Language Fluency May Ward Off Dementia

By Michael Smith, North American Correspodent, MedPage Today

The ability to learn and speak two languages in addition to one's native tongue appears to keep the brain in shape, protecting it from dementia.

 

Wed. Feb. 23, 2011 — Speak English? Parlez français? Habla espanol?

Those who can say yes, oui, or si to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Dr. Magali Perquin, of the Public Research Center for Health in Luxembourg, and colleagues. 

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Moreover, the effect appears to add up — more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

“It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study,” Perquin said in a statement.

The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called “cognitive reserve” — developed by intellectual activities — protects against dementia.

Indeed, a similar study from a Canadian group, presented at the annual meeting of the American Association for the Advancement of Science this month, showed that having two languages rather than one appeared to delay the onset of dementia.

The “use it or lose it model of cognitive function” has been gaining popularity for several years, according to Richard Lipton, MD, of Albert Einstein College of Medicine in New York City. With colleagues, Lipton showed in 2003 that such activities as chess, bridge and doing crossword puzzles appeared to protect against Alzheimer’s disease.

In that context, Perquin’s findings “are not surprising to me,” Lipton told MedPage Today.

But he cautioned that there are at least two other possible explanations for such data, including his own findings.

On one hand, he said, it’s possible that the intellectual activities themselves are not protective, but that being the sort of person who does crossword puzzles or learns several languages is the key factor.

On the other hand, he said, it may be that the causality is reversed — that incipient cognitive impairment impairs the ability to perform such activities.

But the study is “fascinating,” he added, and “as an optimist, I would like to believe it is completely true.” 

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Which Conditions Are Related to Dementia?

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The so-called MémoVie study in Luxembourg is a longitudinal analysis of cognition and its risk factors in the elderly and one of the aspects of the study is the effect of multilingualism.

Luxembourg, a small country in the heart of western Europe, has three official languages and a large number of people who speak several tongues.

For the analysis, participants in the MémoVie study were classified as having normal cognition, some cognitive impairment, or frank dementia, with the latter being excluded.

All told, 44 participants had cognitive impairment and the remaining 186 were cognitively normal, the researchers reported.

Participants had spoken — or currently spoke — two through seven languages; those with only two languages were considered the reference group for a multivariate analysis that adjusted for age and years of education, Perquin and colleagues reported.

Analysis showed that, compared with bilinguals:

• Participants who had spoken three languages were four times more likely to be protected against cognitive impairment.
• Those with four or more languages were even better off — they were six times less likely to develop dementia than those who mastered only their native tongue.

Perquin noted that more research is needed to confirm the findings and to see if protection is limited to thinking skills related to language “or if it also extends beyond that and benefits other areas of cognition.”

Normal Memory Loss or Dementia?

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH 

Lost your keys? Don't stress — a memory glitch here and there often accompanies aging. Lost your way home? This could be signaling something more serious.

 

Is it just age-related memory loss — or the early signs of Alzheimer’s disease? Sooner or later, you will ask this about yourself, your spouse, or someone else in your family. But the question of whether you are noticing dementia signs is not an easy one to answer.

A certain degree of forgetfulness may accompany aging. Normal memory loss most often means that you have a harder time recalling new pieces of information, such as the name of a person you met for the first time last week.

“Typical signs [of dementia] are extreme forgetfulness, not just forgetting the keys here and there. Rather, forgetting where one is, whether or not one just ate, forgetting to put shoes on before going outside, and that sort of thing,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa.

So if you go for your daily walk and experience a little confusion about how to get home, should you worry? Many experts, like Andel, think it’s a good idea to err on the side of caution and get in touch with your doctor if you have moments of forgetfulness that worry you.

“The difference can be very subtle, and any suspicion should be consulted and/or confirmed by a professional, such as those working at memory clinics of Alzheimer’s disease centers,” he says. The advantage to working with an expert, such as a neurologist, is that an expert can give you memory tests that help determine whether your experience with memory loss is normal or not.

