Memory loss is typically the first warning sign when you think of dementia but new Canadian research is shedding light on other changes in personality and behaviour.
At the Alzheimer’s Association International Conference in Toronto, University of Calgary scientists introduced a new syndrome called “mild behavioural impairment” or MBI – they say it may be the precursor to Alzheimer’s disease or other dementias.
They also presented a 38-question checklist that could help to identify those who are most at risk.
Has the person lost interest in friends, family or hobbies? Are they anxious or worried about things that are routine, like events or visits? Do they become agitated, aggressive or irritable? Those are among the string of questions the doctors came up with.
“Dementia is a brain illness caused by a loss of structure in the brain – it shrinks, you lose neurons, and they don’t connect as well. While it’s clear that when you lose brain structure and function, you won’t think as clearly, it’s not that much of a stretch to think that other brain functions like the way you interact with the world, your confidence, motivation, sensitivity and empathy would also be affected by a degenerating brain,” Dr. Zahinoor Ismail, the study’s lead researcher, told Global News.
“Historically, [people with these personality changes] may be written off as being cranky and that it’s part of aging, but we’ve reframed it to think of it as part of the symptoms of a brain breaking down and not working as well,” he said.
Ismail is a neuropsychiatrist and clinician scientist at the Calgary university’s Hotchkiss Brain Institute.
READ MORE: 10 warning signs of Alzheimer’s disease
He calls MBI the precursor to dementia. These changes can happen before, at the same time or after memory loss sets in, too. What’s key is doctors and loved ones pay attention to these changes, especially in the early stages.
Right now, if patients turn up with these symptoms, such as apathy or irritability, but no signs of memory loss, doctors may not make the connection to cognitive decline straight away.
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Letting go of social norms and tact or giving up on interests is often chalked up to aging, and not something more.
Large clinical trials hoping to treat dementia have been “unsuccessful,” according to Ismail. That’s because it’s often too late in the course of the disease to reverse symptoms.
“If we can use this diagnosis and checklist to capture people who are at risk, and then treat them with anti-dementia drugs, we might find a group who responds to the treatment,” Ismail said.
The new syndrome, diagnostic criteria and the checklist were put together by an international team of scientists led by Ismail. It’s in its preliminary stages and needs to be refined but Ismail hopes the checklist will be adopted and used by frontline doctors, Alzheimer’s associations and loved ones to screen for patients at risk of dementia.
Ismail said the idea for MBI stemmed from treating patients in clinic — it was unclear if they were grappling with depression or dementia. In nursing homes, patients wouldn’t be referred to him unless they had “difficult behaviours.”
“It became clear that behavioural changes are fundamental to the overall dementia process,” he told Global News.
His team’s next steps are to dissect the 38-question checklist to identify which risk factors tamper with vulnerability to dementia most, and which aren’t as major.
This isn’t the first time doctors pointed to mood changes as an early warning sign for dementia. Last year, for example, University of Washington doctors said apathy, irritability and lack of appetite could be clues to the early onset of dementia.
They said the link between Alzheimer’s and these mental health concerns has been established but it’s still unclear which comes first.
About 747,000 Canadians are living with some form of dementia and the society says this number is slated to double to 1.4 million in less than 20 years.
Here’s a sample of the 38-question checklist the doctors are proposing to help identify who is at risk of Alzheimer’s or other dementias. The symptoms must mark a change from prior behaviour and have lasted at least six months.
—Has the person lost interest in friends, family or home activities?
—Has the person become less spontaneous and active — for example, is he/she less likely to initiate or maintain conversation?
—Does the person view herself/himself as a burden to family?
—Does the person feel very tense, having developed an inability to relax, or shakiness, or symptoms of panic?
—Does the person hoard objects when she/he did not do so before?
—Has the person recently developed trouble regulating smoking, alcohol, drug intake or gambling, or started shoplifting?
—Does the person say rude or crude things or make lewd sexual remarks that she/he would not have said before?
—Has the person started talking openly about very personal or private matters not usually discussed in public?
—Does the person report or act as if seeing things or hearing voices?
With files from the Associated Press