Virginia H. Templeton, M.D., is the Head of the MemoryCare Clinic in Asheville, NC, established to provide appropriate assessment, treatment, and support for memory-impaired individuals and their families. MemoryCare is a non-profit organization that provides specialized medical care to older adults with memory loss, supports caregivers with education, counseling, and improved access to services, and provides community education.
Opinion8ed2: Do memory loss disorders usually occur gradually over time or more suddenly?
Dr. Templeton: When you talk about memory disorders/dementia, really they are umbrella terms for a spectrum of illnesses where there are changes in thinking to the point that the person can no longer do things they did in the past because of that change. There are many different types of dementia and they present in a variety of ways. Alzheimer’s is the most common (60%) and it generally has a gradual, insidious onset that is hard to pinpoint just when it began. Other types, like vascular dementia, tend to be associated with an event like a stroke so can have more sudden onset. Lewy Body Disease is another and often presents with really vivid visual hallucinations. And on. But all dementias are progressive over time- some gradually and some “step-wise.” Because everyone is different, it is hard to know what to expect.
Opinion8ed2: Are there classic signs of dementia that the patient or family and friends might notice that would indicate something other than “normal” memory loss?
Dr. Templeton: You hit it on the nail with your article. With normal aging, it is the pace of processing that changes- it takes longer to get information in, longer to store it and, as you eloquently describe, longer to retrieve it when you want it. But, the system is intact.
The transition to clinically diagnosable dementia is when the memory loss, or rather change in cognition which includes more than just memory, is to the point that a person’s day to day functioning is impaired because of the change. Change in function because of a change in cognition is the key to making a diagnosis.
One last comment. We tend to focus on memory as the cardinal symptom of dementia but it can be judgment, reasoning, decision-making or even how a person uses language that can change as well. These can be harder to identify- but they can get us into trouble early on, particularly with financial/business affairs. Being aware of this and having families work together can reduce the risk of legitimate errors of judgment and of exploitation (a whole other topic for your blog…).
Opinion8ed2: How do you determine when memory loss falls within the “normal” spectrum or is a symptom of something more serious?
Dr. Templeton: If you or someone who cares about you is worried about your memory, the best thing to do is get a medical evaluation. First, you want to rule out reversible causes of memory loss- things like thyroid disease, vitamin deficiencies, anemia, among others. An evaluation should include blood work, a brain scan, and cognitive testing. Especially at early stages, getting an accurate diagnosis can be really difficult- and it’s not something you want to get wrong. It helps to have the doctor talk not just with the person having memory problems but also with someone who knows them well and can speak to any memory issues they are having and how the person is functioning day-to-day.
Opinion8ed2: What types of treatment are available now for various types of memory loss?
Dr. Templeton: There is currently no cure for memory disorders. The medicines that are available to treat the disease rarely make the memory better (with some exceptions) but are intended to slow progression and help the person hold onto functional skills for longer. Because of the limits of medical management, treatment is also in part, learning strategies to manage the changes that occur as dementia progresses- establishing a plan for safety in areas such as medications, finances, driving, and so on. In truth, a person can stay independent for longer if they can adjust to some changes where safety is at risk but it is not easy- my dictum is that it takes a team to age.
Opinion8ed2: Indeed… and it takes a village to provide the health care support that you and your colleagues do on a regular basis. Are there new treatments on the horizon?
Dr. Templeton: There is quite a bit of research about dementia but the recent advances have been primarily in the realm of diagnostics rather than treatment. The research in this area is very exciting but I don’t anticipate new treatments for many years to come.
Opinion8ed2: Is prevention of memory loss considered possible some day?
Dr. Templeton: Prevention is a big goal- lowering risk is probably more accurate, at least for the foreseeable future. There are three main things we can all do now that are really common sense but not always easy to do: 1) stay physically active (goal of 30 minutes of aerobic exercise per day), 2) challenge your mind with things you enjoy (when it gets easy, do something harder), and 3) eat a healthy diet (plenty of fresh fruit, vegetables, and fish). The literature about this is growing and someday I hope/expect we’ll know more.
Opinion8ed2: That’s great advice and thanks much for taking the time to talk with us – I know you’re very busy running your clinic, plus teaching and lecturing to boot – and for putting the issues of memory disorder in clear perspective.
For additional information…
the Alzheimer’s Association: www.alz.org
the Alzforum: www.alzforum.org