Transcription
Hello Health Champions. Today I want to talk about the signs of dementia and why it is so critically important that we recognize the signs early.
Because even though the body has an amazing ability to recover and regenerate, dementia is one of those conditions that once we are beyond the initial early stages, it is just not reversible.
Dementia in general is about mental decline. It's a reduction of the ability to perform mental processes. So, it's associated with memory disorders, with personality changes, with impaired reasoning. And because of that, it is one of the most devastating conditions that anyone could ever get. Because even though the person is technically still alive, that the body is still there, the person that we once knew is not there anymore.
Dementia is like an umbrella term and encompasses many different types of dementia. So, the most common form of dementia is Alzheimer's, and that's a form that's associated with specific findings with amyloid plaques and with something called tau protein tangles. But none of that's really important. There's other types with Lewy body dementia where they have protein clumps, and then there is vascular dementia that is a result of multiple silent infarcts. And this is often with people who have strokes.
And the reason I say it's not all that important is that no matter what the type, there's still not a whole lot they can do about it. It's more like an academic exercise of classification. So, we want to understand the very early signs as well as the mechanisms that bring them about so that we can do early detection, but even better that we can do some prevention.
I watched some videos about this and it was a little discouraging that most of the advice about diagnosis is just about classification, just about labeling it as dementia versus normal age-related decline or forgetfulness. And it's almost like the main purpose of having a classification, having that label of dementia is just so that we have a better tolerance, a better understanding of what these people are going through and who they are becoming. It's like a child, you can't be too upset with the child because you know they're not mature, you know they don't have the mental cognition to deal with things the way we do.
But the main thing that I hope to really drive home is about the process that if we catch things early, then it is still reversible. And why is that? Why is it so hard to reverse it in the later stages? Because we need the brain to fix the brain. We need the function of the brain to be there to prevent further decline. So, once we have a certain amount of brain function, then we have the motivation to do something about it, to exercise, to take action, to lead an active life, to make decisions about healthier foods and so forth. And then that activation drives the brain function, which drives the motivation and so forth.
But the opposite is also true. That once we lose some brain function, once the loss of brain function goes beyond a certain point, now we no longer have the motivation and therefore we lose the activation that further declines brain function and so on and so forth. So, once it's beyond a certain point, we just don't have enough healthy viable brain tissue. We don't have enough energy to change the mechanism, to change the process.
I want to walk you through the seven stages of mental decline, and then you will more understand why these advanced cases are so tough. That once the brain is gone, it's gone.
Stage one, for some reason, is when you're still normal. So, I don't know why they call that stage one instead of stage zero or prior to stage one, but that's just the way they do it. Normal is where you want to be.
Stage number two is very mild decline. And this is where we're still on the green side of the spectrum. It's not really dementia yet. It's where we forget things occasionally. We might not have access to familiar words right away. We might not remember where things are as quickly as we used to. And some of this is perfectly normal. We all have good and bad days, and it could very well just be age-related.
Another thing to understand is when it comes to brain degeneration, that it's an ongoing process. That we all have some of this. But the trick is to have it progress so slowly that we can live our lives and live out to the end of our lives with as much of that function left as possible.
Stage number three is early stage dementia. Now you're kind of officially in the process of developing dementia. You're still in the early stages. It's still considered a mild decline. But some of the things that you might start observing is forgetting names. You're in a conversation with somebody, you're being introduced, you try to remember what their name was, but a minute later, you have no idea what it was. Your short-term memory is slipping.
Another way this could manifest would be if you forget what you just read. You watch a little movie clip or you read a paragraph, and a minute later, you don't know what it was about. And in this stage, you might see people learn to compensate. They figure out, they're aware that the short-term memory is slipping, so they develop a strategy of marking their trail, of writing down things that they know that they need to remember, but they'll probably forget. And we all do this to a degree because we use lists to stay organized and so forth. But here's where it's gone a little bit further, and these people kind of mark their trail like with breadcrumbs where they know they'll find the notes so that they have some organization in their life. And their ability to organize and get things done also gets worse with planning when it's complex, when it's multiple steps involved. Now they really can't handle it without marking their trail ahead of time.
And the thing to understand here is that when people start to compensate and develop a strategy, they still have enough brain function, they still have enough consciousness, they're still aware of the problem, and they have some motivation. At this point, you can still turn it around if you understand how the brain works and what the brain needs. You can develop a strategy to actually reverse this.
