Aging and dementia

By Alan Koenigsberg, M.D.

At a Men’s Club Breakfast recently, a speaker discussed fears, acknowledging them, facing them and dealing with them. It was an excellent talk and slide show and the speaker was well prepared and engaging.

Toward the end of his talk, he asked if anyone in the audience would be willing to share any fears he or she had and he could then demonstrate what he was discussing.

He started with one of his most recent fears, due to a climbing accident. He had torn the meniscus of his right knee, was in a brace and might never be able to walk well, let alone engage in his lifetime passion, climbing. He discussed how he acknowledged the injury, went to the surgeon for treatment, was working in physical therapy, facing life from this point on and new limitations he might have to face.

Our audience consisted of men and women in their later years, mostly 50s, 60s, 70s and older. When the speaker again asked about a fear someone might be facing, a man said simply, “Dementia.”

The audience was surprised initially and then, from my vantage point sitting toward the back of the room, I saw the majority of the audience quietly nodding in agreement.

The speaker thanked the man for his candor, asked for more information and then asked for suggestions. The suggestions, as one can well imagine, ran the gamut of medical recommendations, physical activities, social suggestions and so on.

Listening to this conversation, it occurred to me that this could be a common if somewhat unspoken fear that many people have. One of the men at my table quietly suggested doing crosswords and it got me to thinking about many of the myths surrounding dementia, its causes and what we can do about it.

Dementia is a large category of diseases which have in common severe, progressive memory loss and usually occurs in the older population. It is not one condition. There are dementias due to chronic, excessive alcohol consumption; traumatic dementias; Alzheimer dementia, the one we commonly think of; and vascular dementia, caused by multiple strokes.

About 11% of people over the age of 65 have dementia. The risk factors for developing dementia are increasing age, high blood pressure, diabetes, being overweight or obese, smoking cigarettes, excessive alcohol consumption, physical inactivity, social isolation and depressive illnesses.

Dementia is not inevitable and not a normal part of aging. As we get older, we all tend to find it a bit more difficult occasionally to recall the exact word we’re searching for. That’s a normal part of aging.

A common impression is that if we do mental activities, it may prevent dementia. I wish that were true. For example, one of the men at my table recommended doing crossword puzzles to help avoid developing dementia. While I enjoy doing them too, doing crosswords is fun and helps us get better at doing crosswords, not necessarily avoiding dementia.

While it’s understandably very potentially scary, if you or someone you care about begins to have memory difficulties, I recommend a prompt evaluation from the person’s internist and then a thorough neurological evaluation from a neurologist.

If the condition is caught early, there are several medication treatments that help slow down the disease process. There are also many treatments in the pipeline that may prove helpful.

Learning new skills — such as a new language, a new musical instrument, keeping mentally active at work or volunteering, staying socially active, avoiding isolation, being physically active, doing well training and strengthening exercises — all are good for you and may help avoid developing dementia.

Obviously, if you have any of the medical conditions above, work diligently with your internist to keep yourself as healthy as possible. Move forward!

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at

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