Understanding Memory Loss and Cognitive Decline: Signs, Risk Factors, and Prevention

Hello, and I am your host today, Dr. Valda Crowder, also known as Dr. V. And many of you know I'm a board-certified emergency medicine physician. I am committed to empowering you with life-saving information that will make a difference for you and your family. If you get a chance, make sure to subscribe to my uh podcast and also to the uh YouTube channel that we have. If you just Google Dr. V, I'm up there. So today we're going to talk about something that really touches everyone. I know specifically it has actually really, really touched my family, and that is uh brain on alert, uh cognition, memory loss, and who is actually at risk. Um, I know, you know, some of you have walked into a room and maybe you've forgotten why you went there, or maybe you blanked out on somebody's name. Um, you felt like your brain wasn't really working correctly. Um, and for some of us, those are just moments that sort of pass and and go away and we go back to sort of uh normal functioning. But for millions of Americans, memory changes and cognitive changes are early warning signs for something that is far, far, far more serious. And knowing the difference between what is normal and what is not normal can literally be life-changing and can change the trajectory of your life. So we're talking about memory. Um for us in the uh in the medical field, we call it cognitive decline or cognitive deficits. And so um I'm gonna really have a whole conversation about this today. So when we talk about cognition, this is a full range of mental processes that really allow us to sort of gather information, understand it, remember it, and then use it to function in the world. So it includes a lot of different things. So it includes memory, um, it includes attention, uh, which is sometimes a problem in younger people, language, reasoning, problem solving, and the ability to sort of plan and execute certain tasks. So when cognition is compromised, whether or not it's gradual or sudden, it really affects every dimension of a person's life. So let me break down the different types of memory and cognition and then sort of what we see actually go first. The first type of cognition or memory is short-term memory. So that's holding on to a phone number that you just heard, a person's name that you were just introduced to. Uh when we go in, when you go into the doctor's office, they may ask you about four objects and then wait a couple minutes and then ask you to recall those objects. Um, short-term memory is sort of what that is. And then there's working memory, which is sort of manipulating information in real time. So let's say I have to follow a recipe to make something, or I've got to follow a set of directions to get somewhere. So short-term memory and working memory are usually the first casualties in cognitive decline. What you see next is what we call episodic memory. So episodic memory is like, you know, do you remember life events that occurred or experiences that you had in the past? So that's usually the next line of memory that sort of disappears. And that can be a very early marker for Alzheimer's disease. The next type of memory that we have is what we call procedural memory. So procedural memory is like do you remember how to do things? Do you remember how to tie your shoes? Do you remember how to brush your teeth? Do you remember how to ride a bike or park the car in the garage? So that's kind of procedural memory. Um and then we have long-term memory, which usually lasts uh the latest. Um memory is, you know, do you remember what happened, you know, when you got married 40 years ago, or something along something along that line. Uh, and then somatic memory is general knowledge or general facts. So in the uh in the emergency department, when I'm working and I'm seeing patients like this, we may ask, you know, general facts, you know, who's the president? Where where are you right now? Do you know what I mean? So general facts like that that most people should know. And that that's a when you start to lose somatic memory, um, it can be extremely disorienting. Um, and that is a later, uh, a later sign of very significant uh cognitive decline. So when we look at this, we've got about 7 million people in the Amer in America that are living with um Alzheimer's disease, and by the year 2050, it is expected to be about 30, 13 million people. Um so when we talk about dementia, people often talk about Alzheimer's, and they kind of think that Alzheimer's and dementia is the same, and it's not. So I want to really kind of clarify that Alzheimer's is the disease, dementia is the actual symptom. So it's like saying chest pain and heart attack. So you can have chest pain and it cannot be a heart attack. So similarly, you can have dementia and it cannot be Alzheimer's. So about 60 to 80 percent of dementia is Alzheimer's. So you have about another 30 or 40 percent of dementia that is not Alzheimer's, it is something else, right? And we'll discuss some of the things that can actually cause you to actually have dementia. This is really, really important because people assume that dementia is Alzheimer's, they assume there's no treatment, and they're like, why do we even need to go to the doctor to go get this checked out? And that is actually the wrong way to think about it. One is there's a lot of dementia that is not Alzheimer's, there is some dementia that is treatable, and there are even new treatments for Alzheimer's, which I'll