Along with worrisome memory lapses, sudden and long-time changes in behavior or personality may be a harbinger of chronic brain disorders collectively known as dementia, a new study suggests.
On July 24, a team of experts from Canada outlined a newly identified cognitive syndrome — "mild behavioral impairment" — branching off from dementia.
Mild behavioral impairment may be an early indicator of dementia such as Alzheimer's disease, they say.
To help detect this early syndrome, researchers had proposed a checklist of symptoms that could alert physicians, patients and families.
The main goal is to measure and recognize something that some scientists believe is often overlooked: sharp changes in mood and behavior.
Experts believe that these symptoms may come before the onset of memory and thinking problems, which are the markers of dementia.
The questionnaire, which contains 38 points to consider, includes the following:
1. Has the person become temperamental, agitated, aggressive or irritable?
2. Does the person have unrealistic beliefs about his/her wealth, skills or power?
3. Does the person no longer care about anything and has lost interest in his/her favorite activities?
4. Is the person suddenly making crude comments in public?
Neuropsychiatrist Zahinoor Ismail, an expert from the University of Calgary who presented the checklist at the Alzheimer's Association International Conference, says all the symptoms stated above have been considered a psychiatric issue or just a mere part of aging.
Ismail says that when it comes to the detection of dementia, lapses in memory may not "have the corner on the market anymore."
Nina Silverberg, the director of the National Institute of Aging's Alzheimer's disease program who was not involved in the creation of the questionnaire, believes we "need something" like it.
"Most people think of Alzheimer's as primarily a memory disorder," says Silverberg. "But we do know from years of research that it also can start as a behavioral issue."
Under the new proposal, mild behavioral impairment will be classified as a clinical designation that precedes mild cognitive impairment.
The latter is a diagnosis created years ago to describe people who have been experiencing cognitive problems but can still perform daily activities.
Ismail says reports and anecdotes have indicated that behavioral and emotional changes were "a stealth symptom" of dementia. It means that these changes were part of the progression of the disease.
He says whatever it is that erodes thinking and memory skills may also be leaving an impact on the systems of emotional regulation and self-control in a person's brain.
Furthermore, if two patients were diagnosed with mild cognitive impairment, the person with behavior or mood changes often progresses to full-blown dementia faster than his or her counterpart.
In fact, patients with behavioral and mood changes fare much worse over time and after death: autopsies show they experience more brain damage, says Ismail.
Still, he underlined the fact that not everyone with behavior or mood changes is suffering the early signs of dementia.
To be classified as mild behavioral impairment, the symptom should last for six months and beyond. It should not be a "blip" in behavior, but a deeper, fundamental change.
If the checklist is validated, doctors may soon better identify the people who are at risk of Alzheimer's disease, and investigate how the changes progress over time.
Photo: Tim Regan | Flickr