Memory Loss and Dementia Explained with Dr. Anne Constantino

Memory Loss and Dementia Explained with Dr. Anne Constantino


Hi, good afternoon. I am Dr. Anne Constantino, and welcome to
our second Lunch and Learn series. Actually, we will be having more of this every
month. So we hope you tune in, and listen to us. So I am one of the neurologists working here
at Medstar Southern Maryland. I am a Georgetown neurologist. I have specialized in movement disorders and
trained at New York, mainly at Cornell and Columbia University. So I’m here to talk about one of the things
that interest me, and what interests patients a lot. We have, in my clinic we have a lot of patients
being referred for dementia and memory problems. And I would like to talk more about what is
dementia? What is forgetfulness? What is memory loss? So I would start to get the ball rolling. And we will be entertaining questions along
the way. Okay? So first is what is dementia? It’s a big term. It’s an umbrella diagnosis, and it is what
we call a syndrome. When I say a syndrome, it’s a combination
of many other symptoms. And one of the most discussed things in people
with dementia is the element of memory. “I forget things. I lost my keys and I don’t know where I can
find it. I know it was there,” so questions of memory,
“I don’t remember what date it is today.” Thinking processes. Behavior is one of the most important things
that we’ll be discussing later. And the ability to perform activities that
you used to do are all affected when people have dementia. Alzheimer’s disease is just one form of dementia,
actually. It is the most common form of dementia, and
it affects around 60 to 70 percent of cases. The people with– as I said, it is an umbrella
diagnosis. And Alzheimer’s is one. There is another disease, which has other
symptoms of Parkinsonism, or Parkinson’s disease, like tremor, and problems with difficulty
thinking, and hallucinations, called Lewy Body disease. There is also one, this is called frontal
temporal dementia, in which people become more agitated, and have behavioral issues. There is vascular dementia, which is secondary
to strokes, mainly in the frontal lobe, or any part of the cortex. Okay? So there is a cartoon– I hope we can show
you slides, but there a cartoon that says that, “Age doesn’t make you forgetful.” So it doesn’t matter what age you are, you
can be forgetful. It is the amount of things that you have to
remember. So much stupid things that you have to remember. “Oh, do I have to remember the name of a singer
who I knew like ten years ago or twenty years ago?” And then you freak out because you don’t remember
it. So those are the things that we have to think
about when we talk about dementia versus memory. So let me distinguish between forgetfulness
and dementia, okay? First of all, not all forgetfulness is dementia. And forgetfulness, you can forget some details. For example, “I know I have an appointment
today, but I forgot the time.” So that’s okay. You can look at your schedule book, you know
where to find your schedule book, and you retrieve that information. You often remember– or sometimes you forget
information that has been reminded to you. You’re maybe– like me as a physician. “I have an appointment with doing a talk today,
and I forget that it’s today. Well, that is– well, I know it’s today, but
I forgot that it’s– I should be there at 11:30 instead of 12 o’clock.” So that is acceptable, I hope, okay? For instance, you are aware of your memory
loss. This is most important. Because people who are forgetful are aware
that they have memory loss. Which means they insight into their disease. As opposed to people who have dementia in
which they do not only forget that they have an appointment– that they don’t know when
the appointment is, but they forget they even have an appointment. And they cannot recall anything. You tell them that, “Okay, mom, you left your
key in the car.” And she forgot that you even told her that
she left her– remember that she left her key in the car. The other thing also about dementia is that
you don’t know that you have memory loss. You keep on denying it, “I don’t have memory
loss! I’m okay.” So those are the things that may be a key,
or it’s something that’s a clue, that you’re dealing with someone who’s demented rather
than someone who’s just forgetful. Okay? So question that I always ask– that I get
asked by patients, “Am I getting demented? What I should be concerned? Is this memory loss leading to dementia?” Okay, so I would be concerned, or I would
be concerned about a family member who keeps on forgetting even the special days. Their birthdays. They forget it’s their birthday. They forget their favorite son’s birthday. They forget that it’s Christmas! Okay? So those are very common things. They don’t even know what occasion it is. Not recalling or knowing where they placed
