October 28, 2022 — When Michelle Greenfield reflects on her mother Joan’s worsening dementia, the warning signs have been around for years: At an awards dinner, her mother pulled out dental floss and began flossing on the table. Forget about the family’s old friends when her children mentioned them in the conversation. The fact that she stopped cooking, is something she has long loved. However, it was several years before the family could bring Joan to a doctor for a diagnosis.
“We couldn’t get her on board for any test, and when we finally did, and the doctor suggested she might have dementia, she was mad at him,” Greenfield says. “This was a doctor she loved and had seen for years, but now she’s mad at him.”
The family’s journey with Greenfield’s mother is common as it often takes years to diagnose dementia. In fact, new Research It is suggested outside the UK that in most cases, symptoms of dementia begin up to 9 years before actual diagnosis.
Using data from the UK Biobank, the researchers compared cognitive and functional measures of people who later developed a form of dementia with those who did not. Biobank is a collection of medical and genetic data from half a million volunteers that is used to help researchers prevent, diagnose, and treat a wide range of diseases.
“We wanted to see how early on we could catch some of the disease markers,” says lead author Timothy Rittman, PhD, a senior clinical researcher in the Department of Clinical Neurosciences at the University of Cambridge.
“We were suspicious of subtle signs long before we really noticed them.”
The study involved 500,000 people between the ages of 45 and 69 and looked at their daily jobs.
“We wanted to look for meaningful differences between groups,” Reitman explains. “Once we found them, we wanted to know if they always had these symptoms, and whether or not they were getting worse. The closer we got to the diagnosis, the worse it got.”
This verifies the Greenfield experience. As her mother’s illness worsened, other symptoms began to appear.
“She would talk to the TV or put her spoon directly into a bowl of ice cream, which she would never have done,” Greenfield says. “Then she had some fender bending while driving, and we had to work to get her license revoked.”
While symptoms become more noticeable as dementia progresses, early signs can be easy to dismiss—or, in the case of patients themselves, to dismiss. But knowing the early signs and acting on them can be important for early intervention.
what are you watching
Oftentimes, people wait until they are severely disabled before seeking an evaluation for dementia, says Heidi Roth, assistant professor of sleep medicine, memory and cognitive disorders and a leader at Duke-UNC Alzheimer’s Disease Collaborative.
“This could be a breakdown in their ability to work,” she says. “They struggle to take care of finances, go shopping, constantly forget appointments, obvious signs like that.”
Roth says research in the UK indicating a full 9 years from early symptoms to diagnosis makes sense, for a number of reasons.
“There may be subtle changes early on, but they probably don’t react,” she says. “Or family members may not want to accept that their loved one shows signs of weakness, because it can be a huge adjustment for everyone.”
There’s also the fact that everyone experiences some slight cognitive decline with age – walking into a room and forgetting why you were there, for example. Or forget about the occasional appointment. Even in our 30s and 40s, we may be concerned about these conditions. But as behaviors become more consistent, or when people start commenting on your ‘small mistakes,’ you should take notice, says Roth.
Reitman suggests that if you or someone in your family has concerns about subtle changes, see a doctor for an evaluation.
“They can test logic, fluid intelligence, memory, and reasoning,” he says. “There are general signs that will appear with dementia.”
The examination can first determine if you’re heading towards dementia or if there are other causes for your symptoms. In some cases, especially with elderly patients, the problem may be multiple medications, or the use of multiple medications to treat a single condition. Removing one or more drugs from this combination may be all that is needed to clear some of the symptoms. Screening for anxiety and depression — and treating them if needed — can sometimes reduce dementia symptoms early.
If dementia is indeed the diagnosis, the value in early screening is that there are some lifestyle changes the patient can make that may help.
“There is a lot of evidence that diet and exercise can reduce dementia risk,” says Roth. There is also evidence that sleep can play a role in cognitive function. For example, people with untreated sleep apnea begin to show cognitive decline a full 10 years earlier than others.”
As clinical trials of drugs advance, there is also hope that if the disease is caught early enough, beneficial treatments may prevent it from progressing as well.
“We’re making progress on that front, but we’re not there yet,” Roth says.
Reitman agrees with his research and sees it as a contribution to dementia research and treatment.
“Medications are coming, but we also need to think more creatively about the mechanisms of these diseases, and perhaps combine drugs to attack them,” he says. “I hope this experience contributes to the awareness that we need to look early when symptoms appear.”
After her experience with her mother, Greenfield advises others to act early when they suspect a loved one has dementia.
“Don’t wait too long,” she says, “until the situation becomes serious.” “It pays to plan for the inevitable, especially if people are living alone.”
Discussion about this post