事件记录
面试官: 与大发娱乐生命中老去的亲人, we always kind of in the background of our mind are worried about them developing some sort of a cognitive disorder like Alzheimer's and dementia. But it gets a little tricky because general memory trouble is also a pretty common effect of aging. So the trick is how do we as loved ones recognize cognitive impairment and when it's just our loved one having a senior moment?
Dr. 米歇尔·索维德（米歇尔Sorweid）是一名老年医生和认知障碍专家 衰老大脑计划 犹他健康大学的研究员.
Dr. 比如，年长的父母或亲人似乎正在忘记一些事情. 也许他们总是用错误的词来形容事物, 我每次见到他们都讲同样的故事. 这些是我应该担心的事情吗，还是这只是变老的一部分?
Dr. Sorweid: 如果有人走过来问我：“我应该在我所爱的人身上寻找什么？?“人们普遍注意到的是短期记忆的变化, 也就是重复之前讲过的东西的细节, 尤其是当它们是非常重要的话题时, 但也不一定. And then there is a really common presentation where people might not recognize these changes in themselves. 也可能是其他人, 比如爱人，同事，甚至是熟人, 注意到这些变化.
面试官: 让大发娱乐从, 首先, 作为旁观者, 我应该注意哪些不同类型的认知障碍, 这些是怎么出现的? 还是说真的有太多可说的了? 你能帮我缩小范围吗?
Dr. Sorweid: 有很多. 记忆和思维改变有100多种不同的原因. 但我要说的是，其中很多都有很多重叠的特征.
The one thing that I want to definitely make sure people are aware of that's less commonly known is that short-term memory isn't the only presenting symptom. Sometimes we might see things like personality changes or even severe depression or what seems like severe depression. 所以他们对日常活动失去了兴趣，对他们曾经喜欢的事情失去了兴趣. 这些可能是大脑中某些东西正在发生变化的迹象.
你提到了找词困难, whether it's substituting words that don't make sense or describing words instead of using the word they want to use, 尤其是常用词. 大发娱乐都有“老年时刻”,“但实际上，这种情况越来越频繁, 如我所说, 用的词可能不太合适.
面试官: 你是否发现有些病人忽略了这些症状, 首先, 大发娱乐已经讨论过了, 因为这只是因为“哦, 只是变老了。”? 但也许是因为有点害怕他们会发现什么?
Dr. Sorweid: 绝对. 我认为人们不愿意寻求大发娱乐的原因有很多. There are a lot of cultures specifically that have a stigma 再一次。st people with memory and thinking changes. 我知道我花了很多时间和世界各地的西班牙裔社区在一起, “痴呆”这个词在西班牙语里是疯狂的意思. 所以大发娱乐尽量不专门用这个词来形容某些群体.
但是，确实，人们不寻求大发娱乐的原因有很多. 同样，这些疾病都缺乏治疗方法. But I think the one thing that patients and families may not realize all the time is that part of this disease process oftentimes includes lack of insight or not being aware of one's own deficits. And so that's really difficult to navigate as a family member of someone you know is having changes and they insist that they're not and that things are fine. 甚至让他们去看医生来弄清楚发生了什么都可能很棘手.
So we encourage our families and patients to seek this type of screening assessment or visit as maybe just seeking a baseline and finding out where things are at. 这样，如果有变化，大发娱乐就可以进行比较.
面试官: 作为一个家庭成员, 如果我理解正确的话, 初级保健医生实际上可以使用一些筛查工具. So one could accompany an older adult to an annual type physical or health checkup and request that these screenings be done if, 我猜, 他们很难说服当事人. 或者这是你不推荐的伎俩?
Dr. Sorweid: No, I would really encourage family members to present to physician visits with their loved ones and provider visits. 所以这是我非常鼓励的.
And then spending time with them in their own home can be really helpful and eye-opening and seeing what's going on day to day, 他们的药物是怎么回事，他们是怎么用药的. 他们的家到底是什么样子的? 这真的会让人大开眼界.
但是,是的, seeking help from their primary care provider can be really helpful and asking for something like an annual wellness visit, 哪些在医疗保险范围内.
面试官: Back to the afraid to acknowledge it because for fear of finding out that they might have a cognitive impairment that really not a lot can be done about. 我知道很多原因也可能是生理上的, 如果你照顾好身体, 然后认知问题也就解决了. Talk about some of those physical symptoms that might present that would go hand in hand with cognitive issues.
