Before the symptoms of dementia are recognized, it is often too late for treatment to delay progression.
In recognition of Alzheimer's & Brain Awareness Month, Walker Baptist Medical Center neurologist Dr. Paola Tumminello spoke with the Daily Mountain Eagle to discuss dementia and its many forms.
"Dementia is the generic term. Alzheimer's is a form of dementia," Tumminello said. "There are multiple forms of dementia. Alzheimer's is one, Lewy body dementia, frontotemporal dementia, Parkinson's dementia, alcoholic dementia — there are many different kinds of dementia."
Dementia is a group of conditions that result in memory loss and impact daily functioning.
According to the Alzheimer's Association, more than 5 million Americans are living with Alzheimer's and one in three seniors die from Alzheimer's or another form of dementia.
In addition, Alzheimer's is the sixth-leading cause of death in the United States, killing more people than breast and prostate cancer combined. Deaths from Alzheimer's disease increased 146 percent from 2000 to 2018.
Tumminello describes the early warning signs of dementia as "very subtle" and often missed.
She said forgetting to pay bills, misplacing items, and having difficulty with activities of daily living are usually evident in people suffering from a type of dementia.
"Usually if the patient is married or in a relationship with somebody, the spouse or the significant other will compensate. Those are the cases where the early signs are missed," Tumminello said. "We all have memory problems when we get older. That's normal. The transition between just being senile and being demented is gradual and difficult to pick up without specific testing."
She added, "Most of the time, I don't see early cases. I see advanced cases that have been compensated by the family for the longest time."
Imaging scans can be used to show structural changes in the brain, which could indicate vascular dementia, Tumminello said, while imaging can also reveal brain shrinking that is indicative of Alzheimer's.
However, more in-depth testing is usually required to diagnose specific forms of dementia.
"Most of the time, the brain looks fine, and there's not a specific pattern of shrinking of the brain," Tumminello said.
Patients exhibiting symptoms of dementia are typically screened by a neurologist and undergo cognitive testing to make a definitive diagnosis. For example, patients can be observed on their ability to tell time or recognize their own medications in cognitive testing.
"This testing takes time. It's going to take us months to get there," Tumminello said. "There is not an overnight diagnosis."
Once a diagnosis has been reached, medications can be used to treat symptoms and slow progression, but there is no cure for dementia.
Tumminello said dementia often becomes evident to family members when a person suffers a traumatic health event.
"All of a sudden the patient goes from the security of their house where they have been all along to a new place, like the hospital, and we start to see the symptoms," she said. "All of a sudden what was already there becomes visible even more."
She said patients already experiencing signs of dementia may also present with delirium during illness.
"Delirium is usually on top of something, and what it's on top of is dementia," Tumminello said. "Delirium can be the way dementia shows itself up to people who maybe have not noticed it before."
During the COVID-19 pandemic, many seniors in nursing homes and other senior care facilities have not been able to see their family members as a precautionary measure to prevent the spread of the disease. Such separation has been particularly difficult for dementia patients.
"Already they have been taken out of their environment where they feel safe — their home. The nursing home for a dementia patient is difficult. It's extremely difficult," Tumminello said. "Even if they have routine, it's still difficult with people coming and going — lots of confusion. Now the family all of a sudden cannot come around. That's terrifying."
She said even though seniors with dementia can talk to their loved ones and friends over the phone, dementia patients need visual cues to limit confusion.
"Imagine talking with a family member over the phone without being able to see them," Tumminello said. "They don't remember their name. They may not recognize their voice. They might become scared of who the voice is over the phone because they cannot put the face with the voice."
Tumminello said she hopes family members who suspect that their loved one has dementia will seek testing to confirm a diagnosis.
"It's better to have the patient checked than to continue to make excuses, because if there is a chance that we can slow it down and buy that person a couple of years of functioning, why should we deny that?" Tumminello questioned. "Even if the patient says, 'I'm fine. You're crazy. You're not taking me to the doctor,' let's figure out a way to do it because it's important for them."
She said testing for dementia can sometimes create family quarrels; however, she urges families to do anything they can to buy their loved one more time.
"I've seen the fights. Those are the things we should avoid," Tumminello said.
For resources on dementia and Alzheimer's, visit https://www.alz.org/.