things that they usually do know they placed there. Like for example, they put their shoes in
the shoe rack, but then they do not recall that their shoes are in the shoe rack. They will look in the refrigerator or somewhere
else where they– and sometimes spouses find things in odd places. They forget about an incident soon afterwards. Like they were going to the shopping mall,
they bought something. They don’t remember that they even got into
the shopping mall. Then another key also– and this has been
a study that was done, people who keep on repeating questions. Okay, they ask their spouses, they ask their
children, “Did I say that? Or what did you say again? Did you tell me that?” So those are clues that it may be something
leading to dementia. Unable to learn new activities, okay, is another
thing. Melanie has a question, but before that, let
me just complete this, because I think her question is related, okay? So not remembering stories or movies that
you have watched. I guess if you watched a movie like 20 years
or 10 years ago, you know, I would not remember it. But you just watched a movie yesterday, and
you don’t know about it. Unable to do daily chores that you were finding
easily done before. So if you have difficulty with them, or if
a family member has difficulty with them, then I would suspect something may be wrong,
okay? So Melanie’s question is, “My mom constantly
repeats stories that she already told me. Does it mean that she has or is developing
dementia?” Well, it depends on what your mom’s age is. Because some people just like rehashing stories. Especially if they know that you don’t listen. I know there are people who will keep on telling
things repeatedly just to emphasize, or they forgot what they told you. But if she just told you like ten minutes
ago, and then she repeats it, then I will be concerned. If she told the next day, “Oh, you know, I
had this experience,” then I may forgive that a bit. But if it becomes more frequent, and consistently,
and then you tell her, “Mom, I think you told that to me,” and then she tells it to you
again, then that’s a red flag, okay? So moving on, I guess, “Am I getting dementia?” question as I said is always a question that’s
being asked. And that is what I clarify when I see patients
in my clinic. The other thing that is also of concern in
dementia is behavior. A patient who used to be outgoing, becomes
withdrawn. Or a patient who’s very quiet becomes very
noisy. Talking a lot, and usually they talk about
things that they never talked about before. Some people have increase in– they have disinhibitions,
which means that they laugh around a lot, even if there’s nothing funny! Or they actually say sexual comments about
some people, when they never did this, okay? Now another thing is they change their mood. They may be happy one time, and then they
may be sad the next time, they may be crying the next time. That’s another red flag. They become anxious too often. But I’m going to talk about anxiety and mood
about later on. They have loss of control of their impulses. If they want to buy something, they buy something. There are people who spend tons of money,
okay, buying the same things all over. Like I just had a patient who kept on buying
groceries when they only have already a whole closet of bathroom tissue. And she would still buy tissue paper. Okay. So those are red flags. They lose the control of their impulses. They lose the control to hold back their anger,
or their happiness, or even, you know, they just jump into something. They eat a lot. They binge eat. They binge drink. So those may– and these are people who never
did that. Again, related to your behavior is social
appropriateness. If you’re socially appropriate in certain
conditions, then– and you’re forgetful, that maybe is forgetfulness. But if you’re inappropriate, and your talk
to someone, and it’s really very embarrassing, it embarrasses people, that may be something
that is not right. You have perceptions that the people don’t
see. So people can have hallucinations. They could have delusions. Okay, or they’d say, “Oh, I saw the President
talked to me this morning.” Or, “I saw like, you know, a whole group of
people who were clapping their hands when I talk.” So those are red flags. Or maybe as simple as, “I talked to my son,”
when the son is in another country, or in another place where there is no access to
communication. Okay. Another question, let’s, “How can I actively
work to slow down the process of dementia from developing if it runs in my family?” Okay, we will go through that later in– I
have a piece on how to prevent progression of disease if you have memory problems, okay? So we’ll do that later. So we have behaviors. We have things that are inappropriate, so
those sort of things. Now Bill had asked the question of preventing
dementia. So let me just tell you that dementia, as