discuss a little bit later. So black Americans are twice as likely to develop Alzheimer's, and Hispanic Americans are 1.5 times more likely to develop Alzheimer's. Women actually make up about two-thirds of patients with Alzheimer's, and that's really related to their increased life expectancy. But there are some studies going on now to kind of look at what is the role of sex and hormones in the development of Alzheimer's. We're also seeing younger onset Alzheimer's. About 200,000 Americans are affected at younger ages, less than 50 years old. And these diagnoses are often either missed or misdiagnosed. Um, only about 25% of people with cognitive impairment actually get formally diagnosed. So 75% of people have cognitive decline and memory issues and actually never ever go to the physician to actually get checked out. And if there's one thing that I'd like to see from this show, is that people actually go and get checked out by their physician. It's really, really important. Um, cognitive decline and dementia cost us about$360 billion with a B years, billion dollars per year, and it is is expected by 2050 to cost us almost a trillion dollars a year. Caregivers are really, really also important. Um, they provide a lot of care for these uh patients uh yearly, and sometimes um that is uncompensated. Uh so so what is normal aging and what is cognitive decline that we should be concerned about? So I want to kind of go over some things that um I would say are normal. So normal is occasionally forgetting a name, but then you might remember it later. Taking a little bit longer to learn new technology and skills, um, misplacing items occasionally, but then kind of retracing your steps and finding that particular item. These are all things that I would consider to be normal. Um needing more time to recall a word, but eventually finding it. Um, occasionally making an error in finance, but not routinely. Um, maybe just feeling like, man, I really didn't get a good night's sleep last night, and I'm just not as mentally sharp as I normally am, and it's associated with a poor night, a poor, a poor poor night of sleep. So here are the things that are not normal. Getting lost in familiar places and forgetting how to drive home, repeating questions and stories multiple times in the same conversation. We see this a lot, we call it sort of perseverating. And they'll tell the story over and over and over again. Um, inability to sort of manage some of the everyday tasks like cooking, paying bills, um, even uh caring for yourself as far as hygiene, washing, showering. Another early sign of uh that is that is really, really important is mood changes. Um if someone you know dramatically becomes suspicious or they dramatically become aggressive or they dramatically withdraw and they've been a social person all their lives, um, that is an early warning sign. Uh something else that is not normal is difficulty following conversations or difficult difficulty following storylines on TV or in a movie. Um The other things we sometimes see are poor judgment, uh giving away money, um, ignoring basic safety things, such as anything related to what, you know, leaving a stove on, certain things like that, leaving a candle lit, um, also forgetting the the uh names and faces of close family members. So these are all things that are really, really important. And if you s if you have a family member and you experience any of these warning signs, these are things that are actually not normal and you should actually go see your go see your physician or if you feel like the person is really um in danger, uh take them to the emergency department to really get this checked out. We see patients all the time in the emergency department that are brought in for confusion or mental status change. So now let's talk about um let's talk about the risk factors. And and I also want to talk about what we can do and how you can actually protect yourself. But I think the risk factors are really um important as well. So when we look at uh the the risk factors, the single greatest risk factor is obviously age. Um but I want to talk about how this kind of works. The risk doubles every five years after the age of 65. So that's why you sort of see this, you know, by the time someone gets 85 or 90 years old, the the predominance of some sort of cognitive decline, uh, even mild, uh, dramatically increases. Now, one thing that we actually don't talk about a lot and which you don't hear a lot about, which is really, really important, is family history and genetics. And I really want to talk about this because dementia and specifically Alzheimer's, the Alzheimer type of dementia really, really runs in my family. So whenever I have a family reunion, I've I've often felt like it's like, you know, everyone who's elderly, not everyone, but it seems like almost everyone in the family is dealing with some sort of uh dementia. There is a gene associated with dementia, and this is really, really important. And it is apolipoprotein E. It is found on chromosome 19, and it is the strongest genetic risk factor for Alzheimer's. So, what this gene actually does is it actually makes a protein. It makes a protein called apolipoprotein E. So this protein actually acts like a delivery truck, right? And what it does is it brings cholesterol to your brain, and your brain actually needs cholesterol to function, and your brain does not have access to the cholesterol that is circulating in your blood. So there are different types of variants. So everybody has