No one likes to talk about dementia. It encompasses disturbing images of the loss of control, the loss of self and, of course, the frightening endgame of fatality. But patients need to be encouraged to discuss dementia, and primary care physicians (PCPs) play a special role in normalizing that conversation. PCPs also have the opportunity to educate patients about the benefits of awareness and lifestyle changes.
Patients can experience extreme fear and stress when confronted with the topic of cognitive decline, especially if they’ve experienced its progression in a family member or friend. Unfortunately, misunderstandings and myths about the vast family of cognitive conditions abound, so PCPs need to be well-versed in how to respond.
The good news: Greater understanding and social acceptance has brought the topic of dementia to the fore in recent years, says Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association. “It’s getting easier to have these conversations.”
PCPs are the front lines in detecting and documenting cognitive decline. Even if patients are referred to a neurology specialist, it’s still important for the PCP to follow up with regular screenings every 6-12 months and speak to family members about the importance of ongoing observational notes in partnership with regular office visits.
Here are six myths about cognitive decline:
All cognitive decline is Alzheimer’s disease.
Although Alzheimer’s is by far the most common form of cognitive decline, it’s just one type. Most patients have little or no comprehension of the 100-plus other types of cognitive decline, including conditions caused by vitamin deficiency, excessive alcohol use, thyroid problems and head injuries, according to the National Institutes of Health. Other conditions also can cause symptoms that mimic dementia, such as adverse drug reactions and urinary tract infections.
You have to be “really old” to have dementia.
Not so. Alzheimer’s-related dementia usually strikes patients aged 65 and older but several other types, including early-onset, can strike patients in their 40s or even earlier and is therefore often misdiagnosed, notes the Mayo Clinic. PCPs should never ignore patient-reported symptoms of memory loss or decision-making problems regardless of age, since any form of cognitive problem needs to be explored.
Memory loss or gaps in time are a normal part of aging.
This is a tough one for clinicians to explain, because while simple forgetfulness can be a normal attribute of aging, forgetting other things are not. One of the most patient-friendly explanations comes from Nicole Absar, MD, neuropsychiatrist and behavioral neurologist at Integrace Copper Ridge Neurocognitive Clinic, who spoke on neurocognitive disorders at the Spring 2017 Memory Care Forum in Philadelphia. “If I forget where I put my car keys, that could be normal forgetfulness. But if I forget what my keys are for, that could be dementia,” she said during her presentation.