The D-word: no one wants to think about what life would be like if their loved one develops a form of dementia, and many are currently wondering if they are beginning to see early signs. According to the Alzheimer’s Association, someone develops that form of dementia every 67 seconds.
Early treatment can help slow the progression of some of the debilitating symptoms of dementia, but do you know what those early signs of dementia are? Two of the most familiar hallmarks of dementia are memory loss and mobility issues. Yet a 2009 study published in the Journal of Alzheimer’s Disease (JAD) showed that falling and problems with balance could be one of the earliest indicators yet, before memory issues even begin to show.
Progression of Dementia
Dementia is an umbrella term for multiple types of brain diseases that defines a decline in a person’s mental ability in such that it interferes with a person’s daily life and ability to live independently. As we age, it is common for some memory problems and mobility issues to arise. Yet if a person has dementia, these natural characteristics of aging are progressive and debilitating, far beyond the normal parameters of getting older. There is currently no cure for dementia, but early identification, intervention, and treatment may prove beneficial in slowing down the progression of symptoms and preventing injury from a risk management point of view. This makes identifying the earliest signs, such as balance issues and falls, of utmost importance.
Stages of Dementia Have a Common Thread: Memory and Motor Problems
Have you ever been in your home and thought to yourself that you wanted to make a sandwich and just automatically made your way to the kitchen without thinking about it, meanwhile weighing in your mind whether you wanted turkey or ham and whether there was any lettuce leftover in the refrigerator?
As memory issues arise, the risk of injury due to falling also increases.
We use our memory unconsciously all the time. Yet memory influences just about everything we do. The three stages of dementia all involve memory to a great extent. As dementia progresses, memory issues become more noticeable, and the risk of falling also increases. According to a study by researchers Allan, Ballard, Rowan, and Kenny (2009) older people with dementia are eight times more likely to fall than older people who are not diagnosed with a dementia. As memory issues arise, the risk of injury due to falling also increases.
The beginning stage of dementia is often identified as a gradual decline in memory that presents in losing track of time and becoming lost in familiar places. Falling becomes a greater than normal risk when certain medications are implemented and other health complications develop that coincide with aging. This beginning stage is often overlooked and symptoms are attributed to “just getting older”.
The middle stage is a progression of forgetfulness, including forgetting familiar names and faces and even having trouble communicating. People in the middle stage of dementia also begin needing help with taking care of themselves and are prone to wandering. Fine motor skills begin to degrade and mobility issues make falling a significant injury risk. Most people get diagnosed at this stage, when considerable care is needed.
The late stage brings about behavioral changes that make independence impossible. Aggression and uncharacteristic behavior are common. Late stage sufferers will become completely unaware of location, time, or loved ones’ identities. Eventually all mobility is lost as a result of muscle wasting, and death ends the disease.
Characteristics of Dementia Naturally Point to a Reasonably Early Identifier
Knowing the progression of dementia helps researchers and caregivers better understand the risk factors involved and how to minimize them. The unfortunate reality is that by the time loved ones and care providers notice the warning signs of dementia, it has already had a significant impact. What if there was a way to identify the very earliest of dementia signs before the initial onset of daily symptoms associated with it appear? What many studies are finding is that physical signs often overlooked as natural to getting older, could in fact be the very beginnings of a dementia disorder.
The idea that “conscious” or working memory is not the only affected part of our cognitive functioning has prompted some researchers to look into the link between simple balance performance and cognitive decline. Autonomous memory that assists us with such taken for granted tasks as facial recognition and, say, walking to the kitchen, body awareness in space, and the ability to balance as a result of that body awareness, as well as other cognitive processes, are all dependent upon a memory base or reservoir. Dementia is a known risk factor for falling, but it could be that an increase in problems with balance is actually one of the precursors to an impending onset of dementia, almost like the dog who instinctively runs in circles before the earthquake.
Researchers in Amsterdam published a study in 2009 in the Journal of Alzheimer’s Disease (JAD) on the topic of whether or not balance tests are effective at predicting typical cognitive decline associated with dementia. What they found was that the link between physical balance and cognitive decline was confidently established. In fact, the results concluded that the failing of a one-legged balance test–the ability of participants to stand on one leg for five seconds or more–corresponded to high risks of rapid cognitive decline associated with dementia within as little as 12, 18, and 24 months.
