It’s Dementia? Now What?

You’re out in the doctor’s office lobby hall with your sister, brother and your mother who Dr. Jones just diagnosed as having Alzheimer’s disease. True, you all suspected this as Mom has been getting worse with her memory and other symptoms for years, but no one, even Dr. Jones seemed ready or willing to make the call. She got a lot worse last year after Dad died following a long illness. 

You or your sibs visit her almost daily to help, but she has been having more and more trouble keeping her meds straight and taking care of the house. Since her doctor didn’t offer any treatment or referrals, you, Mom and your sibs hug right there in the hall softly sobbing while thinking about the road ahead for all of you, especially since Mom is only 66 years old, the same age that her older sister was diagnosed. Should you be worried about your own dementia risk?

This scenario plays out all too often leaving persons living with dementia, their care partners and family wondering about their next steps and about their own risk of developing dementia.  Newer and much more hopeful and science-based dementia research messages haven’t reached most mainstream medical practices yet outside of our internationally acclaimed research centers like UCLA and Cornell.  Here, and in other countries especially United Kingdom, the latest research has clinicians like UCLA’s Dr. Dale Bredeson talking about their positive clinical results where they have halted or even reversed dementia symptoms in hundreds of patients with Alzheimer’s type dementia.  It may be the fact that their treatment protocol involves using multiple non-pharmacologic modalities and lifestyle adjustments instead of just drugs that explains why American medicine has not yet welcomed and adopted this multimodal treatment into daily clinical practice. Most American patients with dementia or its precursors subjective and mild cognitive impairment have never actually been formally diagnosed as yet, and those who are diagnosed have had much less than a full evaluation, risk factor assessment, family history or any discussion about genetic testing.

Minimize Your Risk

Whether we have a family history of dementia or not, there’s a lot we can do to minimize our risk for dementia, delay its onset, minimize its impact or just maybe prevent it altogether.  Start now, even if you have no dementia symptoms by checking how many risk factors you have. Some of these we cannot change like age over 65 years old, positive early family history of dementia, and pollution exposure among others.  Other risk factors that we can control offer us an opportunity to improve our odds once we realize these risks and make lifestyle adjustments or receive treatment– but certainly offer no guarantee.

Social isolation and depression that often goes with it can both increase risk. Hearing loss can worsen social isolation so preventing or treating it is important.

Smoking and the cardiovascular disease that it contributes to are each important risk factors if not adequately addressed.

Higher levels of education even self-education of any kind are protective, so we should continually challenge our brains to learn new and different information, play and learn music or a new language and engage our brains with new, challenging activities.

Exercise done regularly and moderately can actually increase the size of our hippocampus – the part of the brain that does memory functions, so sedentary lifestyle is a dementia risk factor. Obesity on the other hand can literally shrink the same parts of our brain and is an increasingly common risk factor.

Our Western World diet, high in sugar, refined grains and multiple sweeteners while low in fiber and a variety of nutrients is a major dementia risk factor. Dementia has been called Type 3 diabetes since the insulin resistance of diabetes or pre-diabetes is almost universally present in those eating high sugar, high calorie diets daily even years before they are actually diagnosed with diabetes. Almost all Alzheimer’s diseased brains examined after death show evidence of insulin resistance if an autopsy is done. Insulin resistance whether from poorly controlled diabetes or just poor diet and health habits is a major dementia risk factor. Weight loss, a low carbohydrate diet and regular balanced exercise is the best strategy for handling this risk factor, but check with your medical provider on how to do this safely especially if you are already diabetic or have multiple other medical problems.

Certain medications, especially antacids and some diabetes meds can cause poor vitamin absorption even if your diet contains reasonable amounts. Low blood levels of B vitamins, other vitamins and the mineral zinc can cause or contribute to dementia symptoms. This could result from medication side effects, poor absorption or just nutritional deficiency. If you develop low hormone levels, this can cause or contribute to dementia symptoms especially with thyroid, cortisone and sex hormones. Poor oxygen to the brain from undertreated lung disease, smoking, untreated sleep apnea, living at altitude, hypoventilation or any other low-oxygen condition can contribute to dementia symptoms. Certain medications can have side effects that mimic dementia, so this type of problem should be considered at your dementia evaluation visit.

As our American medical system catches up with the latest dementia research we can look forward to a more complete, kinder, more optimistic model of dementia care and management.  We will learn how to collaborate better with our several community dementia services providers and be sure to make timely referrals for their help. And yes, there is a lot we can do about it right now, today.

About Patrick J. Zook, MD

Born in Cleveland, Patrick Zook earned a BS Degree from John Carrol University and graduated from Creighton University School of Medicine, Omaha, NE, in 1974, and is in the Alpha Omega Alpha honor society. He completed a Family Medicine Internship/Residency at Creighton University Family Practice, 1974-1977.

He practiced as a family physician at the St. Cloud Medical Group for 40 years until retirement in November of 2017. He was on the Medical Staff at St. Cloud Hospital serving as Chief of Staff during 1999, Family Medicine Department Chair, and served on Executive Committees, and the Board of Directors.

He is the current President of Stearns Benton Medical Society, he served on the Minnesota Medical Association Board of Directors for 9 years, and other various committees of the Minnesota Medical Association; he currently volunteers with the Salvation Army Clinic.

Dr. Zook’s special medical interests include dementia, sports medicine, functional medicine, and dermatology. He has been married 47 years to Penny, has 3 children and enjoys playing with his four grandchildren. He remains active by lifting weights, shooting baskets, playing pickle ball, kayaking, and walking.

“We have been working with Central MN Council on Aging and 80+ dementia professionals and interested community volunteers on our latest Stearns Benton Medical Society’s public health campaign with a mission to improve access to quality dementia care in our community. Our vision includes development of a community Dementia Resource Center that would collaborate with community physicians and other providers to enhance dementia care for patients, their care partners and families. We have met many times over three years taking steps toward achieving our goals. Our Medical Society non-profit arm is the Central Minnesota Circle of Health which has so far operated the campaign. However, we are now ramping up with a new community cooperative action network model starting with building an effective Board to operate as a peer-to-peer community action network.”