apolipoprotein E-gene. All of us have it. It's a matter of what sort of variant do you have. So variant four is the one that is most associated with uh Alzheimer's with Alzheimer's. And I'm gonna tell you a little bit about how it works because we all have two chromosomes. Remember, you have a X XX or your XY, and so you have two appolipoprotein genes. So the appolipoprotein gene variant four is the one that is has the highest risk of Alzheimer's. So if you have four and four, your risk is 50 to 90 percent that you will actually get Alzheimer's by the time you are 85 years old. If you have two and two, your risk is much less, like 30 percent. So this, you can actually get this test. So because I had uh dementia, so much so many people with dementia in my family, I actually got this test because I wanted to know. Um, and I was two and four, which is a 30% lifetime risk of dementia. So I think it's really, really important. There is, you know, rather than kind of hoping that you don't get this, you can actually get this test and actually determine what is your actual lifetime risk of Alzheimer's. The other things that are associated with risk factors for Alzheimer's is cardiovascular disease, high blood pressure, diabetes, obesity, a sedentary lifestyle, um, also head trauma, repeated concussions, chronic sleep deprivation, all of these things are actually increase your risk of uh of Alzheimer's disease. Social isolation, loneliness, depression, low education attainment, and hearing loss are all additional risk factors. So these are things you really want to actually consider when you look at all of your lifestyle and how you're and how you're living your life, because it really does make a difference. Alrighty. So to hear more about today's topic and other critical health issues, listen to my podcast. My podcast is called What the Health Is Happening, and you can find it on all streaming platforms. If you have missed any episode of this show, it will actually be on my podcast and it lives there forever. So you can actually go check it out. Maybe you don't need the topic now, maybe you need the topic later, but it has all the breaking news and life-changing medical updates and information that you actually need. Download, subscribe, comment, and share with family. All right, news you can use. So since we're talking about uh uh dementia and a component of dementia being Alzheimer's, I think what's really important is there were two recently approved new FDA treatments for Alzheimer's. Um there was one drug that was probably approved about maybe eight years ago. We've got two more drugs. We're starting to see real uh treatment options in the arena of uh Alzheimer's and cognitive decline. With these two drugs, what they do is they slow the progression of early Alzheimer's by targeting amyloid plaques in the brain. So again, they're not cures, but the goal is to actually slow the progression. Because if you slow the progression so that the person can still actually take care of themselves, I think that that really makes a difference in the type of care that people need long term. All right, so we're gonna get on to some questions here. Got some questions that came in uh by email, and I'm gonna actually go over uh go over those. There's one question that came in by email, and I want to really make sure I uh talk about this. So I'm gonna take this question first. And it says, Dr. V, what can people do right now, today, to protect their brain? So thank you for actually answering this qu asking this question because I'm gonna actually go over it. So there's a lot of things that people actually that you hear about, right? People say, oh, if you're right-handed, then use your left hand more to brush your teeth and do things. Okay, that does not make a difference on your brain health. So let me put that out there. That does not make you see ads on TV, previgin, no, that does not help either. Okay. So let me tell you about the things that actually really do help. All right, so one is social engagement and social contact. Decrease the likelihood of cognitive decline by 19%. So get together with your friends for lunch, go visit people, go to church, do your social activities. That is actually really, really important. The other thing that makes a difference is if you are experiencing hearing loss, make sure to get hearing loss treated. Make sure to actually, if you need a hearing aid or you need some sort of a supplement, or there's some people are even doing cock uh cochlear implants. Um, hearing loss being properly treated decreases the likelihood of cognitive impairment by 19%. The other thing that actually makes a difference is the Mediterranean or mind diet. So let me go over what the Mediterranean or mind diet is: fish, olive oil, berries, nuts, green leafy vegetables. What things you do not eat in the mind diet, red meat, sugary sweets, fried food. The other thing that actually makes a difference is actually learning a second language. You do not have to become fluent in the second language. You just have to start learning a couple words here and there. That actually really, really makes a difference. So download Duolingo or any other app where you can learn a couple words and start picking up a couple words a day in a different language. That really helps. The other thing that helps is getting good sleep, good quality sleep. So if you're having problems with your sleep, you want to go to your physician and see what he can give you to sort of help with that and what is causing that problem. Last thing is exercise. So aerobic activity, about 150 minutes a week. It doesn't matter if you walk, it doesn't matter if you do pool exercises, it really doesn't matter what you do, any type of aerobic activity. 