 

Dementia Signs that Indicate a Problem

Consider these red flags of memory loss and cognitive problems:

• Does it interfere with daily life? Everyone forgets a name, only to remember later — but if you’re consistently forgetting appointments, can’t remember how to cook foods you’ve always been able to cook, or people tell you you’ve asked them for the same information multiple times, those are more serious signs.
• Do you have trouble thinking things through? We’ve all made a mess of our accounting once or twice, but if you just can’t figure out how to balance your checkbook or plan the kind of trip you used to enjoy, it may be time to seek help. In fact, a recent study suggests that problems remembering how to handle money foreshadows an Alzheimer’s diagnosis by up to a year.
• Are you having trouble retracing your steps? Everyone misplaces their keys, but most people usually can go back over their steps to find them again. Dementia signs include an inability to retrace your steps to find lost items.
• Are you at a loss for words? We all know about the tip-of-the-tongue phenomenon, when a word you want is just out of reach. But frequently being unable to come up with the word or phrase you want can be a sign of Alzheimer’s disease.
• Do you lose your sense of place and time? Forgetting where you are, how you got there, the order of events, or even what day it is — these are all more than just “normal” signs of memory loss.

 

Other Causes of Forgetfulness

It’s natural to worry about dementia and Alzheimer’s disease as causes of your more-than-normal forgetfulness, but you should know there are some other possible causes, including:

• Alcoholism
• Dehydration
• Depression
• Head injury
• Medication side effects
• Protein deficiency
• Stroke(s)
• Vitamin B12 deficiency

When you talk to your doctor about your concerns about memory loss and the risk of Alzheimer’s disease, she should also ask questions that will help her find out whether there may be other causes of your problems.

“True dementia cannot be reversed whereas cognitive impairment due to other causes can be reversed" in many circumstances, says Andel.

So if you’re worried, talk to your doctor. At best, you will be reassured that your occasional forgetfulness is normal for your age — and at worse, you will be able to start early with dementia treatment and management strategies.

The Enigma of Early-Onset Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH

The risk of being diagnosed with dementia increases with age — but for a small group of people, dementia symptoms start appearing as young as 35. 

 

Dementia is usually thought of as a health concern of the elderly — but for a few patients, a dementia diagnosis comes earlier. This loss of memory and cognitive abilities at a younger age is called early-onset dementia. Diagnosis of early dementia is a challenge, and dementia treatment is complicated by the demands of younger families and jobs.

“The majority of cases of dementia in the United States are in people over 65, and 50 percent are in people over 85 years old but … we’ve seen patients who have the disease at 35,” says Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago.

As many as 6 percent of Alzheimer’s disease cases occur before age 65, usually in a person’s forties or fifties. Close to 60 percent of those cases are inherited — 13 percent appear in families in which three generations have developed Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia symptoms, but other causes of early-onset dementia include:

• Vascular dementia. Changes in blood flow to parts of the brain, often due to mini-strokes, can begin in mid-life.
• Frontotemporal dementia. A fatal disorder in which parts of the brain shrink.
• Parkinson’s disease. Motor skills — walking, balance, and the like — deteriorate because the brain stops producing dopamine.

The Complications That Come With Early Dementia

 

Early-onset dementia comes with complications that do not arise in later years, including:

• Difficult dementia diagnosis. Dementia is usually not a doctor’s first conclusion when a person starts to lose cognitive function in middle life — which means that it can take a while to arrive at a correct diagnosis. However, while the diagnostic process is taking place, dementia symptoms can wreak havoc on personal relationships and work obligations.
• Family. When people are diagnosed over age 65, they are usually finished with child-rearing responsibilities, but early-onset dementia can interrupt family life as adults in middle age may still be raising children, supporting young adults in college, and even caring for their own aging parents.
• Employment. Dementia treatment often focuses on helping patients stay as long as possible in the working world. Patients and families also have to work with employers to adjust workloads or tasks to suit abilities.
• Finances. The burden of early dementia combined with the possible loss of employment can cripple a family’s financial situation.
• Qualifying for services. Many services and funding programs are only available for people over age 65, which means patients with early onset dementia and their families have to work harder to get the support they need.

Handling an Early Dementia Diagnosis

 

“We have to take a slightly different approach to building the care plan,” says Dr. Shah. A care plan is a detailed approach to dementia treatment that creates a so-called web of services around the patient and his family. These services include a medical team, occupational therapists, support groups, and community services or agencies that can provide assistance.

Therapy may be necessary for the children and spouses of the dementia patient, who may experience significant anger, grief, and resentment over an early dementia diagnosis. The care plan has to be adjusted as the needs of the patient and family caregivers change.

There may be a perception that early dementia progresses more rapidly than later onset dementia, but this is likely because everything related to dementia treatment, including entering a nursing home, is happening at an earlier age rather than happening more quickly or severely.

Early onset dementia places a significant burden on families — but with the dedicated help of their medical team, friends, family, and coworkers, patients may be able to maintain quality of life for many years.

