Beth Brown (0:10): Welcome to a special edition of the Healthy Living for Life podcast Q&A with Dr. K, where we sit down with Dr. Doug Kuntzweiler and get your questions answered. Because on Q&A with Dr. K, the doctor is always in.
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Beth Brown (0:36): Hello, everyone, this is Beth Brown, your host, and hello to Dr. Kuntzweiler. So good to have you here, Dr. K. Let's get started with today's question from a patient, which today is about dementia. And we got this question via email. So bear with me, it's a little bit long. I'm gonna go ahead and read this email to you. How do you spot signs of dementia in yourself and when should you start to worry? My mother is in memory care. And every time I find myself doing something she used to do, I start to worry about myself. For example, I sometimes get too distracted to finish something I started. This morning, while weaving, I ran out of thread on my bobbin. I went to the other room to wind more thread on my bobbin, after which I saw my water bottle and started refilling it, which led me to cleaning pictures off my refrigerator. After taking some of the pictures upstairs to put away, I went back to my loom. But I couldn't weave, because I left the bobbin in the room where I wound it and went to get it saw my water bottle, finished filling it and went back to weaving again without my bobbin. This is just one example. Sometimes I can't remember why I went into a room, or I can't remember someone's name, the same sort of thing everyone around me seems to be doing or forgetting. But are we just aging? Or are we developing dementia? When should we start to worry? Because of watching my mother's decline? I'm not sure I put things into perspective. I'm not sure I've really changed at all.
Dr. Doug Kuntzweiler (1:59): I can't remember what the question was.
Beth Brown (2:02): Well, we'll talk about that. But I think it is tough there, because she's got someone that she's watching decline. And then she started to notice these things in herself. So let's start with her question about are we just aging? Or are we developing dementia? So what is normal forgetfulness?
Dr. Doug Kuntzweiler (2:21): That really is a good question. And if you have a family member who suffers from dementia, that does raise your risk a little bit and so it's very understandable that people are concerned. Yeah. And it's true that as we get older, we all have a little bit of trouble with memory. But it's usually you know, trying to remember oh, what's his name, you know, that guy who did that thing? Right? And that show that thing, that guy?
Beth Brown (2:51): I do that.
Dr. Doug Kuntzweiler (2:52): That's pretty normal, and getting distracted and forgetting what task you started on, that that's pretty normal. The things that are worrisome are if you're having trouble with simple everyday tasks, like you know, writing bills or doing laundry, you might notice in a in a family member that they are being very repetitious telling you, you know, the same story within an hour or two of themselves. That's, that's a little bit worrisome. Getting lost in a familiar environment. That's a common fairly early thing that happens in dementia, and that's pretty worrisome. Getting confused about time and place, you know, waking up--we all wake up sometimes and can't remember exactly what day it is. But if this was happening consistently, that's pretty worrisome. And then misplacing stuff. Like I'm constantly looking for my keys, or something. But if you do something like you know, you put the screwdriver in the refrigerator, that's a little more ominous, because it's outside of the ordinary. And dementia is really a deterioration of cells in the brain. And so our ability to function deteriorates. This is different than still knowing how to get up and dress yourself in the morning and night, you still know how to cook and you know where you live and that sort of thing. With dementia, all those really basic functions start to deteriorate. If it's happening in yourself, oftentimes people don't notice it. But I've had patients who did notice it and were able to kind of fool their family for a while because, they'd write themselves little notes and little reminders. And they're able to kind of compensate that way for a while. But, but I would say generally if you are worried about yourself, or if you are worried about a loved one, the best thing to do is go see a primary care doctor. Tell them your concerns, and they can do some testing and get you started on getting some relief anyway, from your worries.
Beth Brown (5:09): Yeah, that's great. Yeah, it's interesting. We don't want to admit it, when our mind starts to slip, that's a tough thing to come to terms with, for sure. And using the workarounds, like the post-it notes. Sometimes that feels easier, but all you're doing is putting off the help that you should be getting.
Dr. Doug Kuntzweiler (5:25): Yeah, really. Yeah. So if you're worried, go talk to somebody about it. That's my advice.
