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Understanding Memory, Cognition, and Dementia · Meaningful Medicine with Novant Health

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Melanie (Host): Welcome to Meaningful Medicine, a Novant Health podcast bringing
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you access to leading doctors who answer questions they wish you would ask.
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From routine care to rare conditions, our physicians offer tips to navigate medical
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decisions and build a healthier future.
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I'm Melanie Cole.
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And today, we're learning about memory, cognition, and dementia.
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Is it forgetful or something more?
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Joining me is Dr.
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Robert Wiggins.
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He's a neurologist with Novant Health.
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Dr.
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Wiggins, welcome to the show.
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Thank you so much for joining us today.
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I'd like you to start by telling us a little bit about memory loss.
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Is this something that is a natural part of aging?
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Is it inevitable?
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I mean, because I'm 62, and I am noticing myself forgetting words,
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forgetting things all the time.
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What's considered normal forgetfulness?
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And, you know, when does it become something more concerning?
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Robert Wiggins, MD: Of course, we all feel that way, right?
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I mean, even I think that I'm forgetting names more often, forgetting
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to do this or forget to do that.
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And there is this process we call normal cognitive aging, which is effectively just
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the brain is taking a little bit longer to make those connections than it used to.
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And, and that is very normal.
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So whenever people talk about things like forgetting, the names, the, the words on
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the tip of my tongue, or I lost my keys, or I can't find my keys, or I just wish
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that I could be quicker and sharper.
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Unfortunately, those are pretty normal.
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That's part of normal cognitive aging.
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When we start to be concerned or really start wanting to hear a little bit
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more about those symptoms is whenever someone's cognitive changes actually
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start to impact their daily functioning.
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So, for example, rather than just, losing the keys for, you know, thirty minutes,
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an hour or so, it's more that someone loses their direction or their-- where
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they're going while they're driving.
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They get lost while driving or, maybe you put the, the ketchup in
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the freezer or something, rather than that it's leaving the stove on.
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And so it's this much more meaningful, impactful, impairment of our independent
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cognitive functioning that we really start to, to be concerned about.
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And, and, and, and there's a lot going on there we can talk
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about
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Melanie (Host): Yeah, I mean, it's pretty scary.
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I mean, even those little things you were talking about can be scary.
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We all get scared, and we've heard this term dementia.
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We also hear Alzheimer's disease.
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Can you just tell us a little bit about this umbrella that
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the disorders of cognitive function really exist underneath?
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How is dementia and Alzheimer's different?
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How do they go together?
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Robert Wiggins, MD: Yeah.
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So, the way I like to look at it is the larger umbrella
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would be cognitive impairment.
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And we really have two major, areas where you can kind of fall into, and
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one is called mild cognitive impairment.
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What that means is that on a test, you may have some impairment of your test numbers.
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When we really kinda grill you hard, you have some issues, but you're not
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necessarily having impairment of your independent cognitive functioning.
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That's mild cognitive impairment.
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Now, once someone's also has impairment of their daily functioning, so they
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have more trouble with a checkbook or they, have trouble with cooking, they
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can't shop, that becomes more impairment of cognitive function, and that's
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when we go to a term called dementia.
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Now, you mentioned one of the many types of dementia called Alzheimer's disease.
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Alzheimer's disease is a type of dementia, and there are others.
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So for example, one is called Lewy body dementia or dementia with Lewy bodies.
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Another one is called frontotemporal dementia.
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There's a vascular dementia.
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There's a wide swath of different types of dementia, but the thing
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that links those dementias together is they all have impairment of
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independent cognitive functioning.
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And then, uh, once we've kinda decided, oh, this person has
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dementia, then we start the work to try to figure out, well, why?
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What, what, what's the cause here?
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Is it one singular cause or is it multiple causes?
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And that starts to impact what we can actually do to try to help
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people make them feel better, and in a few cases, try to slow down
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that progress, that progression
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Melanie (Host): And we'll get into that in a minute, but how do you
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determine what's going on, Dr.
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Wiggins?
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Is, is this a one-time pattern when you're doing an evaluation?
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Is this something that takes time to diagnose?
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Is there a test?
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Does it show up on CT scan?
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How do we know if it's actually, you know, mild cognitive impairment or dementia
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or turning into something more serious?
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Robert Wiggins, MD: typically we would be able to determine
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mild cognitive impairment versus dementia probably even in one visit.
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that's something that we can do based on testing in a conversation.
