Memory
loss may not always be the first warning sign that dementia is brewing — changes
in behavior or personality might be an early clue.
Researchers
on Sunday outlined a syndrome called "mild behavioral impairment"
that may be a harbinger of Alzheimer's or other dementias, and proposed a
checklist of symptoms to alert doctors and families.
Losing interest
in favorite activities? Getting unusually anxious, aggressive or suspicious?
Suddenly making crude comments in public?
"Historically
those symptoms have been written off as a psychiatric issue, or as just part of
aging," said Dr. Zahinoor Ismail of the University of Calgary, who
presented the checklist at the Alzheimer's Association International Conference
in Toronto.
Alzheimer's,
the most common form of dementia, affects more than 5 million people in the
U.S., a number growing as the population ages. It gradually strips people of
their memory and the ability to think and reason.
But it
creeps up, quietly ravaging the brain a decade or two before the first symptoms
become noticeable. Early memory problems called "mild cognitive impairment," or MCI, can raise the
risk of later developing dementia, and worsening memory often is the trigger
for potential patients or their loved ones to seek medical help.
It's not
uncommon for people with dementia to experience neuropsychiatric symptoms, too
— problems such as depression or "sundowning," agitation that occurs
at the end of the day — as the degeneration spreads into brain regions
responsible for more than memory. And previous studies have found that people
with mild cognitive impairment are at greater risk of decline if they also
suffer more subtle behavioral symptoms.
What's
new: The concept of pre-dementia "mild behavioral impairment," or
MBI, a term that describes specific changes in someone's prior behavior that
might signal degeneration is starting in brain regions not as crucial for
memory, he said.
Ismail is
part of an Alzheimer's Association committee tapped to draft a checklist of the
symptoms that qualify — new problems that linger at least six months, not
temporary symptoms or ones explained by a clear mental health diagnosis or
other issues such as bereavement, he stressed. They include apathy,
anxiety about once routine events, loss of impulse control, flaunting social
norms, loss of interest in food. He even cites extreme cases, like a
68-year-old who started using cocaine before anyone noticed her memory trouble.
If
validated, the checklist could help doctors better identify people at risk of
brewing Alzheimer's and study changes over time. "It's
important for us to recognize that not everything's forgetfulness," said
Dr. Ron Petersen, the Mayo Clinic's Alzheimer's research chief. He wasn't
involved in developing the behavior checklist but said it could raise awareness
of the neuropsychiatric link with dementia.
Technology
specialist Mike Belleville of Douglas, Massachusetts, thought stress was to
blame when he found himself getting easily frustrated and angry. Normally
patient, he began snapping at co-workers and rolling down his window to yell at
other drivers, "things I'd never done before," Belleville said. The
final red flag was a heated argument with his wife, Cheryl, who found herself
wondering, "Who is this person?" When Mike Belleville didn't remember
the strong words the next morning, the two headed straight for a doctor.
Physicians tested for depression and a list of other suspects. Eventually
Belleville, now 55, was diagnosed with an early-onset form of dementia — and with
medication no longer gets angry so easily, allowing him to volunteer his
computer expertise.
"If
you see changes, don't take it lightly and assume it's stress," Cheryl
Belleville advised.
— Complex
jobs that require working with people may help the brain build resilience
against dementia, what's called "cognitive reserve,"
University of Wisconsin researchers reported.
The team
tested 284 adults in late middle-age whose brain scans showed changes that have
been linked to an increased risk of Alzheimer's. Comparing their cognitive
ability and their careers, the researchers found those who worked
primarily with people, rather than objects or data, functioned better even if
brain scans showed more of that quiet damage.
—
Preliminary results from a study of "brain training" suggested one
type might help delay cognitive impairment.
Researchers
examined records from 2,785 older adults who'd participated in a previous trial
that compared three cognitive training strategies — to improve memory,
reasoning or reaction times —with no intervention. A decade later, that
reaction-time training suggested benefit: 12 percent of people who'd completed
up to 10 hours had evidence of cognitive decline or dementia compared with 14
percent in the control group, said Dr. Jerri Edwards of the University of South
Florida. The figure was lower — 8 percent — for people who got some extra
booster training.
"It's
the first hint for a cognitive training intervention like this," but more
research is needed, said Dr. Jonathan King of the National Institute on Aging,
who wasn't involved in the new study.
Article courtesy
of LAURAN NEERGAARD AP Medical Writer
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