Forgetfulness: It’s Not Always What You Think

Forgetfulness: It’s Not Always What You Think

Many older people worry about becoming more forgetful.
They think forgetfulness is the first sign of Alzheimer’s disease. In the past,
memory loss and confusion were considered a normal part of aging. However, scientists now
know that most people remain both alert and able as they age, although it may
take them longer to remember things.

A lot of people experience memory lapses. Some memory
problems are serious, and others are not. People who have serious changes in
their memory, personality, and behavior may suffer from a form of brain disease
called dementia. Dementia seriously affects a person’s ability to carry out daily
activities. Alzheimer’s disease is one of many types of dementia.

The term dementia describes a group of symptoms that are caused by changes in
brain function. Dementia symptoms may include:

• asking the same questions repeatedly;
• becoming lost in familiar places;
• being unable to follow directions;
• getting disoriented about time, people, and places;
  and

• neglecting personal
  safety, hygiene, and nutrition.

People with dementia lose their abilities at
different rates.

Dementia is caused by many conditions. Some conditions that cause dementia
can be reversed, and others cannot. Further, many different medical conditions
may cause symptoms that seem like Alzheimer’s disease, but are not. Some of
these medical conditions may be treatable. Reversible conditions can be caused
by a high fever, dehydration, vitamin deficiency and poor nutrition, bad
reactions to medicines, problems with the thyroid gland, or a minor head
injury. Medical conditions like these can be serious and should be treated by a
doctor
as soon as possible.

Sometimes older people have emotional problems that can
be mistaken for dementia. Feeling sad, lonely, worried, or bored may be more
common for older people facing retirement or coping with the death of a spouse,
relative, or friend. Adapting to these changes leaves some people feeling
confused or forgetful. Emotional problems can be eased by supportive friends and
family, or
by professional help from a doctor or counselor.

The two most common forms of dementia in older people are Alzheimer’s disease
and multi-infarct dementia (sometimes called vascular dementia). These types of
dementia are irreversible, which means they cannot be cured.

In Alzheimer’s disease, nerve cell changes in certain parts
of the brain result in the death of a large number of cells. Symptoms of
Alzheimer’s disease begin slowly and become steadily worse. As the disease
progresses, symptoms range from mild
forgetfulness to serious impairments in thinking, judgment, and the ability to
perform daily activities. Eventually, patients may need total care.

In multi-infarct dementia, a
series of small strokes or changes in the brain’s blood supply may result in the
death of brain tissue. The location in the brain where the small strokes occur
determines the seriousness of the problem and the symptoms that arise. Symptoms
that begin suddenly may be a sign of this kind of dementia. People with
multi-infarct dementia are likely to show signs of improvement or remain stable
for long periods of time, then quickly develop new symptoms if more strokes
occur. In many people with multi-infarct dementia, high blood pressure is to blame. One of the most important reasons for
controlling high blood pressure is to prevent strokes.

Diagnosis
People who are worried about memory problems should see their doctor. If the
doctor believes that the problem is serious, then a thorough physical,
neurological, and psychiatric evaluation may be recommended. A complete medical
examination for memory loss may include gathering information about the person’s
medical history, including use of prescription and over-the-counter medicines,
diet, past medical problems, and general health. Because a correct diagnosis
depends on recalling these details accurately, the doctor also may ask a family
member for information about the person.

Tests of blood and urine may be
done to help the doctor find any problems. There are also tests of mental
abilities (tests of memory, problem solving, counting, and language). A brain
CT scan may assist the doctor in ruling out a
curable disorder. A scan also may show signs of normal age-related changes in
the brain. It may be necessary to have another scan at a later date to see if
there have been further changes in the brain.

Alzheimer’s disease and multi-infarct dementia can exist
together, making it hard for the doctor to diagnose either one specifically.
Scientists once thought that multi-infarct dementia and other types of vascular
dementia caused most
cases of irreversible mental impairment. They now believe that most older people
with irreversible dementia have Alzheimer’s disease.

Treatment
Even if the doctor diagnoses an irreversible form of dementia, much still can
be done to treat the patient and help the family cope. A person with dementia
should be under a doctor’s care, and may see a neurologist, psychiatrist, family
doctor, internist, or geriatrician. The doctor can treat the patient’s physical
and behavioral problems and answer the many questions that the person or family
may have.

For some people in the early and middle stages of Alzheimer’s disease, the
drugs tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Reminyl) are prescribed to possibly delay the worsening of some of
the disease’s symptoms. Doctors believe it is very important for people with
multi-infarct dementia to try to prevent further strokes by controlling high
blood pressure, monitoring and treating high blood cholesterol and diabetes, and
not smoking.

Many people with dementia need no medication for
behavioral problems. But for some people, doctors may prescribe medications to
reduce agitation, anxiety, depression, or sleeping problems. These troublesome behaviors are common in
people with dementia. Careful use of doctor-prescribed drugs may make some
people with dementia more comfortable and make caring for them easier.

A healthy diet is important. Although no special diets or nutritional
supplements have been found to prevent or reverse Alzheimer’s disease or
multi-infarct dementia, a balanced diet helps maintain overall good health. In
cases of multi-infarct dementia, improving the diet may play a role in
preventing more strokes.

Family members and friends can assist people with
dementia in continuing their daily routines, physical activities, and social
contacts. People with dementia should be kept up-to-date about the details of
their lives, such as the time of day, where they live, and what is happening at
home or in the world. Memory aids may help in the day-to-day living of patients in the earlier stages
of dementia. Some families find that a big calendar, a list of daily plans,
notes about simple safety measures, and written directions describing how to use
common household items are very useful aids.

Advice for Today
Scientists are working to develop
new drugs that someday may slow, reverse, or prevent the damage caused by
Alzheimer’s disease and multi-infarct dementia. In the meantime, people who have
no dementia symptoms can try to keep their memory sharp.

Some suggestions include:

• Developing interests or hobbies and staying involved
  in activities that stimulate both the mind and body.

• Giving careful attention to physical fitness and
  exercise also may go a long way toward keeping a healthy state of mind.

• Limiting the use of alcoholic beverages is important, because
  heavy drinking over time can cause permanent brain damage.

Many people find it useful to plan tasks; make “things-to-do”
lists; and use notes, calendars, and other memory aids. They also may remember
things better by mentally connecting them to other meaningful things, such as a
familiar name, song, or lines from a poem.

Stress, anxiety, or depression can make a person more forgetful.
Forgetfulness caused by these emotions usually is temporary and goes away when
the feelings fade. However, if these feelings last for a long period of time,
getting help from a professional is important. Treatment may include counseling
or medication, or a combination of both.

Some physical and mental changes occur with age in
healthy people. However, much pain and suffering can be avoided if older people, their families, and
their doctors recognize dementia as a disease, not part of normal aging.