I said, is a syndrome. And there are other things that can cause
memory loss, or can mean dementia. One of them is depression. And would like to really emphasize the people
who are depressed have a tendency to forget things, misplace things, be inappropriate
in their behavior. So you have to make sure that there is no
incident prior to developing this change in behavior. Another thing also is stroke. So you have to distinguish whether the patient
had a stroke. And I always ask for an MRI. Or a cat scan of the brain. In people who they ask or they tell me has
dementia. Because it could be from a stroke. Another reason why people can have dementia
are deficiencies in vitamins. And this is related also to prevention of,
“How could I prevent being demented?” You have to make sure that you are eating
the right amount of food, or you have good Vitamin D, you are not deficient in Vitamin
D, you are not deficient in Vitamin B. Or you don’t have thyroid disease. I see a lot of people in my office who have
thyroid disease. They are hypothyroid. They take thyroid supplements. Make sure that your primary care doctor knows
that you are checked, because sometimes the medications may not be sufficient, or they
may be too much for your system, and that can tip you over on one end. Infections, by the way, can also cause you
to have dementia. That’s why prevention is preventing infection. So prevention involves making sure you have
the flu virus, you have the pneumonia virus, because especially in elderly, the brain gets
configured in a different way when your infection spreads into the system into your blood system
and then goes into the brain. It’s not only the meningitis that you hear
about, that can cause problems with dementia. Another thing that can mimic dementia, memory
problems, behavioral problems, is/or are seizures. So epilepsy. And epilepsy’s another whole list of diseases
that can– there are a lot of other diseases that can cause epilepsy. So you have to make sure that the– if this
happens suddenly, that also has to be ruled out with an EEG, or maybe starting a patient
on a low dose of a medication for seizure to see if it will reverse, okay? But preventing dementia involves sleep hygiene. You may have experienced– or if you’re not
sleeping– I know this from students who have not been sleeping for many days, they’re reviewing,
they forget things the next day. They do poorly on their exams. They’re not demented. Well, translate this into people who are working
and they do a lot more in their activities, and they don’t sleep. Or they get only two hours or three hours
of not healthy sleep. Also people have what we call sleep apnea. Remember when you have sleep apnea, you have
decreased oxygenation of the brain. And that can also lead into developing memory
problems, that if it persists can be– or it can mimic dementia. And can sometimes lead into dementia. A healthy diet is always helpful for preventing–
especially if you have family history, a healthy diet will help. So you would just see people who are in their
90s who have good memory, vegetables, less– vegetables and fruits are usually in their
diet. They don’t have– they don’t eat a lot of
meat. Processed foods are less. I mean, they, you know, they cook their own
food. I think those are helpful in improving or
in preventing you from having memory problems. Exercise is another thing. I see a lot of people who have retired, who
shun exercise, or they watch TV. There have been studies in children that television
has caused stunting in the cognitive functions of kids. So what more in older people who have a lot
of things that they’re thinking about? You watch TV for four hours, five hours a
day, even if it’s a movie, even if it’s the news, more so maybe, because you’ll get scared
and anxious. But these are not good for your brain. What is helpful is going out, walking with
friends, swimming, doing a form of exercise. Whatever you feel like you’re doing, dancing. Whatever you feel you enjoy will help you
both physically and mentally. Mental stimulation, of course you need to
continue whatever you have enjoyed before. Like if you enjoyed your work in computers,
then tinker with computers. If you enjoyed cars, then do maybe some model
cars. So these are mental stimulation. Have an active social life, community. Doesn’t mean you have to party and drink alcohol
every day, but engaging friends, help. You know that there is a saying that if you
help others, you tend to get more out of that helping cognitively. Because you modify your brain to make sure
that you are doing things creative for others. And then, of course, stress management is
another thing. I cannot downplay, I mean, everyone will have
some form of stress, but do something about your stress. If you cannot do anything about it, and it’s
not solved, cannot solve it with stressing out about it, I would suggest just forget