Beth Brown (5:35): You know, we've heard about those little games that people can play on their phones or their little tricks or learning a new language or learning an instrument. Do those work for the normal forgetfulness, and how much do they work for staving off dementia?
Dr. Doug Kuntzweiler (5:53): Those things have been studied. And, and they certainly don't do any harm. There's a lot of evidence that mind games, puzzles, that sort of thing, really don't help all that much. But we do know some things that do help. It turns out that exercise, when you exercise, you form new connections in your brain. And that helps to keep the brain functioning and help to keep it vital. So physical exercise is good for the brain. Who would have guessed that, but it is. And staying socially connected. People who become isolated are at much higher risk of dementia. So keeping up friendships, keeping up relations with your family, keeping involved somehow in your community by volunteering or you know, being on boards, that kind of thing. Anything that gets you moving around, talking to other people, helps to stave off dementia, and reading and learning a new language and you know, puzzles, all that sort of thing are fine. But really, physical exercise and social connection are much more potent, so don't neglect those.
Beth Brown (7:07): Okay, so let's talk about dementia a little bit, because it's an umbrella term, is that correct? So tell us what that means.
Dr. Doug Kuntzweiler (7:16): Oh, that means that it's a general term that covers a whole bunch of specific causes of brain deterioration. So the most common cause is Alzheimer's disease, and then Alzheimer's, there are some abnormal proteins that form in the brain, and they kind of gum up the works. And eventually they actually kill brain cells. And that accounts for about 60% of people with dementia in the United States. The next most common specific cause is called vascular dementia. And vascular dementia is little strokes in the brain that every time you have one it kills off a few brain cells. And over time, that becomes cumulative, and then the brain just doesn't function as well as it used to. Another one is called Lewy body dementia. And that counts for a few percent. And that's associated with Parkinson's. And again, there's an abnormal protein that forms in the brain. And then there's a whole scattering of, of others that are not as common. One that's been in the news, because of the actor Bruce Willis, frontotemporal lobe dementia. And that's not real common. But it's, it's pretty dramatic. It has a tendency to occur in younger people say, you know, age 50-60, whereas the dementia is usually come a little bit later in life. And frontotemporal dementia takes away your ability to speak, and sometimes your ability to understand speech, and it's often associated with personality changes, and usually not for the better. Usually, people get aggressive or they get mean, or they get hyper-sexualized, and it's a pretty devastating disease.
Beth Brown (9:11): So the symptoms there are different from other dementias? Or do a lot of the symptoms cross those different types?
Dr. Doug Kuntzweiler (9:18): They cross over, because as the brain function deteriorates, you're gonna see problems in those normal tasks that we talked about. But some of them do have like the frontotemporal dementia, that's a little bit different. That's not real common in other dementias.
Beth Brown (9:35): So let's go back to the patient who emailed us who talked about their mother being in memory care. And so that's what is causing this concern, because they're watching what their mother went through and now they're noticing things in themselves. Does having a parent who has dementia put you at higher risk for dementia?
Dr. Doug Kuntzweiler (9:55): It depends. There are a few dementias that are genetic. And in those there, there tends to be a pretty strong family history. But for the most part, they're not directly inherited. But if you do have a first degree relative, a sibling or a parent, maybe even a grandparent, who had dementia, then your risk is slightly raised. And you should, you know, that shouldn't scare you. But what it should do is encourage you to stay physically active and stay socially engaged, you know, throw away the cigarettes, eat a healthy diet, those kinds of things.
Beth Brown (10:33): Okay, so the opposite of those would be other risk factors. So smoking is a risk factor, being sedentary. Are there any other risk factors we should mention?
Dr. Doug Kuntzweiler (10:42): Well, chronic disease is associated with an increased risk of dementia, especially cardiovascular disease, which of course raises your risk for strokes. So you're a little bit higher risk of vascular dementia. Diabetes has been associated with a slightly higher risk of dementia, chronic lung disease, sedentary lifestyle, if you just are a slug, and you drive everywhere, and you never get out. And you know, you have a job where you sit in front of a desk.
Beth Brown (11:16): Yep, that's me.
