How do you know who has dementia?
- Dr. Nati Blum
- Published in Walla Health
- No comments
Forgot his son's name and said "I don't remember" 1,778 times: Is there clinical reason for concern? (I.e. A mistake in the son's name and repeated statements of "I don't remember" have sparked a wave of speculation about the Prime Minister's cognitive state. When is there really reason to suspect dementia - and how is it diagnosed?
Recently, a minor scandal erupted when Prime Minister Benjamin Netanyahu got his son's name wrong during a public speech, calling him "Avraham" instead of "Avner." Naturally, such an incident immediately raises questions, and especially at the prime minister's age (75), the question arises as to whether such forgetfulness could indicate the onset of dementia.
In addition, yesterday it was announced after Netanyahu's cross-examination in his trial that he said the phrase "I don't remember" no less than 1,778 times during his interrogation.
As CEO of EMDA, the Israeli association for dementia, Alzheimer's and similar diseases in Israel, it is important for me to clarify: momentary forgetting, even of a significant detail such as the name of a close family member, is not necessarily a sign of dementia.
We all experience occasional “blackouts” or momentary forgetfulness. There are many different reasons for this: mental stress, accumulated fatigue, lack of sleep, multitasking, side effects of certain medications, nutritional deficiencies (such as vitamin B12), thyroid problems, and even emotional conditions such as depression or anxiety. Therefore, it is important to emphasize that dementia is only one of the possibilities in cases of forgetfulness, and is usually not the first that comes to mind in isolated, isolated incidents, even if they are embarrassing.
When should you be suspicious and how do you test?
Dementia is suspected when forgetfulness and other cognitive difficulties become a recurring pattern, affect daily functioning, and constitute a significant change from a person's previous abilities. If you or someone around you notice a persistent decline in memory (especially short-term), difficulty finding words, difficulty orienting yourself to time and place (even in familiar surroundings), decreased judgment and decision-making ability, changes in personality or mood (such as apathy, irritability, or excessive suspiciousness), and difficulty performing complex tasks that were previously easily performed – these are "red flags" that warrant investigation.
The first address to contact is the family doctor. The family doctor knows the patient's medical history and can perform an initial assessment. He or she can also refer for further investigation to specialists: a geriatrician (an expert in geriatric medicine), a neurologist, or a psychiatrist specializing in psychogeriatrics.
Stages of the diagnostic process
- Comprehensive clinical interview: A conversation with the patient and a relative (spouse, child) who knows the patient well. The relative can provide vital information about changes in behavior and functioning that the patient himself may not be aware of or deny.
- Cognitive tests: A series of short tests (such as the Mini-Mental Arousal Test or MoCA) or more comprehensive neuropsychological tests, to assess various mental functions such as memory, attention, language, spatial perception, and executive abilities.
- Blood tests: To rule out reversible causes of cognitive decline, such as vitamin B12 deficiency, thyroid problems, infections, and more.
- Brain imaging (sometimes): CT or MRI of the brain can help rule out other causes of cognitive decline (such as a tumor or stroke) and sometimes indicate structural changes characteristic of certain types of dementia (such as cerebral atrophy in Alzheimer's).
Gatekeepers: Questions Every Family Doctor Should Ask
Family physicians are in a critical position for early detection of dementia. As part of routine follow-up of older patients, or when suspicion arises, there are key questions to ask (of the patient and/or their caregivers):
- Do you (or those around you) notice significant difficulty remembering recent events or scheduled appointments?
- Is there difficulty finding words that were previously common, or is there inappropriate use of words?
• Have there been changes in mood, character, or the degree of initiative and interest in activities? - Is there difficulty managing daily matters such as finances, taking medication on time, or navigating familiar surroundings?
- Is there difficulty planning or carrying out complex tasks (e.g., cooking a complete meal)?
Positive answers to several such questions should set off a red light and lead to further investigation.
Israel: Approximately 160,000 people with dementia
According to estimates, there are currently about 160,000 people living with dementia in Israel, and this number is expected to increase as the population ages.
There are different types of dementia, with Alzheimer's disease being the most common, accounting for about 60%-70% of all cases. Other common types include vascular dementia (caused by damage to the blood vessels in the brain), Lewy body dementia (which also involves Parkinson's-like symptoms and hallucinations), and frontotemporal dementia (which mainly affects the frontal and lateral lobes of the brain and is more pronounced in behavioral and personality changes in the early stages).
As for the prevalence at the Prime Minister's age: At age 75, scientific estimates indicate that approximately 10% to 15% of men may be diagnosed with some form of dementia (including Alzheimer's). It is important to emphasize that the prevalence of dementia increases significantly with age, roughly doubling every five years after age 65.
In conclusionNot all forgetfulness is dementia. We all forget from time to time, and that is natural. But if you or your loved ones are experiencing ongoing cognitive decline that is affecting functioning, it is important not to ignore it. You can contact your family doctor and ask for a referral for further investigation with a specialist in the field. Early identification allows for the adaptation of supportive care, planning for the future, and improving the quality of life of the person and their family.
The writer is a CEO EMDA Association and holds a Doctorate (Ph.D.) in Social Work from Tel Aviv University. For free advice, information and telephone support, contact the EMDA hotline – the Israeli Association for Dementia, Alzheimer’s and Similar Diseases, at 8889*