Dementia begins with seemingly trivial “blunders”. Neurologist: “Unfortunately, patients arrive when the disease is already ripe”

Dementia affects more and more Romanians, and the first signs are often ignored or confused with simple memory problems. Dr. Clara Marion Resit, primary neurologist at MedLife explains in a way that everyone can understand how the disease starts, who is at risk and what we can do to slow down its evolution, in a context where international studies bring new hopes.

Dementia 'isn't just forgetfulness'

For many people, dementia is confused with ordinary forgetfulness. In reality, we are talking about a serious, progressive disease.

“It is a brain condition that alters cognitive function (intelligence, memory) persistently, with evolution towards disability and death. It is a degenerative disease, if we refer at least to Alzheimer's dementia, but also to that of Parkinson's disease, to fronto-temporal dementia – that is, the one Bruce Willis suffers from, to put it more simply. There is also vascular dementia, the one associated with different types of stroke”, explains Dr. Clara Resit.

The doctor emphasizes that dementia is not a normal consequence of aging, but a pathology that progressively affects the essential functions of the brain. This reality is also confirmed by the extensive report published in The Lancet Commission on Dementia Preventionwhich shows that the disease has an irreversible evolution and is one of the main causes of disability in the elderly.

Worrying figures: more and more patients, from year to year

The incidence of the disease increases with age, and the reality in the office confirms the statistics.

“Statistical assessments are made for the population segment over 65 years old and, in general, but almost certainly in Romania, the frequency is 10-12% of the total population, let's say, in the elderly. We know that this percentage increases with each decade, so in the population over 80 years old it is 25%.

Every month I have at least one new patient with dementia, so I can say that every year there are about 12-15, just as every year I lose patients who get worse and die,” says Dr. Resit.

The data are in line with those of the World Health Organization (WHO), which confirms the accelerated increase in the number of cases. In 2021, 57 million people suffered from dementia worldwide, more than 60% of whom lived in low- and middle-income countries. Every year, there are nearly 10 million new cases, the WHO claims.

The first signs: “blunders” that should not be ignored

The onset of the disease is subtle and symptoms are often overlooked.

“Patients realize that they are no longer able to solve slightly more complicated situations that they managed easily before, they can no longer process more data, they no longer remember details of recent events, they no longer pay attention to spatial details, they make confusions, all this happens in conditions where, as a rule, they have a quiet, regular, predictable daily activity and a satisfactory sleep.

Unfortunately, quite often patients come with a son or daughter or spouse, who are already worried because of “blunders” and serious confusions, memory losses that lead to the repetition of questions and reports that patients make, ignoring these deficiencies, and this is an already “ripe” stage”, explains the doctor.

Research published in Alzheimer's & Dementia shows that impairment of recent memory and executive functions are among the first signs of the disease.

Who is at risk of dementia?

According to Dr. Resit, there are several factors that increase the risk of dementia:

• age over 65 years
• the female sex
• low educational level
• cardiovascular diseases
• head injuries

“Let's not forget about genetics,” draws the doctor's attention, mentioning the genes involved in the onset of Alzheimer's disease.

International studies show that many of these factors can be controlled, which paves the way for prevention.

The role of genetics and testing

Genetics also play a crucial role:

• Causative genes: Presenilin 1, 2 and APP can produce early disease (below 65 years).
• Risk gene: APOE epsilon 4 is associated with the onset of the disease at older ages.

Genetic analysis is recommended for young patients (under 65 years), those who are about to start biological therapies with monoclonal antibodies or descendants of those diagnosed with early forms. Although a negative analysis can be reassuring, a positive one often creates anguish, especially since the tests are expensive and unsettled.

Serum proteins (phospho-tau 181 and 217) or cerebrospinal fluid proteins (phospho-tau and beta-amyloid) can be tested. An increased titer of them confirms the diagnosis of Alzheimer's. A definite outcome helps the family anticipate difficulties and advance important actions before the disease progresses.

Can dementia be prevented?

“It is important to lead an orderly life and to treat vascular risk factors, to treat minor mental illnesses as well,” advises Dr. Resit.

• Diet: Balanced in protein, fiber and healthy fats.
• Sleep: Minimum 6 hours of rest per night.
• Movement: Daily exercise, preferably outdoors.
• Mental training: Daily reading, crosswords, sudoku and constant communication with others. Avoid excessive TV or phone viewing.

One of the most important clinical trials, the FINGER trial, demonstrated that lifestyle interventions can slow cognitive decline. Unfortunately, many patients reach the doctor late, when the disease is already advanced.

The unseen burden on the family

Dementia not only affects the patient, but also their family.

“Medium and severe forms are a psycho-physical burden for the relatives […] about 30% of those who take care of these patients can get seriously ill”, warns the doctor.

Dementia doesn't start suddenly, but with seemingly insignificant details—a repeated question, a minor confusion, a wrong decision in an ordinary situation.

In a disease that cannot yet be cured, time becomes the most important resource. Early symptom recognition and prompt intervention can mean years of independence and quality of life—for both the patient and their caregivers.

Sources:

https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext

https://www.who.int/news-room/fact-sheets/detail/dementia

https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12083

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60461-5/abstract

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This article is supported by MedLife, the largest network of private medical services in Romania, and is part of an extensive information and education effort, dedicated to prevention and a long-term healthy lifestyle.

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