Navigating Memory and Cognitive Health: A Guide for Families Facing Dementia

When families gather, it can be a chance to notice changes in aging loved ones, including potential memory issues.

While some cognitive decline—such as occasional word-finding difficulties or minor memory lapses—is a normal part of aging, the warning signs of Alzheimer’s disease are much different, says David Gill, MD, Chief of the UR Medicine Division of Cognitive and Behavioral Neurology.

Here’s what Dr. Gill says to look for, along with guidance for families facing difficult conversations and decisions associated with memory and cognitive challenges.

Recognizing Early Signs of Dementia

Look for:

• Memory disruptions that interfere with daily life.
• Difficulty planning or solving problems.
• Challenges with familiar tasks.
• Confusion about time or place.
• Misplacing items with an inability to retrace steps.
• Poor judgment.
• Withdrawal from social or work activities.
• Significant mood or personality changes.

Identifying these signs early allows for timely clinical evaluation and care that can make a meaningful difference.

How Alzheimer’s Is Diagnosed

“Anytime someone is concerned about a loved one’s memory, they should contact the primary care provider (PCP) and ideally attend the appointment to provide context and history,” says Dr. Gill. PCPs can often conduct initial assessments and, if needed, refer patients to specialists for further evaluation, which may include:

• Lab tests
• Brain imaging
• Neuropsychological assessments

Once a diagnosis is made, a personalized treatment plan is developed to address medical, emotional, and social needs, including medication and non-medication approaches. Regular follow-up care ensures the plan remains effective.

When to Intervene

Questions about when to take action, such as taking away the car keys or managing finances, are best answered in collaboration with healthcare providers.

“Our role is to help families navigate these decisions and minimize confrontation between patients and caregivers,” explains Dr. Gill.

Establishing a power of attorney early can simplify financial and logistical decisions, allowing caregivers to set up automatic bill payments and change billing addresses. It can also include strategies to reduce the need for the person to drive.

Can Memory Loss Be Slowed or Even Reversed?

“We now realize up to 40 to 50 percent of all dementia is preventable, so starting in midlife, and maybe even earlier, we need to address the things that increase risk, such as quitting smoking and controlling blood pressure,” says Gill. Emerging evidence suggests that lifestyle changes can support cognitive health and potentially reduce memory loss. Steps include:

1. Physical Activity: Engage in regular exercise like walking, swimming, or gardening. Aim for at least 30 minutes of moderate activity most days.
2. Mental Activity: Participate in brain-stimulating activities such as puzzles, memory games, reading, or learning new skills. Memory training programs may also help.
3. Social Engagement: Maintain an active social life through clubs, volunteering, or group activities to reduce cognitive decline and enhance well-being.
4. Diet: Follow a Mediterranean diet rich in vegetables, whole grains, fish, and olive oil, while limiting saturated fats and added sugars.

Treatment Options for Alzheimer’s

Recent advancements have significantly improved the diagnosis and treatment of Alzheimer’s disease. New diagnostic tools, such as amyloid PET scans, cerebrospinal fluid analysis, and blood tests for phosphorylated tau, enable early and accurate detection—even before symptoms develop.

Breakthrough treatments, including monoclonal antibodies like lecanemab and donanemab, have shown promise in slowing disease progression in its early stages. While these therapies do not cure or reverse Alzheimer’s, they represent a major step forward. However, these treatments are costly and carry risks, requiring close monitoring by healthcare professionals.

How to Get Help

Support is available in our region through organizations like Lifespan’s Finger Lakes Alzheimer’s Caregiver Institute and the Rochester & Finger Lakes Chapter of the Alzheimer’s Association. These organizations provide information, resources, and support services for families, including assistance with legal documents and long-term care funding strategies.

URMC Alzheimer’s Research

• The University of Rochester Medical Center Alzheimer's Disease Care, Research and Education Program (AD-CARE), led by Anton Porsteinsson, M.D., has been involved in more than 200 clinical studies for Alzheimer’s disease since 1986. URMC served as a study site for the phase 2 and 3 clinical trials of lecanemab.
• Kerry O’Banion, PhD, and John A. Olschowka, PhD, with the Del Monte Neuroscience Institute, study how inflammation affects brain health, focusing on Alzheimer’s disease.
• Researchers in the Center for Translational Neuroscience, co-directed by Maiken Nedergaard, MD, were the first to describe the glymphatic system, the brain’s unique waste removal process. This breakthrough discovery could point to new therapies for Alzheimer’s.
• Giovanni Schifitto, MD, and his colleagues are studying how chronic inflammation in people with HIV—and more recently, people recovering from long COVID—drives cerebrovascular disease, increasing the risk for cognitive problems and Alzheimer’s as they age.
  
  

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