about it, let someone else deal with it, okay? And our– there’s another question here from
Lisa, “Can you reverse dementia?” Okay, if it is one of those things that I
told you, the secondary types that can cause memory problems, they may be reversable. Like, for example, Vitamin D deficiency. You take a lot of vitamin– I mean you replace
the vitamin deficiency, then you will be able to maybe reverse the memory problems. With dementia, per se, we’re still working
on that. It’s part of the studies that are being done
right now, and there are so many things being done by the NIH, pharmaceutical companies. First to see how they can prevent dementia
from progressing. Or finding out exactly what is the cause of
dementia, maybe modifying that, okay? If it’s nerve cells that have been modified
in the brain, it’s harder. But by building elasticity, and there have
been so many studies on the brain being plastic, and that when you do something, it’s like
exercising. When you do something repeatedly, your muscles
build up. I think it’s brain muscles as well. So if you have some forgetfulness, and you
try to do some things geared towards that, maybe if you want to improve your mathematical
ability and you do math calculations, maybe that will help. With reversing, or not reversing, but stopping
the progression of dementia. Okay? So treatment, which is related to how can
you reverse dementia? It’s the main thing is reducing the cognitive
symptoms through medications, I would not talk into that, because it’s a whole slew
of chemical components of medications that might help. Reducing behavioral symptoms. I would like to stress that if you have a
family member who is already having beginning Alzheim– beginning dementia, or beginning
Alzheimer’s, it is helpful not to stress them out with saying, “Oh, you’re so forgetful! What is happening to you?!” Just don’t scare them. Relax. “Mom, let’s go to the doctor, let’s see what
we can fix, and see if we can change this.” Because once they get more agitated, then
they’re going to withdraw, and you cannot help them, okay? Now if they have behavioral symptoms that
are unsafe. Like, for example, they have hallucinations
in which dragons are fighting them, or a whole army is after them, then we have to treat
that with medication. So okay, there is no treatment that’s not
medication for those kinds of symptoms. And we mentioned about decreased– or slow
the progression of the disease, and prevention or delay of onset of disease. And that is something that is always being
reviewed and done. There are so many studies that are being,
as I said, done right now on both chemicals, on ancillary measures, on herbal supplements,
on other ways to prevent dementia from getting worse. Question is from Angela, “I have a strong
family history of Alzheimer’s, does it mean I will have this disease someday?” It’s hard to tell. We don’t have a risk– well, there is a higher
risk, but it is not always like a 100 percent that you’re going to have the disease. Again, as I said, there are many forms of–
or many causes for memory loss before you get into dementia. There are many things that I have to consider. So you have to take care of those things before
we even say that it’s dementia. But I would say it’s a higher risk, but it’s
not always true that if you have a family member who has dementia, you’re going to get
demented later on. Okay? You have to do whatever you can do to prevent
it from happening, but again, live a comfortable and a healthy lifestyle. And that means, if ever you have other secondary
causes that may prevent it from happening. Okay. Again, for Alzheimer’s dementia, there are
specific treatments, which I’m not going to tell you. I think this is too short to discuss all this. But if you come to my clinic, I usually explain
all the medications and the side effects to the patient. Vascular dementia, I just want to emphasize
it, that strokes cause dementia. That is why if you have risk for strokes,
hypertension, diabetes, high cholesterol, that has to be treated in order to prevent
you from developing the vascular type of dementia. If you already had a stroke, you have to be
tested. Make sure that we are doing the rehab part
and also the cognitive rehab part and the physical rehab part, so that you could get
as much benefits, or get rehabilitate the part of the brain that had a stroke, okay? So next is support for dementia. This is mainly for family members who have–
who already are dealing with people who are demented and have memory problems. Before I go into that, Kate wants to know,
“What should you do if you think a family member has dementia?” Kate, I would just advise you to go your primary
care and just make sure the general blood tests are checked, okay? Because as I said, those can be repleted,
and it may not be dementia. And then if it still continues, maybe two
