Q: I was shocked when my 75-year-old husband was caught in the act of shoplifting, as he has been scrupulously honest all his life. He was not criminally charged, but I’m worried. Could this behavior be related to his mild cognitive impairment?
A: In some individuals who suffer from cognitive impairment or dementia, mental decline may be accompanied by a weakening of inhibitions that prevent unacceptable behaviors. Recent research suggests that more than one-third of people with frontotemporal dementia, which accounts for up to 15 percent of all cases of dementia, engage in minor transgressions, such as theft, shoplifting, aggressive behavior, and traffic violations. As many as eight percent of Alzheimer’s patients also engage in these behaviors, which should be thought of as unintentional and related to their brain disease. In 14 percent of people studied, these petty crimes were the patient’s first symptom of dementia. For this reason, experts advise families of older adults to be alert to unexpected changes in behavior and personality and signs of possible loss of impulse control in their loved one. A medical evaluation should help identify underlying causes for such changes. If the changes are related to cognitive decline, families can then help head off opportunities for unintentional “crimes” by taking steps such as restricting the individual’s driving or accompanying him or her on shopping outings.
Q: My elderly cousin was recently diagnosed with cerebral amyloid angiopathy. Is this a form of Alzheimer’s disease?
A: Cerebral amyloid angiopathy (CAA) is a condition characterized by the buildup of the protein beta-amyloid in the walls of blood vessels in the brain. This build-up causes brain damage and cognitive decline by restricting the supply of oxygen and nutrients to brain cells and causing blood vessels to become brittle and rupture, triggering hemorrhagic strokes. Beta-amyloid accumulation is also a hallmark of Alzheimer’s disease (AD), but in that disease, the toxic beta-amyloid proteins occur largely in brain tissue outside the blood vessels. CAA is difficult to diagnose and its precise cause is unknown, but it is believed to be a major factor in cognitive decline in older adults. No treatment is available for the condition. However, recent research in animals suggests that finding ways to limit an immune system protein called CD36, which appears to promote inflammation and the generation of cell-damaging free radicals, might one day result in effective therapies for CAA.
Q: I have been physically inactive most of the winter and have noticed that I am much more de-pressed than usual. If I force myself to exercise will that help boost my mood?
A: Abundant research suggests that exercise can, indeed, help reduce feelings of depression. For example, a recent study published online Oct. 15, 2014 in JAMA Psychiatry found that people who exercise are less likely to develop symptoms of depression, such as sadness, hopelessness, fatigue, sleep disturbance, and irritability. The researchers found that formerly inactive participants who began exercising three times a week reduced the likelihood of developing depression by 19 percent over five years, while those who remained inactive showed no change in depressive symptoms. Regularly engaging in 30 to 45 minutes of moderate-to-vigorous physical activity five times a week or more has been tied to growth of new brain cells and connections that is thought to explain the depression-lifting effects of exercise. However, it may be especially challenging for people who feel depressed to summon the energy to begin an exercise program. For this reason, I ad-vise people who experience symptoms of major depression for two weeks or more to see a mental health professional for assessment and treatment.