혹시 나도?..."건망증과 치매 구분법" Is It Ordinary Memory Loss, or Alzheimer’s Disease?

Is It Ordinary Memory Loss, or Alzheimer’s Disease?

BY JANE E. BRODY

Soon after her 65th birthday, a close friend became increasingly worried about her memory, wondering if she could have the beginnings of dementia.

Although she seemed to have no more difficulty than the rest of us her age in remembering events, names and places, her physician suggested that, given her level of concern, she should have things checked out.

MELISASource

혹시 나도?..."건망증과 치매 구분법"    뭔가를 잊는 일이 잦아진다면 자연스러운 노화 과정의 일부분일 수도 있고, 알츠하이머 치매의 초기 징후일 수도 있다. 치매를 일으키는 대표적 퇴행성 뇌질환인 알츠하이머병은 65세 인구에게서 주로 나타나는데, 한 번 발생하면 되돌리기 어려운 질병이다. 하지만 자주 망각하는 현상을 보인다고 해서 모두 치매는 아니라고 전문가들은 말한다. 우울증, 약물 부작용, 알코올 남용, 비타민 B12 부족, 갑상선(갑상샘) 기능 저하증, 사별이나 은퇴로 인한 걱정이나 스트레스 등도 기억력 손실을 일으킬 수 있다. 기억력이 떨어진다고 해서 이를 치매로 단정 짓기보다는 노화로 인한 기억력 손실과의 차이를 알아두는 것이 보다 정확한 증세를 판단하는데 도움이 된다. 이와 관련해 ‘웹 엠디’가 노화로 인한 일반적인 기억력 손실과 치매 징후간의 차이점을 분석했다. 1. 전자기기 사용법을 잊었다 자주 쓰지 않는 TV 리모컨이나 오븐 사용법이 헷갈려 다른 사람에게 묻는 것은 충분히 있을 수 있는 일이다. 하지만 평소 익숙하게 사용하던 전자기기의 단순한 사용법이 헷갈리기 시작했다면 이는 병적인 기억력 손실과 연관이 있을 수 있다. 2. 똑같은 것을 자꾸 물어본다 오늘 계획했던 일을 깜빡했지만 나중에라도 다시 떠오른다면 크게 걱정할 수준이 아니다. 그런데 가족이나 친구에게 자꾸 자신의 계획을 묻거나 혼자 할 수 있었던 일을 대신해 달라고 반복해서 부탁하는 상황에 이른다면 치매 징후일 수 있다. 3. 계산을 잘 하지 못한다 가계부를 정산하는데 약간의 계산 착오가 생기는 정도는 있을 수 있는 실수다. 하지만 쉽게 정리했던 월말 청구서나 영수증을 정리, 계산하는데 어려움을 느끼기 시작했다면 이는 걱정해야 할 단계일 수 있다. 4. 위치 감각이 없어진다 오늘이 며칠인지 깜빡했지만 달력을 본 뒤 혹은 누군가에게 날짜를 물은 뒤 기억이 난다면 걱정할 수준이 아니다. 반면 자신이 현재 있는 위치가 어디인지 헷갈리거나 이곳에 어떻게 도달했는지 모르겠다면 우려할 수준이다. 5. 틀린 이름을 말한다 상황에 맞는 적절한 단어가 곧바로 떠오르지 않는 건 누구에게나 있을 수 있는 일이다. 하지만 다른 사람의 이름을 잘못 부른다거나 사물의 이름을 잘못 알고 있다거나 본인이 현재 무슨 이야기를 하고 있는지 감이 오질 않는다면 병원을 방문하는 것이 좋다.   정책브리핑 edited by kcontents 6. 엉뚱한 행동을 한다 간혹 안경이나 열쇠를 어디에 뒀는지 기억이 안 날 때가 있다. 하지만 냉동실처럼 전혀 예상치 못한 엉뚱한 장소에 뒀다거나 다른 사람의 물건을 잘못 가져오는 일이 자주 한다면 이는 치매의 조기 증상일 가능성이 있다. 7. 작은 변화에도 분노를 표출한다 일이 자신이 계획했던 방향과 다른 쪽으로 전개되면 누구나 화가 나거나 짜증이 날 수 있다. 그런데 규칙적인 일과에 사소한 변화가 생겼을 때도 극도로 화가 난다거나 우울증에 빠진다거나 불안하고 두려운 감정에 빠진다면 이때는 병원을 방문해보는 것이 좋다. 8. 모든 것에 흥미를 잃는다 직장이나 가정에서 책임져야 할 자신의 일이 번거롭고 지칠 때가 있다. 그런데 이전에 좋아했던 취미나 사교 생활조차 유지하기 힘들 정도로 귀찮아졌다면 이때는 자신의 변화된 행동에 주목해야 할 시점이다. 9. 갑자기 청결 관리에 둔감해진다 평소 청결에 신경 썼던 사람이 갑자기 몸, 옷, 실내 환경이 불결해도 신경을 쓰지 않는다면 치매를 의심해 볼 일이다. 갑작스런 불결함은 치매 초기 증상을 알려주는 신호다. 권순일 기자 코메디닷컴 케이콘텐츠

edited by kcontents

So she consulted a specialist at Mount Sinai Hospital in New York and had a full-blown neuropsychological assessment — two days of tests of her cognitive abilities. The dozen measures included I.Q. and memory scales, auditory learning and animal naming tests, an oral word association test, a connect-the-dots trail-making test, and a test of her ability to copy complex figures.

