists. Trained in nervous system disorders, including issues with the brain, spinal cord and peripheral nerves. Neurologists typically receive formal training in Alzheimer’s disease and other dementias.
- Neuropsychologists. Psychologists who administer various tests to assess cognitive abilities, including memory, attention, language, reading, and problem-solving skills. Most practicing clinical neuropsychologists have a Ph.D. or Psy.D. in clinical psychology and additional training in neuropsychology. They typically work closely with other specialists and primary care physicians during the diagnostic process.
Your Doctor’s Visit
Regardless of which type of medical professional you decide to see, the steps in a memory evaluation are likely to include a comprehensive medical history (including any current and past medications you’ve taken), family medical history, and nutritional profile, including alcohol and drug use.
Next, your doctor may administer the SMMSE and/or other cognitive status tests that evaluate memory, thinking, and simple problem-solving abilities.
He or she may also screen for depression, which, like stress,can cause memory problems similar to dementia. In fact, more than 50 conditions can mimic dementia, including:
- Medical conditions such as high blood pressure, diabetes, urinary tract infections, high cholesterol, hypothyroid, or heart disease
- Insomnia or sleep deprivation
- Substance abuse
- Lack of exercise
- Poor diet, which can lead to vitamin and mineral deficiencies
- Head injury/TBI (traumatic brain injury)
- Medication interactions and side effects
The next step is lab tests such as blood and urine samples, to check for and eliminate infections and nutrient deficiencies.
Finally, brain scans such as an MRI (magnetic resonance imaging) or computerized tomography (CT) may be recommended, to look at the structure of your brain. Others, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET), look at how your brain is functioning. These scans can rule out conditions that may cause symptoms similar to Alzheimer’s but require different treatment, such as brain tumors, aneurysm, stroke, or buildup of fluid in the brain.
What To Do After Diagnosis
If your doctor determines you have early stage Alzheimer’s, don’t despair. You can make positive changes that improve your cognitive health and life overall, that may delay or eliminate the need for memory care down the road.
According to Drs. Dean and Ayesha Sherzai, authors of The Alzheimer’s Solution, dementia is not a point, it’s a life process. By choosing to live a complex, healthy life, we can maintain powerful, vibrant cognitive capacity — even reversing or slowing symptoms.
They outline a five-point neuro-protective program:
Nutrition: Eat a primarily plant-based diet
Exercise: Needs to be strenuous and consistent. Leg strength is associated with brain size and cognition.
Unwind in ways that challenge the brain, e.g., learn an instrument or a new language.
Restorative sleep. Deep sleep is critical for memory encoding and cleansing the brain. Microglia or “janitor cells,” get rid of waste material that has accumulated during the day. Chronic sleep deprivation causes microglia to eat away at healthier parts of the brain. Sleep apnea correlates with dementia, because your brain isn’t receiving enough oxygen.
Optimize mental activity. Zero stress actually creates the greatest cognitive decline. Complexity and purpose keep our minds sharp.
With the wealth of memory detection and memory boosting resources now available, people in the early stages of memory impairment can take smart steps to maintain their cognitive capacity.