A new review of a major study from 2016 found that about a third of nearly 3,500 people, aged 65 and over, had either dementia about (10%) or mild cognitive impairment (22%).
You're a psychiatrist specializing in geriatric mental health and cognitive and memory disorders. I'm guessing your patients worry about this a lot.
It can be very difficult to tell. Dementia or mild cognitive impairment from effects of normal aging. So I have a lot of patients who are concerned about their cognitive health in late life.
What's the difference between the two?
So with dementia, cognition is impaired and that affects day-to-day functioning. They may have trouble managing appointments or taking medication or navigating their environment.
People with mild cognitive impairment have had some changes in cognition, but those changes are milder and it's having less of an impact or no impact on their day-to-day life.
Some people with mild cognitive impairment will progress on to dementia, but not everybody with mild cognitive impairment develops dementia.
The study also found the prevalence of dementia and mild cognitive impairment differs related to education level, race, and ethnicity, which you've said points to social determinants of health. Meaning what?
Factors in a person's life, their community, where they live and work, affect their health. This includes things like education level, access to health care, transportation, economic stability, and housing. And we have more and more studies showing that these are very important, both with managing risk for disease, but also management and disease.
One of the findings said each additional year of education was associated with a decrease in the risk of dementia. Meaning what? The more you stimulate the brain, the more you may hold dementia at bay?
We do know that mental activity and mental exercise are very good for brain health and that can help maintain or protect cognitive ability.
But it may also be that people with higher levels of education also have more access to care, or maybe they have greater health literacy. So they're managing their health conditions to a greater degree than other people. It's hard to say. That's very case-by-case, but I don't think we can 100% explain why education level correlates to lower risk of dementia.
About race in the study: Dementia was more common among non-Hispanic black individuals and mild cognitive impairment in Hispanic individuals compared with non-Hispanic white individuals. What could account for the differences there?
The study does not go into that level of detail to look at what are the specific factors that would cause those results when it's really looking at a broad population view.
So we can't necessarily apply those to individual people, but it does indicate that we need more research with communities that are more at-risk to look at:
- What are those factors?
- What are the social determinants of health in communities at risk?
- How do we help address those through prevention and healthcare initiatives once they're already present?
What do people of color do upon hearing this?
I think that being attuned to that risk is very important. I think everyone, including people of color, can be aware of warning signs of dementia that may indicate a problem and seek help:
- Changes in thinking,
- Changes in memory,
- Changes in functioning.
Usually, people will reach out first to their primary care doctor or providers they're already working with, who can do additional testing and advise about the next steps.
But we should recognize that while there are changes with normal aging, those changes should not affect day-to-day functioning the way dementia does. And so if those cognitive changes are starting to affect day-to-day life, it's really important to check in with the health care provider for more investigation.
It's also important not to sit back and say, "I'm getting older. That's just a part of it?"
It's important not to attribute everything to age. While we do know from this study and from other studies that the risk of dementia is higher with age, and we know that there are changes that happen in thinking with normal aging, it can be difficult to tease those out. Working with a professional, I think, is very helpful to try to distinguish normal aging from another process.
It's also very important for older adults to stay active. There are a lot of modifiable factors that can help reduce the risk of dementia, including mental activity, social activity, and physical activity. So it's important to take a proactive approach to brain health.
I'm guessing this is probably what you're having to tell your patients?
Yes, we have this conversation often in retirement. For a lot of people, they have the idea that it's going to be a time of relaxation, and it can be, but it also needs to be a time of activity. Again, staying physically active, socially active, and mentally active.
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