Dr. Doug Kuntzweiler (11:20): That raises your risk a little bit. Alcohol excess, a little bit of alcohol, you know, like maybe one glass of wine a day is semi-protective, but drinking to excess raises your risk. Um, traumatic brain injuries, kids who are in contact sports and have repeated concussions, that raises your risk. And there's uh I think people know about the traumatic brain encephalopathy of football players from repeated severe concussions. That's another one of those types of dementia that falls under the umbrella. But head trauma is not a good thing for our brain.
Beth Brown (12:02): So when we notice something in ourselves, or we notice something in someone we love, you mentioned, talk to your primary care provider. And then what happens?
Dr. Doug Kuntzweiler (12:09): Well, they can do some simple testing to get started. And there are some other things that masquerade as dementia, for instance, depression, can look like dementia. It takes some questioning and, you know, some exploration to tease that out and figure out what's really going on. Sometimes a brain tumor could masquerade as dementia. Stroke can do that. So there are other causes, there are some things like vitamin B-12 deficiency, hypothyroidism, all those can kind of look like dementia. So that's one of the reasons to talk to your primary care so they can make sure there isn't some other cause. And then they can do imaging, and imaging is getting better and better at finding things like Alzheimer's disease. It's, it's not 100%, but we're getting better and better. There are some new blood tests on the horizon, that can detect these abnormal proteins that are in the brain, some of those leak into the bloodstream. And so there's some blood tests that can be helpful. But the main thing is testing your neurologic and your cognitive function. And there are a variety of tests that they can do to look at that. And you could say, you know, because there's no treatment, what's the point in doing this, but if you know ahead of time, then the family can plan. And that can be just invaluable.
Beth Brown (13:44): Yeah. I should tell folks, if you can hear that alarm, they're testing or weirdness is happening. We aren't in any danger. We're not being irresponsible by sitting here. Okay. So it might be easier, unless you are trying to avoid it, to notice these in your notice these kinds of symptoms are things in yourself, what do you do if you notice it in someone you love, because I've experienced, you know, people kind of say things behind that person's back like, Whoa, that wasn't good they just repeated themselves three times in that conversation. But then don't really say anything, because that's a tough conversation to bring up. So any advice there?
Dr. Doug Kuntzweiler (14:22): It is. My habit has always been to stick to the truth. The conversation will never be as difficult as you imagine it's going to be, that's been my experience. I think you have to tell people that you're concerned about them, and that you would really like them to go see their primary caregiver. You know, and you tell them, if everything's fine, everything's fine, but I'm concerned about some of these things that we've been seeing. And when I've had families come to me and ask me to talk to their loved one. most the time the loved one was worried, too. And, and we're concerned about, you know, not being as sharp as they used to be. So I know it's daunting, but you just have to screw up your courage come from a position of love and, and confront them and say, I'm really worried. And I'd like you to go see somebody.
Beth Brown: Yeah, that's good advice. If they know we care, and that's why we're saying something.
Dr. Doug Kuntzweiler (15:18): Yeah, it's always worse imagining things in your mind, you know that it's gonna be horrible, and they're gonna never speak to you again, and that sort of thing. But my experience is that that that really rarely happens.
Beth Brown (15:30): Okay, great. All right, so we end the episode with where can we get more information? So where can folks look up stuff about dementia or the differences between dementia and just some of that normal forgetfulness that we start to experience?
Dr. Doug Kuntzweiler (15:44): Well, there's an American Alzheimer's Association, and they have chapters in every state. I think in Montana, it's in Billings, which you can look them up on the Internet. And that's a pretty good source. And they can put you in touch with people who specialize in treating dementias. They can put you in touch with respite services and help you with planning and that's where I would start.
Beth Brown (16:12): Okay, perfect. And we'll make sure that we add that with this episode, so folks can check out that link. That's it. Unless there's anything else you wanted to add.
Dr. Doug Kuntzweiler (16:21): There's nothing else I can remember.
Beth Brown (16:23): Right, fair enough. Well, then we'll wrap this episode. Thank you, Dr. K. And thanks to everyone for listening. If you have a question for Dr. Kuntzweiler, please email us at QandAwithDrK@mpqhf.org. Send us your questions. The doctor is always in, and that email address will be with this episode as well.