Cai’s Story
Memory recovery in 6 months
Sleep Apnea, Diabetes, Alcohol, Medication
Cai was 76 when she came to her appointment quite concerned that she had dementia. Both her parents had been diagnosed in their early 80’s, and she was nearing that age as well.
She had noticed over the last year that she had more trouble with memory. However, when we dug a bit deeper, she described issues with things like:
Following along with a TV show or reading a book - she would often have to re-read the sentence several times before she “got it”
Forgetting almost right away what a recipe called for, to the point she had given up cooking
Having to ask her husband to repeat himself multiple times because she hadn’t been paying attention to what he said
Her memory testing was 20/30 (low for her age and education).
What did this tell us about Cai?
Cai’s story of memory problems and her memory testing both pointed towards problems with “working memory”, which is different from the changes in “short-term memory” that go with dementias like Alzheimer’s Disease (you can read about different kinds of memory problems here).
In Cai’s case, she had a number of reversible reasons for her troubles including:
Undiagnosed sleep apnea
Alcohol of 2-3 glasses of wine a night
Sleeping pill called Trazodone
Low blood sugars due to too much insulin injections for her diabetes
In addition, she had several other problems that can lead to poor brain health, which meant that her brain was no longer able to perform as well when all of these factors were added together (you can read about the concept of “brain balance” here). These included:
High blood pressure
Lack of exercise
Not eating well (and losing weight)
Hearing impairment (and not wearing hearing aids)
What did we do?
We came up with the following plan to tackle each one of her problems one at a time. With such a list, it can be overwhelming to try and fix everything at once!
We went in the following order:
Sleep apnea
We started by treating her sleep apnea. This was diagnosed after sending Cai for a sleep study. She was waking up 60 times a night due to low oxygen levels! (normal is less than 5).
She started using a CPAP machine every night to fix her problems, meaning she no longer had breathing pauses (for more on sleep apnea, read this).
2. Stop taking Trazodone
Her sleep improved with the CPAP machine, and she no longer needed her sleeping pill, which was incidentally also probably making her memory worse!
3. See a Diabetes Specialist
Cai went to an endocrinologist (the diabetes experts), who adjusted her insulin. Because she wasn’t eating as much lately, she had lost weight, and this meant that she didn’t need as much insulin to control her sugars. If she stayed on the same dose, her sugars were actually going too low!
4. Reduce her alcohol intake
Given Cai’s family history of dementia, she was eager to do everything possible to reduce her risk. She cut out alcohol completely then and there.
What happened next?
After 6 months, Cai’s memory had significantly improved.
Her memory testing was now 26/30 (normal!).
Without intervention, it is likely that her memory problems would have progressed to dementia. With simple changes, she was able to recover.
Motivated and encouraged by her recovery, Cai wanted to do even more to lower her risk, especially given her family history. We came up with a few more steps, including:
5. Improved nutrition
Cai went to see a dietician. She had never known what foods were good or bad to eat with her diabetes. She also didn’t know how to look out for and prevent low blood sugars. With the dietician’s help, she brought her blood sugars into an optimal range for her (4-7 mmol/L).
6. Exercise
Cai had her knee replaced a few months before I met her, and had not been moving around as much since. She went back to the orthopedic rehab program, worked on her mobility, and started going for daily walks with her husband.
7. Hearing Aids
Cai knew she had hearing problems, but she didn’t know that she could completely remove the associated risk of dementia if she simply wore her hearing aids all the time. She started putting them in every morning after she brushed her teeth.
8. Blood Pressure
Cai’s blood pressure tended to be about 140 to 150 systolic (the top number). With diabetes, the top number should be less than 130. For memory protection, the top number should be less than 120, as long as you aren’t falling or feeling light headed. We increased Cai’s blood pressure pill and her number now sits between 120-130.
How is Cai now?
It’s now been a year since I met Cai. She has tackled 6 out of her 8 risk factors for dementia, which is a huge accomplishment.
Most importantly, she focused on the causes that were responsible for her difficulty concentrating (sleep apnea, trazodone, alcohol, and low blood sugars), and then worked on reducing other causes of damage (high blood pressure, poor diet, hearing aids, and exercise).
You can read more about this approach here.
Together, she was able to reverse her memory problems, score normal on her memory testing, and feel confident that she could take control of her health and avoid dementia.
Read more about each of Cai’s dementia prevention targets:
Disclaimer: The stories shared on this website are composites of several clinical cases, designed to protect individuals' privacy. They are intended for educational and informational purposes only and should not be construed as medical advice or a reflection of any specific person. Any resemblance to actual persons, living or deceased, is purely coincidental.