A nationwide study of memory loss and pre-dementia has good news for one of its first recruits, Graeme Newton. We profiled him in our April 2017 issue, and later sat in on his annual reassessment. Donna Chisholm reports.
Three years after being diagnosed with mild cognitive impairment, Graeme Newton was convinced his memory was getting worse. Names of people he’d met and plants he tended in the garden were eluding him more, and he struggled with the mental arithmetic at which he’d once been so adept.
It wasn’t for want of trying to do what all the textbooks advise for people with pre- dementia; as one of the first participants in the country’s new Dementia Prevention Research Clinics, Newton knows the importance of keeping physically active, socially connected and mentally agile – and he works hard at all three.
So when he meets neuropsychologist Dr Christina Ilse at the Auckland Universitybased Centre for Brain Research for his annual reassessment, Newton is blunt about his deterioration. “I feel that I’ve declined.”
His wife Jay agrees, he says, noting he’s become more verbally aggressive because of his frustration, when he is usually very mild-mannered.
“She has difficulty because she doesn’t know what I might or might not remember. Sometimes I’ll remember everything and sometimes I won’t, so there’s an inconsistency that she finds difficult to deal with.”
Things are worse when his mood is low; then “most of the day can disappear” without him knowing where exactly it went. But he realises it’s just an off day and his depression is unlikely to last.
Ilse tells him that’s a big positive. “Some people who have an episode of depression have a combination of symptoms, including reduced drive, having really sad thoughts about themselves and the future, reduced appetite and disrupted sleep. Then they feel tearful, shaky and upset.
“It sounds like you have just one – not feeling the get up and go – so that’s really reassuring. It’s okay to have a day like that and being able to say, today isn’t great, but tomorrow might be different.”
Big family occasions are now a thing of the past for him – trying to keep up with a conversation with multiple people has become just too hard. To celebrate his 75th birthday in June, they went out to dinners with a couple of good friends at a time, rather than having everyone come to a party.
Newton manages his memory loss by keeping multiple lists and diary notes. He says he’s become adept at not dwelling on it when he forgets a name or task but feels less confident driving to places he doesn’t know well. “A year ago, I’d rate myself 8/10. Now I’m getting down to a 6.5. I still think I’ll get there, but just thinking about it is an issue.”
Ilse says she’s trying to work out whether Newton’s memory has in fact declined, or whether he’s just become more worried about it. Newton believes there’s a bit of both, and that although the deterioration is hard to quantify, it’s definitely happening.
Self-assessments vary in accuracy, explains Ilse. “We get some people who report no difficulties but their partner reports them and the tests show difficulties, so the person has reduced awareness of the problems. We also have situations where a family member reports problems, but the person doesn’t and the tests show no difficulties, so perhaps the family member is picking up stuff that is not even there.”
For Newton, the results, when they come in, are good news: the objective tests show no evidence of decline, despite his and his wife’s perception of change. Although his memory is impaired, “attention, processing speed, general verbal and visuospatial abilities and executive function remain intact”.
It’s encouraging news, says Newton, who says he’s hoping to at least maintain his current functioning, or even improve, ahead of the 2018 tests, which will include a brain scan.
He’s chosen to share his progress to help raise awareness and understanding of mild cognitive impairment in the community.
Estimates vary as to how many people with MCI will go on to develop Alzheimer’s disease or other forms of dementia. Some studies suggest 5-15 per cent a year, while one metaanalysis found more than 60 per cent had not developed dementia 10 years after being diagnosed. It’s estimated around 50,000 New Zealanders have dementia and the figure is predicted to top 150,000 by 2050.
Dementia Prevention Research Clinics are being set up in Auckland, Dunedin and Christchurch with the establishment of Brain Research New Zealand, a Centre of Research Excellence, in 2015.
Graeme Newton manages his memory loss by keeping multiple lists and diary notes.
Neuropsychologist Dr Christina Ilse at the Centre for Brain Research in Auckland. She told Newton she had to work out whether his memory had declined, or whether he’d just become more worried about it.