150 minutes a week is roughly about 30 minutes a day with two days off. Uh so 30 minutes a day for five days a week uh really does uh make a difference. So I wanted to really answer that question first because people always want to know what what can you actually do? I get another question here, uh, and again, Dr. Crowder, what are the different types of dementia and why do they all seem to look the same? So they all seem to look the same because the destruction at the end of it is basically your brain cells. But with there are different types. So there is Alzheimer's, as I discussed. There's also what we call vascular dementia, which is where people have s mini strokes and they have multiple mini strokes that eventually kind of deteriorate their cognition and memory ability. There's also a thing called lu body dementia, and this is where there's a there's a protein in your uh nerve cells, it kind of folds the wrong way and it clumps and it eventually and it causes these things called lu body. You see this in Parkinson's, and then there's frontal temporal dementia where people actually get real personality changes and behavior changes, um, and it can strike people in very early in their uh 50s. Um, you also have things that cause uh dementia like head trauma, syphilis. There's a lot of different things that can actually cause dementia. So when we see a patient or when I see a patient in the emergency department, usually, you know, we start the initial evaluation by trying to get a very detailed history and seeing how long has this been going on, what has it been impacting, what is the family history. We sort of review their medication, we get labs, we get a CAT scan, and then we normally admit them to the uh uh hospital so that they can actually see a neurologist and get a formal workup for what we call mental status change or cognitive decline. You can also get this actually done as an outpatient. So usually we admit patients when um it's something sudden or it's gotten to the point where they're they're living alone and they're a danger to themselves. But if something is going on that's sort of mild and the patient, the person is actually safe in their home, then this is something that we actually do actually work up as an outpatient as well. There's a lot of important resources that I want to make sure that people actually know about. The Alzheimer's Association has a 24-7 helpline. It's 1-800-272-3900. Uh, their website is alz.org. There's also a National Institute of Aging that is by the NIH. Every community has an institute or an aging part of the public health department. There is an aging department inside your state government or local government. Um, that can also be very, very important if you want to try to get local uh local help. AARP has uh brain health resources uh on their website, and there is a Lou Body Dementia Association, and their website is lbda.org. The other thing that is really important is Caregiving. So there is a Caregiving Action Network, and their their uh their uh website is Caregive CaregiverAction.org. So this is not something that you actually have to struggle with by yourself. There are a lot of resources out there, and I tell people it is really, really important when you're dealing with this to actually get the help and the resources that you need. Because caring for folks with Alzheimer's can be very, very tricky. One of the things that is most important to recognize is when to take the car away, when to take the car keys away, when is that person a risk for walking off and possibly getting lost? It is really, really important. I know you've heard stories on the news where an elderly patient can't be found. There are dementia ward nursing homes, um, and these nursing homes actually specialize in people with dementia. They often will have electronic or locked entrances so that people can actually will not get out of the nursing home and will not uh get lost. So it's really, really important that we keep our loved ones safe as they actually go through this. It is very, very important. I'm gonna take one more question here. Um I think that this is really important. People have asked me what supplements actually make a difference. So I'm gonna actually go over this really, really quickly. So, one, omega-3 fatty acids, the other thing is B vitamins, and also aceticoline. Um, so those are supplements that really, really make a difference. Um, and so um I wouldn't waste your money on other things that you see because um they really don't make a difference. And it is important to get medical grade uh supplements, which I'm gonna actually do a show on supplements and talk about on another on another show. So, all right, I want to thank you guys for joining me today. We are committed to answering your most pressing health questions. Please send me an email or an audio message at info at askdrv.us. That's info at askdrv.us. You can follow me on YouTube, on Twitter, on Instagram, and remember, your brain is the most powerful organ in your body. It is never too early to start protecting it. If something feels off with your memory or thinking, please take it seriously and go see your physician. Early detection saves lives and it preserves your independence. We'll be back next week. Stay informed and empowered about your health.