Stage number four is still considered early stage dementia, but you're a little further down now. There's moderate decline, and this is where it's getting tougher and tougher to turn this around. It's almost impossible to reverse, but you can still do things to slow it down. An example now would be that you forget recent events. Things that happen beyond just reading a paragraph, you might have done something and you don't remember it anymore.
Another thing that often happens here is impaired calculation. Your ability to do simple math is not so great anymore. So, an example would be subtracting sevens. You start with a 100 and you subtract seven. So, 100 minus seven is 93. 93 minus seven is 86, and so forth. So, normally you should be able to do that, even if you can't do it instantly or as fast as someone else. But once you get into this stage, you're just not able to do that at all. And some of the other things you're losing is maybe the ability to pay bills, to manage your finances. Even if you concentrate, you just can't figure it out anymore. And tasks requiring more planning and managing, they're getting increasingly difficult. So, someone else has to start taking over those tasks now.
When it comes to these stages, we have to understand that even though we're focusing mostly on the cognitive portion, on diagnosing mental ability, this mental ability is reflected in physiology. That the physical tissue of neurology, it's declining. And that this decline is progressive. And before we ever get to any noticeable decline in cognitive function, there's already been a progression of physical decline. So, we're talking about the cellular machinery that your brain cells, as they start ever so gradually declining in their ability to produce energy, in their ability to produce signals, that's the beginning of this. And then as it progresses, we might notice a decline in brain endurance. And we'll take a look at what what that means. And then once we've had these first things, then we see the early degeneration, and eventually we see these early signs that lead to more progressive signs that lead to dementia.
So, again, if we catch it in the stages of early degeneration, we can reverse this. But as we start getting into the early symptom and into the later symptoms, now it's simply too late.
In the very earliest stages, before there's any sign of cognitive impairment, we might see a reduction in brain endurance. So, this might be a reduction in attention span. It might be more mental fatigue. It could be that you can't stay focused as long as you used to. It might be that you feel you need caffeine or some other stimulant to keep you going. Or it could be that you notice that in some other aspect that you feel your brain function just isn't providing the quality of life that you're used to. You notice that there's a change there.
Another thing to look for in the very earliest stages is changes in posture and movement. Your cognition is still there, but these things indicate a degeneration of brain function, of the physical capacity of the brain to perform work. So, if you're sitting still and you're noticing a twitching or a tremor, that's a sign that the brain is not able to control that as well as it used to. If you notice that your handwriting is getting smaller, and it's not because you're just a neat type of person that always wrote like this, but you used to write a certain way and now you're writing different, that is becoming more compressed, called micrographia. That's another sign.
If you can't smell the food as much, smell is a result of brain function, like everything else, absolutely everything. So, if you can't smell the food, that's very common. If your quality of sleep is declining, your brain function determines the hormone production and the regulation of sleep cycles and the regulation of stress and so forth.
Another thing you might notice as your brain degenerates is a hunched posture. So, posture is part of brain health. We start our lives as babies, we start as a in a fetal position, we're all curled up. And then as the brain develops and progresses and the brain, the frontal lobe learns to inhibit certain things, we get an upright posture. And then as the brain starts weakening, we get back, we get more and more curled and hunched over, and we sort of return back to that childhood posture.
Another sign that the brain isn't working as well is a loss of arm swing. That when you're walking, you might swing one arm more than the other, or both arms may not swing very much at all. So, the thing to understand though is that poor brain function results in these, but it works the other way around. That if you pay attention to your posture and if you pay attention to your arm swing, you're actually reinforcing brain function.
So, when do we start worrying about it being dementia and when is it just something that is normal for age? With dementia, it's very common to have poor judgment, but these people have chronically poor judgment. They are unable to have good judgment. What's normal with age is that you have occasional bad choices, but once you think about it, you're able to reason it out. With dementia, you're often unable to manage a budget. However, I think every one of us has missed paying a bill at some time, and that's different. It's once in a while.
People with dementia are often losing track of what time it is, what day it is, what month or even season. They can start in the summer and say, "Oh, are we going to have snow today?" They really have no clue about time or even season. Normal would be that you don't know if it's Wednesday or Thursday because there's a lot going on, you got distracted. But if you sit down and think about it, you can figure it out.