months, three months, you’re repleting your Vitamin D and she still is failing, and you
see all the red flags that I talked about, then maybe have them come see a neurologist,
and we can tease out what are the other causes of the memory loss, or whether that patient,
or that family member of yours has dementia. For those who have already are dealing with
family members who have dementia, okay? Support is very important. Love for the family, kindness, empathy. Being patient with a family member. I just had a patient who has– whose family
is very annoyed with her, because she keeps on badgering them about her money. And she keeps on saying that, “You did not
give me money again!” So I said, “You know what? Just be patient. Make fake money. Sometimes they don’t know which is fake money,
which is real money. Show them, you know, photocopy, like a dollar
bill, and give them dollar bills, like are photocopied so that they will be happy.” Support them. I mean, it’s important for you not to get
angry. Not to butt heads with them, because that’s
when they get more agitated. Again, important to be flexible with the family
member who has dementia. Provide safety. If it is unsafe, then definitely we have to
treat or place them in a place where they are going to be protected. There are certain non-medications that may
help. Music, if a patient loves music from the ’50s
or ’60s, play it for them! If they want to look at pictures, you know,
show them pictures. I always ask patients what their occupation
was before, and if they enjoyed their job. If they, for example, have been a writer,
give them a notebook, and let them write anything, no matter what. If they have been a painter, give them paints
and colors and have them draw something, because that will help. Okay? Focus on the strengths of the patient that
has dementia. If they’re good at being nice and they want
to go to church every day and pray, support them in going to church, and you know, helping
other people and they’re saying nice things about people. And it’s also nice to reminisce the past with
these patients, because that will instigate or stimulate their memory. And sometimes it’s nice to give them a good
feeling that, you know, they have been once this type of person that they are different
from right now. Some of them have pent up memories that can
get out of their system, and it’s nice to see a family member who is, you know, very–
who you think does not forget things, and then suddenly they remember, “Oh, this is
my grandson!” And that’s something that’s a nice feeling,
not only for the person who has lost their memory, but also to the family members. Okay, Daniel wants to know, “How can the caretaker,
family, etcetera, self-care when taking care of someone who has dementia?” You know, I am very concerned about caregiver
burnout. Okay? So the caregiver of a demented person needs
to take care of themselves, as well. So everyone in the family should pitch in
and give time. Not only for the patient, but for the caregiver,
because the caregiver can flip-out if they don’t have enough support. And self-care only– you know, caring for
the patient, means also caring for the caregiver. It usually is the spouse that’s the caregiver,
okay? So children of patients who are demented should
be supportive. Grandkids should be supportive. And if you can find– I mean, if you have
the means, I always tell the caregiver, “If you have the means to support yourself, or
to have someone take care of this, then find someone who can take care, and take time out
from this. Because if you don’t take time out, you’re
going to be burned out. You’re going to be angry and it’s not good
also for the patient, it’s not good for you.” Okay? I guess that was– any additional questions? I think I have discussed a bird’s-eye view. I am encouraging you to look at the Alzheimers.org
website. NIH has a good website on aging as well. Georgetown, we have a webs– I mean, we have
a Dementia Center. And we all have a lot of physicians who are
dealing with the different types of dementia. From Parkinson’s disease, from diffuse Lewy
Body disease, from stroke. So Georgetown, our group, has a lot of other
resources that you can go to. So and as I said, I’m always here. I try to communicate with the primary cares,
with the internist that you have, so that we can make people more aware of how to take
good care of people who have already been diagnosed with dementia, but more so for the
people who are worried that they may be coming up, or they may have a family member who has
dementia. Or they have signs and symptoms themselves
that may be a red flag. Okay? But please, as I said, don’t stress yourself
out. Let us take care of it. Because if you stress yourself out, then when
I give the test, or the mini-mental status on you in the exam and you fail, that’s even
another stress on you. Okay? So I hope everyone has enjoyed this Lunch
and Learn.