Dr. Sorweid: 绝对. So we know that there are a lot of things that we can treat and intervene upon as far as preventing further decline or treating symptoms related to memory and thinking changes, 比如高血压, 糖尿病, 高胆固醇, 心律失常, 睡眠呼吸暂停. So there are a lot of different changes that we know make an impact on memory and thinking, 关于大脑.
面试官: Do you find that patients are afraid that they're going to find out that they or their loved one have Alzheimer's? 我的意思是，如果你开始注意到认知能力下降，这是不可避免的结果吗?
Dr. Sorweid: 并不是所有的记忆和思维变化都等同于 阿尔茨海默病. 并非所有的记忆和思维变化都等同于痴呆过程. 这当然是有可能的, 但大发娱乐越早知道发生了什么, 大发娱乐就越能影响别人的生活质量.
大发娱乐经常可以做一些事情来真正改善别人的日常生活, such as harmful medications that either are over the counter or may have been prescribed by a provider just lacking that training with older adults. 有些情绪障碍是可以治疗和改善的. I have some patients who've come to see me that thought they were developing a dementia process and it turns out they were just severely depressed. 所以大发娱乐能够在这方面大发娱乐他们.
面试官: So it's really important for loved ones or acquaintances or friends to bring this up with that individual. 你是否发现这个人对寻求大发娱乐非常开放，还是不那么开放? 如果是这样，你如何大发娱乐他们获得大发娱乐?
Dr. Sorweid: 是的, 并不总是因为大发娱乐所说的缺乏洞察力, 在记忆和思维发生变化的老年人中，哪一种情况最常见. 他们可能不知道大脑里发生了什么. 大脑对它们开了一些玩笑. 他们可能没有意识到自己身上发生了什么. So they therefore might not be as likely to seek help or be amenable to someone else saying they need to.
所以我想我会尝试采用这种方法, “这只是一个评估，看看你的基线是多少, 如果未来有变化, 然后是这条基线.“这是你整体健康的一部分, 就像接种流感疫苗或进行抑郁症筛查或乳房x光检查一样.
面试官: 如果有人来做了评估, 你可以从你的初级保健医生那里得到什么因为他们有这些工具, 它又回来了, 那么在这一点上，下一步可能是什么呢?
Dr. Sorweid: So asking for that assessment from your primary care provider through the Medicare annual wellness visit, 每年都在医疗保险范围内, 这真的是好的第一步吗. 如果你的初级保健大发娱乐提供者不愿意采取下一步措施, 例如, 某些血液检查或核磁共振或其他检查, 那就是你可以要求转介给大发娱乐做进一步检查的时间.
面试官: 你越早解决认知问题越好. 解释一下为什么会这样.
Dr. Sorweid: 当火灾已经开始时，灭火真的很难. It makes it harder for us to make a large impact on families and patients when things have kind of escalated to the point where we're, 再一次。, 只是为了扑灭那股火. 所以大发娱乐越早知道发生了什么, 大发娱乐对生活质量的影响就越大, 缓慢下降, 避免使用有害药物, 评估睡眠, 治疗任何睡眠障碍. 大发娱乐可以在早期做很多事情.
面试官: And tell me a story about somebody who recognized cognitive impairment in a loved one and did something about it. 在你看来，它是如何改变了那个人的人生轨迹的?
Dr. Sorweid: I do specifically remember a patient who was in the hospital for severe memory changes and also some harmful thoughts about herself. 当她出院的时候，医生告诉她她得了痴呆症. 当她来找大发娱乐时，大发娱乐发现她实际上只是严重抑郁. And she was actually doing really well functionally after receiving treatment for her depression. 她并没有他们所说的那种痴呆症. 她有严重的抑郁症.
所以大发娱乐可以做很多事情，如果一个人有真正的记忆，并且在早期就改变了思维. 再一次。, I have so many examples of giving them the right diagnosis and helping families understand what's to come. 有很多情况会影响精神和身体健康. And so even if it's as simple as getting the patient the appropriate targeted physical therapy, or an assistive device like a walker or a cane to help them with their motor symptoms that might be related to one of these conditions, 这会对他们的生活质量产生很大的影响.
这很难，因为伴随这些认知障碍而来的耻辱. 像我说的, 没有很多治疗这些疾病的方法, but there's so much positive impact we can make that doesn't necessarily include medication.