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When we're looking to figure out the more, uh, more kind of advanced specifics of
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what the etiology or what is the cause of the dementia, that may take a few extra
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tests and a few extra visits, we'll say.
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And what I mean by that is this.
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It's, it's not necessarily always easy to determine just by one
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brushstroke what the picture is.
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Sometimes we have to look at several brushstrokes, and so that
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could be an MRI of the brain.
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That could be different blood tests.
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More importantly perhaps, there is also a, what does your family say?
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What have they noticed is going on?
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What were the first symptoms that you had?
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Oftentimes these different types of dementias, though they end up looking
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very similar the more advanced they get, they start very differently.
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So someone who has trouble with or who's developing Alzheimer's,
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they're gonna definitely have that short-term memory issues.
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They're also gonna start having some executive functioning issues, where
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other conditions may not have the same.
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They may actually start with other issues.
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You may have something called hallucinations when you're seeing
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something that other people don't see that's not actually
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there earlier on in your course.
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At the end of all dementias, everyone can have hallucinations,
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but at the beginning, a lot of these dementias start very, very different.
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So that, that's the important part of really trying to get at what's
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the cause, and it's how did it start?
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Melanie (Host): So, it's really a lot of evaluation and determination by you as a
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neurologist and our physician figuring out all of these patterns and those changes.
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Now, if we notice these things in ourselves or in a loved one, which
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happens quite often where we start to notice in our elderly parents
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some things going on, what do we do?
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When does it become that conversation with the doctor?
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And what if the person that we love that's experiencing these things
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that we say, "Mom, you know, I'm noticing this or that," and they
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don't really want to get help.
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What do we do in these kinds of situations?
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Robert Wiggins, MD: Yeah, th-there's a lot of points there.
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The, the first thing that I would say is if you or others are noticing cognitive
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troubles, I would start taking notes.
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And what I mean by that is it's so, so often in my clinic when someone
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comes in and says, "Oh, there's so much I wanna talk to you about, but I
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can't remember what it actually was.
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I can't remember the stories, the examples."
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And so the strong recommendation would be to say, "Go ahead and start
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writing down what you're noticing."
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Don't just write down memory issues.
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Write down what you mean by memory issues.
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I, kinda laugh 'cause I think I get on my patient's nerves by
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asking, "What do you mean by that?"
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And then, "What, what do you mean by that?
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Really, what are the specifics of the situation?"
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So start taking notes.
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Then the typical next step is to go to your primary care physician or
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your primary care clinician and say, "Hey, here is what we're noticing."
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That primary care physician or clinician is gonna start saying,
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"Okay, well, are there any other non-dementia things going on?"
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They're gonna look at your medication list to try to see if there are any
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medications that are causing troubles.
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Oftentimes, there are medications that are kinda blunting our cognition.
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Maybe they're making us more sleepy and not really allowing our body,
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our brain to work at its best.
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So that could be medications.
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Also, things like depression and anxiety can really get in the
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way of our brain functioning.
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If you look at it like this, if, if our brains are like a computer, they
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can only take on so much at a time.
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And then you throw on really a meaningful, like anxiety or depression
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or stress, it's gonna be harder and harder for the brain to actually
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function on its normal, normal levels.
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And that does not necessarily mean you have dementia.
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It means that there might be things getting in the way.
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So that's the role of the primary care, clinician to look into these things.
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Typically, they will also check your thyroid and your B12 levels.
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That is the sign of a good primary care clinician or primary care physician, that
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they're looking at those because those are what the primary care associations really
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recommend the primary care doctor check to make sure that those are not contributing.
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They'll check B12 levels, thyroid levels, depression, anxiety medications.
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If we can't find an answer there, that's typically the time whenever
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they will refer to a neurologist.
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And that's when you really wanna come in with that list, and that's
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when you're gonna probably get a picture of your brain, an MRI.
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You can get a more in-depth, a more meaningful cognitive
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evaluation or cognitive screen.
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And we're really trying to figure out the question of, "Hey,
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what is actually going on here?
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Is it actually a dementia-like process, or is it more just what
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we call normal cognitive aging?"
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Melanie (Host): If the person that we love doesn't wanna come see you, do you
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have any advice for that conversation?
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Robert Wiggins, MD: I think that's partly why it's really important that
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a primary care physician is actually checking, uh, cognition every year.
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And so we, we oftentimes by doing those kind of annual, uh, scheduled regular
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screening exams at primary care, we can start to pick up on some early things.
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Otherwise, if someone still doesn't want to go to see the neurologist, what I like
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to do is say, "Okay, well, no, l-let's-- this is just part of a normal process.