Poor Physical Performance and Increased Risk of Alzheimer’s and Dementias
Wang, Larson, Bowen, and van Belle conducted a study published in 2006 to determine if there was any link between the level of physical ability and the risk for onset dementia and Alzheimer’s Disease. The researchers studied 2,288 people over the age of 65 over the course of seven years. Of those individuals who scored poorly on the physical performance tests, 319 participants had developed dementia; 221 of them were specifically diagnosed with AD. The results were clear in that lower physical performance levels were directly related to an increased risk of dementia and even suggested that poor physical functioning may precede the onset of dementia and AD.
The finding is well within previous multivariate studies, as summarized by Allan, Ballard, Rowan, and Kenny (2009), all of which concluded that significant risk factors for falling are largely characteristic of dementia symptoms. Some of those factors include visual and cognitive impairment, mobility impairment, balance and gait impairments, muscle weakness, and incontinence. The evidence in these studies supports the assumption that known balance problems should be considered a particular risk for developing dementias and particularly dementias with Lewy Bodies (DLB), a dementia characterized by the damaging microscopic deposits causing brain damage. DLB is the third most prevalent form of dementia and accounts for roughly 10 to 25 percent of cases at any given time, including AD.
There is no denying the direct link between falling and dementia…
For decades, researchers have been looking for more answers. They have looked at biomarkers, cardiovascular health, diet, dental health, blood sugar levels, and other risk factors to better understand what causes the onset and how to best treat and possibly cure the brain disease. There is no denying the direct link between falling and dementia, but as of now more research still needs to be conducted in order to alter policy making and hopefully provide another early diagnostic tool, such as a one-legged balance test in annual well-care visits.
Mitigating the Risk Factor
More research is still needed to make a positive impact on dementia sufferers and their caregivers. Until more funding and research can be carried out, the responsibility of identifying risk factors lies with those who are closest to dementia sufferers. The Alzheimer’s Association has published a nationally recognized chart identifying the 10 earliest signs of AD and other dementias. Knowing them could allow early identification that would enable families and caregivers to best protect older people and get them treatment to help slow down some of the progressive symptoms.
The Alzheimer’s Association’s list of the 10 earliest warning signs of Alzheimer’s and other dementias is as follows, reproduced here for the convenient of our readers:
- Memory problems that cause a disruption to daily routines
- Challenges in problem solving and planning
- Trouble completing familiar tasks in the home or at work
- Confusion with location and passage of time
- Trouble understanding spatial relationships and the meaning of visual images
- Progressive problems with writing and/or speaking
- Loss of ability to retrace steps to find misplaced objects
- Decline in judgment calls with regards to money and hygiene
- Social withdrawal
- Personality changes and mood swings
If you notice any of these symptoms, including balance disruptions and frequent falls, it is time to discuss the next step in seeking evaluation and clinical care from a physician. According to the Alzheimer’s Association, one out of three seniors will die from dementia. Paying closer attention to balance problems could not only prevent injurious falls, it can also provide a higher quality of life associated with early dementia intervention.
Allan, Louise M., Ballard, Clive G., Rowan, Elise N., Kenny, Rose Ann. (May 13, 2009). Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People. PLoS ONE, 4(5): e5521.Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677107/. Retrieved February 15, 2016.
Alzheimer’s Association. What Is Dementia? Available at http://www.alz.org/what-is-dementia.asp. Retrieved February 15, 2016.
Alzheimer’s Association. 10 Early Signs and Symptoms of Alzheimer’s. Available at http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp. Retrieved February 15, 2016.
Alzheimer’s Association. (2015). 2015 Alzheimer’s Disease Facts and Figures. Available at http://www.alz.org/facts/. Retrieved February 15, 2016.
Rolland, Yves, Gabor, Abellan van Kan, Nourhashemi, Fati, Andrieu, Sandrive, Cantet, Christelle, Guyonnet-Gillette, Sopie, Vellas, Bruno. (March 10, 2009). An Abnormal “One-leg Balance” Test Predicts Cognitive Decline During Alzheimer’s Disease. Journal of Alzheimer’s Disease (JAD) 16(3). Retrieved February 15, 2016.
Wang, L., Larson, E.B., Bowen, J.D., van Belle, G. (May 22, 2006). Performance-Based physical function and future dementia in older people. Archives of Internal Medicine, 166(10):1115-20. Available at http://archinte.jamanetwork.com/article.aspx?articleid=410366. Retrieved February 15, 2016.
WHO. Dementia. Available at http://www.who.int/mediacentre/factsheets/fs362/en/. Retrieved February 15, 2016.