The result: reassurance and relief. Everything was in the normal range for her age, and she registered as superior on the ability to perform tasks and solve problems.

Fears about memory issues, commonplace among those of us who often misplace our cellphones and mix up the names of our children, are likely to skyrocket as baby boomers move into their 70s, 80s and beyond.

Many may be unwilling to wait to have their memories tested until symptoms develop that could herald encroaching dementia or Alzheimer’s disease, like finding one’s glasses in the refrigerator, getting lost on a familiar route or being unable to follow directions or normal conversation.

But nor do people have to endure the extensive assessment my friend had. Simple tests done in eight to 12 minutes in a doctor’s office can determine whether memory issues are normal for one’s age or are problematic and warrant a more thorough evaluation. The tests can be administered annually, if necessary, to detect worrisome changes.

However, according to researchers at the University of Michigan, more than half of older adults with signs of memory loss never see a doctor about it. Although there is still no certain way to prevent or forestall age-related cognitive disease, knowing that someone has serious memory problems can alert family members and friends to a need for changes in the person’s living arrangements that can be health- or even lifesaving.

memory-loss-alzheimers-dementia/MemoryHealthCheck

edited by kcontents

“Early evaluation and identification of people with dementia may help them receive care earlier,” said Dr. Vikas Kotagal, the senior author of the Michigan study. “It can help families make plans for care, help with day-to-day tasks, including medication administration, and watch for future problems that can occur.”

Long the most popular screening test for memory disorders used by primary care doctors is the Mini-Mental State Exam, or MMSE, an eight-minute test in use since 1975. But neurologists say it is less discerning than the slightly longer Montreal Cognitive Assessment, or MoCA, introduced in 1996.

Both tests measure orientation to time, date and place; attention and concentration; ability to calculate; memory; language; and conceptual thinking. But while the MMSE is considered adequate for routine testing of cognitive function by the family doctor, its score can be skewed by a person’s level of education, cultural background, a learning or speech disorder, and language fluency. And according to Dr. Roy Hamilton, a neurologist at the University of Pennsylvania, this test is not sensitive enough to detect signs of mild cognitive impairment.

Furthermore, the MMSE doesn’t test for problems with executive function, defined as the ability to organize, plan and perform tasks efficiently to reach a particular goal.

“Executive function is typically the first area to suffer if you develop cognitive impairment,” Dr. Sam Gandy, the director of the Mount Sinai Center for Cognitive Health and of the N.F.L.’s neurological care program, reported last month in the School of Medicine’s newsletter, Focus on Healthy Aging. “Translated into everyday life, it’s executive function that enables us to carry out activities of daily living, such as dressing and preparing meals.”

The Montreal Cognitive Assessment, which takes 10 to 12 minutes, is more difficult and can pick up problems the MMSE might miss, Dr. Hamilton has noted. It is also more sensitive, better able to discriminate between normal cognitive function and mild impairment or dementia. Still, many memory clinics and neurologists use both tests, along with others like those taken by my friend.

The Montreal test has 11 sections and a possible total score of 30 (25 or better is considered normal). It includes an executive function test called alternating trail-making, in which lines must be drawn from numbers to letters in correct order, 1 to A, 2 to B, and so forth.

Measuring a person’s ability to follow verbal commands includes counting backward from 100 by sevens. To assess abstract thinking, the test asks a person to find common features between two words in each of three pairs. Verbal fluency, a vocabulary test, requires producing 11 or more words that start with a certain letter of the alphabet.

Copying a drawing of a cube and drawing a clock accurately assess so-called visuoconstructional skills, and memory is checked by having the person try to recall five words that were read aloud earlier in the test.

 

well.blogs.nytimes.com

Taking such a test can be quite stressful, although allowances are made for nervousness. But practicing by taking the test in advance of an evaluation can skew the results and hurt the person taking it in the long run.

The MoCA test has proved valid for assessing people who are not demented but could be at risk for developing progressive cognitive decline.

Keep in mind, however, that neither the MMSE nor MoCA are definitive. Rather, they can indicate the need for a more extensive exam like the one my friend had.

Also, it helps to know when not to worry about memory problems. Dr. Kirk R. Daffner, the director of the Center for Brain-Mind Medicine at Brigham and Women’s Hospital in Boston, lists six “normal” memory problems that should not cause concern: a tendency to forget facts or events over time, absent-mindedness, a temporary block in retrieving a memory, recalling something accurately only in part, having a memory distorted by the power of suggestion (the recalled memory may never have happened), and having a memory influenced by bias, experiences or mood.

https://well.blogs.nytimes.com/2015/05/18/tests-can-answer-fears-about-dementia/

kcontents