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2024 Letterhead Articles (9 x 11_edited.


Facts You Need to Know

By: Dr. Diana Collins

It is not unusual to have occasional trouble finding the correct word or remembering where you put things. But persistent difficulty with memory and carrying out everyday tasks might be signs of something more serious.

Dementia is a general term used to describe more severe impairments in memory, thinking, problem solving, and decision making that interfere with daily life. It can diminish focus, attention, and visual perception. Dementia can also make it difficult for a person to control his or her emotions and can lead to personality changes.

Alzheimer’s disease is the most common type of dementia, with more than 6 million people living with this condition in the United States, according to the Alzheimer’s Association. It is caused by the buildup of beta-amyloid plaques in the brain. While Alzheimer’s is the most common type of dementia for people over 65, there are many types, including Lewy body dementia, vascular dementia, and early onset dementia. Lewy body dementia is the result of microscopic deposits of protein in the brain, whereas vascular dementia is a type of dementia caused by a major stroke or more “silent” strokes often precipitated by high blood pressure. Knowing what type of dementia an individual has can determine the appropriate treatment.

If someone is manifesting signs of dementia, it is important to see a medical expert who can appropriately perform tests and come up with a diagnosis. Dementia is not just a normal part of aging.  It is caused by damage to brain cells that affects their ability to communicate, which impacts thinking, behavior, and feelings. While most types of dementia are not curable, there are several often treatable conditions such as vitamin D deficiency that can cause dementia-like symptoms that are indeed treatable. Identifying what is causing dementia can lead to developing a care and management treatment plan. Here are 10 warning signs of dementia:

Difficulty with Everyday Tasks  
People with dementia may find it increasingly difficult to do things like keep track of monthly bills or follow a recipe while cooking when these activities were not an issue in the past. They may find it hard to concentrate on tasks, take longer to do them, or have trouble finishing them.

Asking a question over and over or telling the same story about a recent event over and over are common signs of mild cognitive impairment seen in dementia or specifically Alzheimer’s.

Communication Problems
Signs of dementia may involve having trouble joining in on conversations or following along with them, in addition to stopping abruptly in the middle of a thought or, struggling with finding names of objects or certain words.

Getting Lost
Individuals with dementia have trouble with visual and spatial abilities. This can manifest itself in getting lost while driving.

Personality Changes
A loved one who begins acting confused, anxious, fearful, or suspicious, or becomes easily agitated and seems depressed is a cause for evaluation of dementia.

Confusion about Time and Place
If someone forgets where they are or can’t remember how they arrived there, these are other warning signs. Signs of disorientation about time and place are red flags.

Misplacing Things
Individuals with dementia may place items in unusual places and be unable to find things.

Troubling or Disturbing Behavior
If your loved one tends to have increasingly poor judgement handling affairs such as money or becomes increasingly unkempt and neglects personal hygiene, pay close attention.

Apathy or Loss of Interest
Another warning sign of dementia is becoming less social or withdrawn, but a sudden loss of interest in family, friends, work, or social events can signal a red flag for dementia.

Memory Loss
Memory impairment is one of the first signs of dementia. 

If your loved one or family member is displaying concerning symptoms, a visit to a primary care physician (such as a family physician or internist) is often the first step. To get a definitive diagnosis, however, you will need to see a specialist such as a neurologist, geriatrician, or geriatric psychiatrist.

If you have difficulty finding a specialist, the National Institute on Aging recommends contacting the neurology department of a nearby medical school. Many medical schools have special clinics on dementia and other neurological disorders.

A specialist will need to know the patient’s full medical history, along with personal risk factors such as high blood pressure, smoking, alcohol use, diabetes, and hearing impairment. Some of these risk factors can be modified and alter the further risk of dementia. They will also want to do a full neurological and medical exam.

Medical Workup for Dementia
Cognitive and neuropsychological tests will evaluate language, math skills, memory, problem solving and other types of mental functioning.

Blood tests are relatively new when it comes to diagnosing dementia and may be of limited clinical use. However, one of the tests may be to measure beta-amyloid levels, which can be a sign of Alzheimer’s disease.  

Brain scans such as CT, MRI, or PET imaging can locate changes in brain structure and function. These tests can also locate strokes, tumors, or other neurological problems that could cause dementia. A physician may use imaging technologies to help identify whether an individual has high levels of beta-amyloid, a hallmark of Alzheimer’s.

Psychiatric evaluation can determine if a mental health condition, such as depression, is causing or exacerbating symptoms of dementia. 

Genetic tests may be helpful, especially if someone is manifesting dementia before the age of 60.  Autosomal Dominant Alzheimer’s disease (ADAD) or “familial Alzheimer’s disease,” which is a rare form of Alzheimer’s, makes up one percent of cases and is strongly linked to a person’s genes. Another gene blood test is for APOE-e4, a risk gene for Alzheimer’s, but it is still controversial and should be undertaken only after discussion with a physician or genetic counselor.

Cerebrospinal fluid (CSF) (a clear fluid that bathes and cushions the brain and spinal cord) tests are currently used to measure several markers such as tau and beta-amyloid. These markers form abnormal brain deposits linked to Alzheimer’s. Another potential marker is neurofilament light (NFL), which also has been associated with neurodegenerative diseases like Alzheimer’s.  
The treatment for dementia will be based on its cause. It will focus on slowing the progression of the disease and improving one’s quality of life. It will not be a cure.  Although no current medications stop or reverse dementia, some can temporarily help with memory and thinking. One or more of the following medications and/or therapies may be prescribed:

Cholinesterase Inhibitors  
These medications work for dementia by boosting levels of a chemical messenger involved in memory and judgement.  They include donepezil (Aricept), rivastigmine (Excelon), and galantamine (Razadyne ER).

Memantine (Namenda) 
This works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions such as learning and memory. Memantine is sometimes prescribed with a cholinesterase inhibitor.

Aducanumab (Aduhelm) and Lecanemab (Leqembi)
These newer treatments have been shown to remove beta-amyloid from the brain and thereby reduce brain cognitive and functional decline in people living with early Alzheimer’s.


Occupational Therapy 
Occupational therapy can assist a person with dementia, make their home safer, and teach coping behaviors. The therapy can also help manage behavior and prepare you and your loved one for when dementia progresses to further stages.

Changing One’s Environment 
Changing one’s environment can help reduce clutter and noise to make it easier for someone with dementia to focus and function. Monitoring systems can alert families of concerning behavior, such as wandering.

Simplifying Tasks 
Breaking down steps and focusing on success, rather than failure, can be helpful.  Developing structure and routine will help reduce confusion for individuals with dementia.

Support and treatment for dementia should be sensitive to the person as an individual. This person-centered care should focus on their well-being and meeting their individual needs. It is important to include friends and family, as well as caregivers, in a comprehensive care plan that strives to improve the quality of life of your loved one through the various stages of dementia.

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Dr. Diana Collins earned her medical degree at the University of Texas Health Science Center in 1992, finished her residency in General Psychiatry in 1995, and completed a Fellowship in Child and Adolescent Psychiatry in 1997. She’s been in practice since 1997 and has had her own office in Sugar Land since 1999. Dr. Collins was voted The Most Outstanding Psychiatrist in 2018 and 2019, received the Reader’s Choice Award of Fort Bend County from Living Magazine, was a KnowAutism Ambassador in 2019, was named a CKW LUXE 2020 Top 20 Inspiring Woman Impact Maker, and received the 2021 Ken DeMerchant award for service in Fort Bend County.

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