And with dementia, people lose things, but they're also unable to retrace their steps and figure out where it is or what happened to it. Normal is that we lose things from time to time, but we still have this basic awareness of what happened or where they might be. And with dementia, they also have difficulty being coherent. So, in a conversation or trying to explain something, the reasoning is all over the place. There is no structure or direction to it. And normal would be that we're sometimes searching for a word, we occasionally get lost, but given some time, we can get back to our train of thought.
And this has received some attention recently in the media where a lot of people are suggesting that this is what might be going on with the leader of the free world. You know, "What do you want to do with button? I want to box. I it be so lucky, you know, I mean, but it is the kinds of things or, you know, stuff that is coming out of Florida, stuff that's coming out of, you know, Robert E. Lee, but in Afghanistan. You're the one, anyway."
Stage number five is mid-stage. So, now you're sort of in the middle or even past the middle of the spectrum. Moderate to severe decline and brain damage. These people cannot recall their very basics, things that they have encountered and talked about and known all their lives. All of a sudden, they don't know their own address or their own phone number. Of course, their ability to realize and recall the time or day or season is getting even worse. And they have trouble selecting proper clothing. So, like in this picture, they have trouble matching things up, and they're not able to select appropriate clothing for the season or for the weather.
I don't want to go in depth on the causes, but I do want to touch on them very briefly here. So, you could have dementia, you could have brain damage from injury or trauma, but that's relatively rare for all the cases of dementia. The vast majority of cases is brain disease and degeneration. It's a gradual decline of the mental processes due to the physical degeneration. And the first thing to understand in that context is the principle of "use it or lose it." Your muscles work the same way. If you break your arm, you put your arm in a cast, then that muscle will shrink because you're not using it. That is the most important component of brain degeneration. Yes, there are genetic predispositions and all that, but we have to understand the the basic mechanism here.
And what does the brain need? It needs fuel, which is the stuff we eat, and then it needs oxygen to burn that food. That's the fuel that produces energy. But then the second part is what people miss. It's the stimulation. And there's a whole lot of confusion about how to stimulate the brain. That most people think it's playing bridge and doing crossword puzzles and having an interesting life. But the fact is, the vast majority, more than 90% of the stimulation of the signals that keep the brain alive come from movement. And that is why I always talk about exercise. It's not the best to reverse insulin resistance, but it is the best to keep your brain alive. If you don't stimulate it, then you'll see a reduction in blood flow, which is part of this brain degeneration. And if you don't lose it, then that is how the brain ends up with less blood flow.
Another factor that can speed up this degeneration is neuroinflammation. And this has to do with metabolic disease. This is what I talk a lot about in my videos. And even though most people worry about their metabolism for weight loss or diabetes, you have to understand that Alzheimer's and dementia is often called Type 3 diabetes. That is how strong the link is between the two. Being insulin resistant and having metabolic syndrome, metabolic disease is a cause of neuroinflammation. And then some other additional causes will be toxins that inflame the body and toxins that come from food and the GI tract. So, environmental insult and from food.
Stage six is mid to late stage dementia. Now you're getting really close to the red. These people have severe decline. And one example of what's happening is they can't even recall their spouse's name. And this is where it's becoming so devastating for a couple that has known each other their entire life, and all of a sudden that person is just gone. They're there in the flesh, it's like they should be there, but they're just not. And these people have to be watched constantly. They're often kept in an institution by now because they tend to wander and get lost, and they have very little judgment on how to take care of themselves. So, they very easily get injured as well. Now, they can't even perform the very basics of taking care of themselves. They need help with dressing and eating. And in addition, there's just basically nothing left of their original personality. Their major personality disorders.
Number seven is late stage dementia. Now you're almost all the way gone. And this is very severe decline. These people have complete detachment. They're just basically not there at all anymore. They're non-responsive. You talk to them, you gesture, and there's just no recognition of anything. They might produce random words, but there's just no context or no meaning to it. They have no awareness of themselves or their condition. And another thing that often happens at this point is they can't even swallow anymore. If you feed them.
I hope you can really, really see that the things that we usually associate with dementia, those are stages that are too late to do something about. So, when you're at this stage, when you have the ability to compensate, when you have some motivation to develop strategies, this is the range where you want to notice and do something about it. In the very early stages, even before there is any cognitive decline, when there's just a little loss of brain endurance or posture, that's where it's time to do something.
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