When it was clear my father had dementia, I started to wonder about my own memory. I've had trouble finding words in the last few years. Just this week, I couldn't retrieve the word "charger" from my brain's database for two days. The fact that I couldn't remember the word for a large decorative plate wasn't life-threatening, but it bothered me. I'm starting to have problems navigating familiar streets, and appointments and must-do items seem to fall off my radar screen altogether. Last night I left a carton of ice cream in the microwave instead of in the freezer.
I blame my memory problems on several factors: lack of sleep, the stress of Dad's illness and death piled on top of other family crises, and trying to keep up with more people than any human was meant to know.
But I worry that these are the first signs of my cognitive decline. Maybe next month I'll have trouble balancing my checkbook, and in December won't be able to match names to faces. By spring, I could be in a nursing home. Dementia paranoia is setting in.
Dementia paranoia changes how I see things. Take the dinner we gave for a family member's 85th birthday the other night - a nice event by any standard. But during the dinner, my fiance John triggered my problem with the word "charger" by calling the decorative plate a "racer." I figured this was a sign he's also on the track to cognitive dysfunction. While John was mumbling about "racers," the normally sharp birthday girl was repeating a story she had told us five minutes before. I wondered if she's developing serious memory problems. Meanwhile, our neighbors stopped by with their aging dachshund. The dog's routine is to hunker down by our front door and bark until we bring her a special organic dog biscuit. That night she sat by the front door, but forgot to bark. In fact, she didn't seem to remember the cookies at all. Seeing dementia everywhere, I diagnosed canine cognitive impairment.
So when I found an abstract of an article in Lancet Neurology about a risk score for the prediction of dementia in 20 years among middle aged people, I immediately took the test. After weighing the factors that make up the score - blood pressure and cholesterol levels, body mass index, education level, exercise habits, gender and age - I was pleased to find I scored 4 on a scale of 15. According to the article, a score of 4 means I have less than a 1% chance of developing dementia in the next two decades.
Then I went back and calculated my father's score at my age. He would have scored a 5, one point higher than me, due to the fact he was male. A score of 5 still predicts a less than 1% chance of developing dementia in the next twenty years. But in fact, he was showing the first signs of dementia 18 years later.
Developed by the Karolinska Institute in Sweden, the scoring system is based on a study of 1409 Finns, who were first examined in middle age, then re-examined for signs of dementia twenty years later. The seven components that make up the dementia risk score were associated with significantly higher rates of dementia in the group of Finns. The fact that four out of the seven components are related to heart health seems to confirm results of other studies showing that cardiovascular factors have a big influence on your chances of developing Alzheimer's disease.
This risk score may be a good first step towards screening people for dementia risk, but I'm not relying on it. Like most things about dementia and Alzheimer's research, the relationship between heart health and dementia is fuzzy. For example, high cholesterol adds two points to your risk score, but recent research shows that cholesterol levels tend to decline a few years before the onset of Alzheimer's disease.
Despite my respectable risk score, my dementia paranoia continues. I've started to rely more on electronic tools to supplement my brain. Directions from MapQuest help me navigate, and my PDA reminds me about appointments and to-do items. But there are some things technology can't fix: did I tell you I left an ice cream carton in the microwave?