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you're 80.
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We're gonna go get your memory checked.
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That's what we do."
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Or I sometimes say, "Well, maybe you go get your memory checked too.
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Have your memory checked, and then have their memory checked."
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It could be kind of viewed as part of the, um, the issue.
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I also sometimes recommend caregivers say something like, "You know,
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maybe you don't have a problem.
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But let's just go get it checked, and if, if you're sure that you don't
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have a memory problem, prove it.
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This is your time to shine, right?
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You can-- They're gonna, they're gonna assess it."
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And, and I think that's important is, trying to not necessarily be
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adversarial, but say, "Hey, let's-- Yeah, okay, maybe you don't.
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Let's go see.
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You know, I'm concerned, but maybe I'm not a doctor.
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Let's, let's get that taken a look at."
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And, and I think it's important that we're really trying to focus on this idea of
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it, it's not about me, i-it's about you.
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I, I want you to have the best quality of life.
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I want you to be with it.
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I want you to enjoy time with your grandchildren.
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You know, in your last years of living, I want them to be great.
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Let's see what we can do about it to make your
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life even better
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Melanie (Host): Those are all great suggestions.
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I went myself and I messed up to have a cognitive test and I messed up the box.
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You know, the 3D box.
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And I got home and my kids were like, "Really, Mom?"
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'Cause I was going like this, you know, and they're like,
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"Two things, connect, connect."
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I'm like, "Oh."
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But otherwise, I did pretty well.
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Now, when we think of these actual conditions, Dr.
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Wiggins, are there treatments?
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Are there-- You mentioned earlier, can we slow down progression?
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Tell us what's exciting in your field right now that can help people with
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whether it's slowing it down or just some of those symptoms that go…
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And then there's comorbid conditions that go along with some of these
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cognitive impairment disorders
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Robert Wiggins, MD: Yeah.
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Could we talk about maybe what to do before you even have an issue?
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Because I think that's a really nice place to start, because we
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all potentially will have cognitive issues or dementia in the future.
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We're all, we're all potentials, right?
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And so what we should do in the here and now is focus on cardiovascular exercise,
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a good nutritious diet, particularly the MIND diet, M-I-N-D, that's very important.
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Staying very, cognitively active, so not just watching TV, but
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really challenging the brain.
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This is the time when most people ask about crossword
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puzzles, Sudoku, et cetera.
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All those are good, but we really like to say, got to be engaged.
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So not just doing the crossword puzzle, but like interacting
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socially, going to events.
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You know, really trying to s-stay up with all the things going on at work.
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That's cognitive engagement.
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And then as you mentioned, comorbidities, really making sure that you're following
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with your primary care physician, because making sure the blood pressure is checked,
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diabetes numbers are low, blood sugar, et cetera, those are all really important.
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Those are all part of something called the brain health recipe, which is
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actually proven recently, uh, via a study, called the US POINTER trial
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from the, um, Alzheimer's Association, showing that these are the four
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things we can do to try to reduce the chance of cognitive impairment.
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Now, let's say then someone does in the future is diagnosed with dementia.
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If it's Alzheimer's disease, we typically turn to a few different pills that
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will help the symptoms of Alzheimer's disease try to almost like be a little
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bit of an oil change, just to try to help the engine run a little bit better.
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and that's honestly all we had for a long time.
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But here in the last few years, we have much more exciting new things going on.
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There are actually two different infusion therapies Rather than treating the
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symptoms, are actually trying to slow down the progression of Alzheimer's disease.
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So unfortunately, we know that Alzheimer's disease does worsen.
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But with some of these therapies, we can try to slow down that worsening by up
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to about a third over about 18 months.
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And the important thing there, Melanie, is it's not just, oh,
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you'll do better with the box, or you'll do better with the testing.
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It's that life can be better, that you'll be able to be more tuned in, more engaged.
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That's more high school graduations that people can attend.
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that's more hours, hours of pickleball people can partake in.
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That's more good life that we can live.
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And so it's not just about the numbers.
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It's not just about the study.
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It's about giving people more life.
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And that's really the role of these therapies to try to help
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with Alzheimer's disease, really try to slow down the progression
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Melanie (Host): Wow, that was really some great advice.
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And when we think about the brain health that you were talking about
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and lifestyle, cardiovascular, all the things that go along with it, you know,
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we need to stop looking stuff up all the time when we can't come up with
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the word or the actress or the name of that movie or the, the song name.
