Answering Pressing Questions About Dementia

Dementia is the most feared disease of aging after cancer, but is it a normal part of getting old?  Will I get it if my parents have it?  How can I support someone who has it? And what can I do to decrease my risk?

Speaking to a full house at On Lok’s 30th Street Senior Center in 2019, UCSF geriatrician Dr. Louise Aronson—author of the New York Times bestseller Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life—answered today’s most pressing questions about dementia, a condition affecting 5.8 million Americans, according to the Alzheimer’s Association.

Seniors are increasingly interested in taking charge of their physical and mental health and, for the past 40 years, the Center has helped them navigate the challenges of aging with curiosity, dignity, and empowerment. As more people are living longer, for many the future may seem like uncharted territory. How Your Age Matters lectures brought experts in gerontology, psychology, and other disciplines to the Center, where they shared practical strategies for facing aging.

Symptoms and risk of dementia

Dr. Aronson began her lecture by addressing some myths about getting older. For example, although seniors may have more difficulty focusing and tolerating distractions, they do not learn less than young people do. “We can keep learning at all ages; learning is not less, just different,” she said. Older adults are also staying active longer: “People over 70 are the fastest growing segment of the workforce.”

Still, as we get older, we all develop some age-related brain changes that can include forgetting (or remembering later with reminders), slowed learning, and more trouble with complex tasks when distracted. Dementia is an “umbrella” term that describes acquired new impairments in thinking and function. Alzheimer’s is the most common type of dementia, but there are many others.

Changes that might suggest dementia include forgetting recent events altogether (not just parts of them); trouble with finances or with planning and organization; changes in personality or behavior, including personal hygiene, social or work activities, language or comprehension; and repeated falls or loss of balance.

The risk of getting dementia increases significantly with age; because women live longer than men, there are more women with dementia than men with dementia. In some populations, accelerated aging due to poverty, diet, and other stress factors can increase the risk of developing it. But although dementia is common, it is not correct to assume that most seniors have it.

Preventing risk factors for dementia is possible.

Dr. Aronson noted that dementias are not primarily genetic, especially if they manifest later in life. “In fact, by adopting healthy behaviors, you can control up to 50 percent of Alzheimer’s risk factors and most vascular dementia risk factors,” she said. People worried about their risk of developing dementia should follow simple guidelines for staying healthy and active and decreasing their risk of Alzheimer’s as well as heart disease, diabetes, and certain cancers:

  • Eat fresh, wholesome foods, with a preference for the Mediterranean diet: lots of fruit and vegetables, whole grains, lean protein.

  • Exercise regularly.

  • Keep the mind active by learning a new skill, for example learning to play a musical instrument, or taking up brain training exercises.

  • Do not smoke.

  • Keep your weight, blood pressure, and blood sugar under good control.

  • Maintain a few close, personal relationships.

“Using a hearing aid in case of hearing loss is a big deal,” said Dr. Aronson. “People with hearing loss are at risk for developing dementia sooner. Get fitted with a hearing aid sooner, rather than later, so that the brain can adapt to it.”

Tips for family caregivers

Dr. Aronson advised caregivers or family members of people living with dementia to keep two things in mind: “First, the person with dementia is not trying to be difficult, annoying, or frustrating. Second, it’s the disease, not the person.”

To communicate more effectively with a loved one with dementia, Dr. Aronson recommended, “Never reason, shame, lecture. Do not say ‘Remember?’ or ‘I told you’ or ‘You can’t.’ Do not condescend, force, or abandon.

"Instead distract, reassure, divert, reminisce, repeat, offer simple instructions and provide choices, for example, ‘Would you like a bath or a shower?’ Be kind, demonstrate, try a different approach, and encourage and support.”

Dr. Aronson

Louise Aronson, MD, MFA is a geriatrician, writer, and professor of medicine at the University of California, San Francisco. She is the author of Elderhood and A History of the Present Illness, as well as a regular contributor to the New York Times and the New England Journal of Medicine, among other publications. Dr. Aronson is the recipient of a MacDowell Fellowship, four Pushcart nominations, the American Geriatrics Society Clinician-Teacher of the Year Award, and a Gold Professorship for Humanism in Medicine.

Dr. Aronson’s presentation kicked off the On Lok 30th Street Senior Center’s How You Age Matters lecture series, a month-long initiative, in May 2018.

Photo: Anna Kuperberg