What is normal?

There can a wide range of 'normal', as everyone is different. We all have cognitive strengths and weaknesses. We also fluctuate in our cognitive performance to a degree. If there is an enduring change for the worse, however, this may be a cause for concern.

One of the big questions I am often asked what is normal as you get older. We do know that certain changes occur cognitively, and these are to a degree mirrored by changes in the structure and function of the brain.

Most obviously, our speed of processing tends to decrease as we get older. This means it takes us longer to bring things to mind and to think through matters. Given time, however, we tend to be able to remember, at least the broader details.

There is also some decline in memory function - it can be harder to remember all the details of events and interactions.

In addition, our so-called "executive skills" do tend to diminish as we get older. This means we may have increased difficulty solving more complex problems and engaging in more tasks that have multiple components or require timing and sequencing.

With age alone, however, we do not expect a significant deterioration in our language skills (though we may have a slight increase in difficulty bringing words to mind). Likewise, we do not expect a significant decline in our visuospatial skills - these allow us to know where we are in space and in relation to other things around us. Problems in these areas are a reason to seek help from a professional.

The other aspect of "normal cognitive ageing” is that the deterioration in our cognitive skills should not cause major impairment of our ability to function day to day. We may need to compensate for instance, using diaries or calendars more often - though we should be able to manage our daily affairs. If this is not the case, again this should be a reason to seek help.

What is dementia?

There is a lot of misunderstanding about dementia. Many people think it is a diagnosis in of itself, though this is not the case. The diagnosis comes from the underlying process that causes damage to the brain that then results in the symptoms and signs of dementia. The most common cause is Alzheimer's disease, though vascular disease (problems with blood supply) can also cause dementia, as can a number of other conditions, such as Lewy body disease, frontotemporal lobar degeneration, excessive long-term alcohol. In fact, there are over 100 different potential causes, though about half a dozen account for the majority. These conditions can also coexist.

Dementia is therefore best seen as a clinical syndrome where there is a decline in cognitive function (compare to how things used to be). There must also be significant impairment of daily function. Dementia is irreversible and tends to progress with time.

Another widespread misunderstanding about dementia is that you have to have impaired memory to have this condition. Although this is the typical presentation, you can have dementia even when your memory is relatively intact. Depending on the cause of dementia, including where in the brain it affects, then maybe various symptoms and signs. These may include problems with language, with visuospatial skills or even behavioural and psychological symptoms. On the whole, has dementia progresses, more and more cognitive functions become impaired.

Dementia may also cause physical problems such as incontinence and impaired mobility as well as changes in behaviour and psychological state.

It is important to realise that there are things that can be done to help all the different complications of dementia. This is why, at Your Brain In Mind, we focus on the whole person and do what we can to address all the issues as they arise.

What else might be causing problems with memory or thinking?

When we assess dementia, it is important to try to rule out reversible causes of cognitive and memory impairment.

A number of medical conditions can cause similar problems. These include obstructive sleep apnoea, thyroid disturbance and disturbance of electrolytes in the blood. Sometimes infections may cause problems with thinking-classically urinary tract infections - and these need to be borne in mind and treated. Psychological conditions such as depression and anxiety and also mimic dementia.

Likewise, many medications can have a negative effect on the brain. These include strong painkillers, allergy medications, and medications for urinary incontinence. Some heart health medications may also cause problems. Often, it is not a single medication but multiple medications together that cause the impairment of thinking. A link in time between starting the medication and the onset of cognitive problems is a red flag that the medication may be the problem.

At Your Brain In Mind, we ensure that these reversible causes are either ruled out or effectively treated.

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