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We always go right to the internet and look something up, and I'm
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trying not to do that these days.
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I'm trying to make my gray matter work a little bit harder in there and say,
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"Okay, I gotta-- W- w- what was that?
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I gotta come up with it myself."
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So I think that your advice is right on, that we really need to work that
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so we can attend those functions.
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Now, one of the things that I feel is so important when we
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think of these disorders, Dr.
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Wiggins, is the caregivers, because as these progress, whether it's Lewy
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body or Alzheimer's, whatever it is, these take an incredible toll on the
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caregivers because there's, there's agitation that goes along with it.
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There's, you know, I mean, there's so much that is heartbreaking to
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watch someone go through, but the caregivers themselves, it's tough, man.
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So give us some advice for those people.
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Robert Wiggins, MD: I think one of the first things that we like to recommend
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when someone has been diagnosed with dementia, particularly the caregiver,
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is let's start asking the question kind of who is your team, right?
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And so rather than having to find a team in a few years when
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things may be worsening, go and find your team now, right?
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That team, of course, is made up of the doctor, hopefully the clinic's
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nurse, a case manager, social worker.
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Those are all things that we are really trying to put in place.
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But it's also, okay, are your children, for example, do they
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live close or do they live far?
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Are they gonna be able to help at nighttime, or are they gonna only be
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able to help with, like, phone calls?
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Local friends, church members, friends, family, that kind…
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Those are the…
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We need to try to kinda create that, that team early on.
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The other thing, and we talk about this a lot, of course, the, the
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typical phrase is you can't help others before you help yourself.
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And so going back to that brain health recipe, even for the caregiver trying
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to focus on, hey, make sure you're getting good exercise, make sure that
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you're sleeping well, make sure that you are eating well, all those things,
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because you gotta take care of yourself.
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You gotta make sure that you yourself are not developing, um, you know, issues.
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And I think that's a good, a little test, so to speak, of
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are you able to do these things
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yourself?
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Now, it's always fine to ask for help, and I really recommend, caregivers
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start practicing asking for help.
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Asking for help is not a sign of weakness.
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It's a sign of strength because you know what your loved one, what your
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husband, what your wife, what your, your father, mother needs, and you know
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that you're not able to provide that.
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And it's actually a good thing to try to ask for help and get them what
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they need because it's something you
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need too
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Melanie (Host): hear.
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hear.
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That's all really great advice.
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And we do have to put on our own masks, as it were.
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We have to take care of ourselves, and especially women.
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We're the caregivers to society, and if we don't care for ourselves, we're not going
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to be able to care for those we love.
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A- and if it's us, then we certainly have to do all the things you've talked about.
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Dr.
17:45
Wiggins, what a great discussion we're having today.
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As we wrap up, for people that are feeling a little anxious, they're
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worried maybe it's genetic, runs in the family, give us some guidance,
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reassurance about these kinds of disorders a- and what you tell your
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patients every day as your best advice
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Robert Wiggins, MD: Yeah.
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So one of the things I think most important is to really
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turn back to the science.
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Go to the things we know, follow the brain health recipe from the US Pointer trial.
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We know that and we rely upon that.
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That's really important.
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What we don't wanna do is make ourselves more anxious by just looking at every
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source, buying every supplement, buying every unproven treatment.
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Those things won't help.
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I think the brain health recipe is a good place to start.
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I think also the thought here is this, is that we're not just trying
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to prevent dementia, we're trying to make our cognition better.
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And you said it earlier on, Melanie, the phones that we're using oftentimes are
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impairing our, our, our cognition, right?
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They're making us, lose attention, lose our ability to think.
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And so the thought here is treat yourself like an athlete.
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Are you doing everything you can to try to make your athletic performance or
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your cognitive performance, your brain health performance as good as possible?
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Don't worry about the future.
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Think about right now what you can do in the here and now to make your
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brain, to make your performance better.
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So that's sleeping, that's following the brain health recipe, that's putting
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the phone down for a few hours a day
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Melanie (Host): That is great advice.
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Dr.
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Wiggins, what a great guest you are.
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Thank you so much for joining us and sharing your incredible expertise for
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something that a lot of people think about, are concerned about, but you've
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answered so many questions today.
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Thank you so much for joining us.
19:32
And to find
19:33
a physician, you can visit novanthealth.org.
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And for more health and wellness information from our experts, you
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That concludes this episode of Meaningful Medicine, a podcast from
19:54
the specialists at Novant Health.
19:56
I'm Melanie Cole.