14 comments on “Memory Loss and Dementia Explained with Dr. Anne Constantino

  1. Muhammad Ahmed Post author

    Hi doctor. Last few day ago my dad suddenly lose his memory for short time am very worry can you give your email or contact number i send you is medical report for disscus

    Reply
  2. sarcastic me Post author

    Dr, once i had depression, but i think i m recovering frm it , but the behaviour that u mentioned are 95 percent matched to my thinkings n behaviour, i dont knw if thats a red flag or what??? , will i get dementia later on??

    Reply
  3. Ms. Anonymous Sing Post author

    I'm only 16 yrs old but then I forgot things Soo quickly.. like I did something a minute ago and then I forgot it later on damn.. sometimes I am holding a comb and then I will try to find it when I am holding it.. and my sister tells me that I am holding it.. goshh

    Reply
  4. Tony Tyler Post author

    I've Always wondered when people wake up from a Coma or recover from a bad head injury and loose there memory…How is it that they can remember how to talk? Is it because only a part of the brain was damaged?

    Reply
  5. Thelma Dumcan Post author

    Hi this is Thelma when I was a little girl I jumped off from the dresser to the bed and hit my head I have Real bad memory problems I am watching this video but don’t remember nothing she says after she says it I can go to store and get two things in soon as I walk out the door I forget what it is people can sit in front of me and talk to me but I can’t understand what they’re saying because all I hear is blah blah blah i’ve had this for a very long time since I was five years old there’s some things I can remember like if I see something it reminds me of something but most of the time I can go to the doctors office and don’t understand what he’s talking about and won’t remember nothing soon as I walk out of that room I really need help with my memory problems because my daughter sent me to a memory doctor and he asked me something I don’t remember what it was and he told me to deal with it and get over it I do have PTSD anxiety depression High blood pressure borderline bipolar but what I’m most worried about is I can’t remember nothing after you tell me something even going to the store I have to take pictures of my food or the stuff in my kitchen and I had to look Often to see what a half sometimes I am forget how to get to the store while I’m driving or while I’m driving I don’t understand where I’m going or what I’m doing either way you can help me there’s a lot more going on in my memory but I would have to talk to you about that

    Reply
  6. Yan Liu Post author

    Lion's Mane mushroom supplement can regenerate neurons, improve memory and help with Alzheimer's Disease – hope this helps!
    http://www.dl.begellhouse.com/journals/708ae68d64b17c52,343363596ed9bda8,45484d446fc46878.html
    Samberkar, Snehlata, Sivasangkary Gandhi, Murali Naidu, Kah-Hui Wong, Jegadeesh Raman, and Vikineswary Sabaratnam. "Lion's Mane, Hericium erinaceus and Tiger Milk, Lignosus rhinocerotis (Higher Basidiomycetes) medicinal mushrooms stimulate neurite outgrowth in dissociated cells of brain, spinal cord, and retina: an in vitro study." International journal of medicinal mushrooms 17, no. 11 (2015).

    Reply
  7. Ma Nithya Tanmayananda Post author

    Watch and Enjoy the powerful teachings of Bhagwan Sri Nithyananda Paramashivam
    https://www.youtube.com/lifeblissfoundation

    Reply
  8. Ionut Baicu Post author

    I was really afraid that I have dementia..the start of dementia but now…I after your video I know I don't have it.Thank you so much!

    Reply
  9. Muhammad Asif Post author

    What good is a soul to soul love when the souls can't retain the memory of it after the death of hosts?
    The souls of our dead don't remember us unless we remember them.
    Same goes within the spirits.
    Even the truest of loves don't reincarnate as true lovers by default.
    What good are souls and spirits without the devils registers. Registers keep karma record of soul and spirit separately, but they have no record of the host who was dealing with both of them simultaneously.
    The companion angel keeps that record and the record is merely series of 1,0,1,0
    1 meaning that host is speaking or doing his soul's work.
    0 is when spirit takes over.
    The series must end with equal number of 1s & 0s for the host to satisfy the baldie.
    Much older people score more 1s don't you think.
    While little children are always scoring non-stop 1s. ?
    The baldie has to wait for the 0s to start coming.
    Teen age is the age of 0s. ?
    Teens are the toons of spirits. ?

    Reply
  10. Jannine Navarro Post author

    Im really concerned because i will just be 16 next year yet i tend to forget things really often (the basic things like name of things 'that thing u use for hair' 'yeah that one' was what i say) … I forget something that I did, like thinking that my wallet was missing and put a fuss over it a few moments later i grab a bag randomly and then i see it there not even remembering putting it there… I forget certain incidents more often but it does not affect my daily life… And this is really troubling me please help me on this one… Is this dementia?

    Reply

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