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Family Members Slow to Recognize Dementia Early recognition can lead to treatment
One out of five families with a demented family member is unable to recognize the signs of dementia in a loved one, according to an article in this week's Alzheimer's disease (AD) theme issue of The Journal of the American Medical Association (JAMA). Dementia is an acquired decline in all areas of mental ability.
G. Webster Ross, M.D., from the Department of Veterans Affairs and the University of Hawaii's John A. Burns School of Medicine in Honolulu, and colleagues studied 191 Japanese-American men with dementia who were participating in the Honolulu-Asia Aging Study. Each had a family member able to provide reliable information about the individual's mental status.
Dr. Ross presented the findings today at an AMA media briefing on AD.
According to the study, early recognition of dementia is important because therapy is available for potentially reversible causes of dementia. Early identification and treatment of subdural hematomas, drug intoxication, vitamin B12 deficiency, hypothyroidism, and central nervous system infections may reverse cognitive decline, say the researchers. Strokes also cause cognitive impairment and progressive dementia and can be prevented by risk factor control and medications.
Of the 191 men with a dementing illness aged 71 to 93 years, 21 percent had a primary family caregiver who was unaware there was a problem with memory. Among subjects with very mild dementia, 52 percent of families failed to recognize a significant memory problem. Even among severely demented subjects, 13 percent of families had not noted memory difficulties. Of the subjects whose families did recognize there was a memory problem, 53 percent had not received a medical evaluation for this problem.
A person with dementia may not remember recent events, may become easily lost in a familiar neighborhood, may fail to grasp the meaning of conversations and experiences, and may become confused over days and dates, for example.
The authors write: "There are several possible reasons for failure to recognize or report memory problems in an aging family member. A caregiver's expectations of his or her elderly relative may decrease with age. Elderly individuals may be less active or take part in activities that are less cognitively challenging, making a decline in cognition and functioning less evident.
"In support of this we found that the oldest subjects were less likely to be reported as having a significant memory problem. We also found that men with higher education were more likely to be recognized as having a memory problem. It is possible that these men participated in more intellectually complex activities in which loss of interest or poor performance would be more obvious."
The authors add that wives or children may deny memory or cognitive problems out of respect for their husbands or fathers. The men studied were all first- or second-generation Japanese Americans, a cultural group the authors say that is known for their respect of the elderly. However, the analysis indicated that cultural factors had only a minor impact.
The most important characteristics that led a family caregiver to recognize dementia were not related to culture or even to the severity of the person's memory problem as measured by formal testing. Rather, they were disturbances of behavior such as hallucinations and agitation, as well as declining ability to perform daily activities such as dressing and toileting.
They conclude: "Unrecognized dementia was common in our population, especially among mild cases. Cognitive screening programs for the elderly and public education policies designed to increase awareness of the early signs of dementia are needed if interventions for these individuals with potentially treatable dementias are to be implemented." # For more information: contact the AMA's Scot Roskelley at 312/464-4431. email: [email protected] AMA web site: http://www.ama-assn.org
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