What's the Difference Between Alzheimer's and Dementia

When someone is told they have dementia, it means they have significant memory problems as well as other cognitive difficulties. Most of the time dementia is caused by Alzheimer's disease.

In many parts of the world the words Alzheimer's and dementia are used interchangeably.

While dementia is an all encompassing term, Alzheimer's disease relates to a specific type of dementia.

Contrary to what some people may think, dementia is not a less severe problem, with Alzheimer's disease being a more severe problem.

There is great confusion about the difference between Alzheimer's and dementia.

In a nutshell, dementia is a syndrome, and Alzheimer's is the cause of the symptom.

When someone is told they have dementia, it means that they have significant memory problems as well as other cognitive difficulties, and that these problems are severe enough to get in the way of daily living.

Too often, patients and their family members are told by their doctors that the patient has been diagnosed with “a little bit of dementia.” They leave the doctor’s visit with a feeling of relief that at least they don’t have Alzheimer’s disease (AD).

The confusion is felt on the part of patients, family members, the media, and even health care providers. This article provides information to reduce the confusion by defining and describing these two common and often poorly understood terms.

What's the difference between Alzheimer's disease and dementia?

• “Dementia” is a term that has replaced a more out-of-date word, “senility,” to refer to cognitive changes with advanced age.
• Dementia includes a group of symptoms, the most prominent of which is memory difficulty with additional problems in at least one other area of cognitive functioning, including language, attention, problem solving, spatial skills, judgment, planning, or organization.
• These cognitive problems are a noticeable change compared to the person’s cognitive functioning earlier in life and are severe enough to get in the way of normal daily living, such as social and occupational activities.

A good analogy to the term dementia is “fever.” Fever refers to an elevated temperature, indicating that a person is sick. But it does not give any information about what is causing the sickness.

In the same way, dementia means that there is something wrong with a person’s brain, but it does not provide any information about what is causing the memory or cognitive difficulties.

Dementia is not a disease; it is the clinical presentation or symptoms of a disease. There are many possible causes of dementia. Some causes are reversible, such as certain thyroid conditions or vitamin deficiencies. If these underlying problems are identified and treated, then the dementia reverses and the person can return to normal functioning.

However, most causes of dementia are not reversible. Rather, they are degenerative diseases of the brain that get worse over time. The most common cause of dementia is AD, accounting for as many as 70-80% of all cases of dementia.

Approximately 5.3 million Americans currently live with Alzheimer's Disease.

• As people get older, the prevalence of Alzheimer's disease increases, with approximately 50% of people age 85 and older having the disease. 
• It is important to note, however, that although Alzheimer's is extremely common in later years of life, it is not part of normal aging. For that matter, dementia is not part of normal aging.
• If someone has dementia (due to whatever underlying cause), it represents an important problem in need of appropriate diagnosis and treatment by a well-trained health care provider who specializes in degenerative diseases.

In a nutshell, dementia is a symptom, and Alzheimer's Disease is the cause of the symptom. 

When someone is told they have dementia, it means that they have significant memory problems as well as other cognitive difficulties, and that these problems are severe enough to get in the way of daily living.

Most of the time, dementia is caused by the specific brain disease, AD. However, some uncommon degenerative causes of dementia include vascular dementia (also referred to as multi-infarct dementia), frontotemporal dementia, Lewy Body disease, and chronic traumatic encephalopathy.

Contrary to what some people may think, dementia is not a less severe problem, with AD being a more severe problem.

Test Your Memory for Alzheimer's and Dementia

• There is not a continuum with dementia on one side and AD at the extreme. Rather, there can be early or mild stages of AD, which then progress to moderate and severe stages of the disease.
• One reason for the confusion about dementia and AD is that it is not possible to diagnose AD with 100% accuracy while someone is alive. Rather, AD can only truly be diagnosed after death, upon autopsy when the brain tissue is carefully examined by a specialized doctor referred to as a neuropathologist.
• During life, a patient can be diagnosed with “probable AD.” This term is used by doctors and researchers to indicate that, based on the person’s symptoms, the course of the symptoms, and the results of various tests, it is very likely that the person will show pathological features of AD when the brain tissue is examined following death.

In specialty memory clinics and research programs, such as the BU ADC, the accuracy of a probable AD diagnosis can be excellent. And with the results of exciting new research, such as that being conducted at the BU ADC, the accuracy of AD diagnosis during life is getting better and better. This contribution was made by Dr. Robert Stern, Director of the BU ADC Clinical Core.