Sticky notes decorate my desk. Electronic beeps remind me to make a phone call, stop by the store, keep an appointment, or take dinner out of the oven. But some things are forgotten. It happens when we multi-task. It happens when we grow older. So what is “normal” forgetfulness and how can we tell if it’s something more than the normal aging process?
By Marcia Swearingen
What is “Normal” about Cognitive Decline?
People of all ages forget things. Experts say the reason we forget has a lot to do with the thing we want to remember—how important it is to us, and what our stress levels are at the time. These factors can influence the quality of the information your brain receives and how well it is processed, stored, and retrieved. But it is a physical fact that as we age, our neural connections slow down and fewer nerve cells are created.
According to Dr. Larry Kean, adult and geriatric psychiatrist at Erlanger North, all of us have a steady decline in our cognitive capacity beginning in our 50s, but it’s usually imperceptible and not a significant problem for most people.
“We jokingly call it a senior moment,” he says, “where you can’t recall something right at that moment. But those are different from Alzheimer’s, because most of the time you’ll remember it later on. That’s normal aging of the brain.”
Even if we can’t remember where we put our keys, the important thing is that we still know how to drive the car. As we age, some things, like vocabulary, actually get better. And even though we may have physical limitations, normal aging does not diminish our memory of how to tie our shoes, brush our teeth or drive a car.
Family practitioner and preventive care specialist Dr. Thomas Mullen of Mullen Elder Care works with nursing home patients in Dalton and Lafayette, Ga.
“If we look at the positive side,” he says, “procedural memory shows no real decline with age. You can still do those things you learned to do as a kid. In fact, short-term memory, the one we’re particularly worried about with dementia, doesn’t go away. There’s really very little decline in short-term memory and in semantic knowledge, like vocabulary, which actually improves as we get older. The problems we get into with aging are remembering the names of things, the names of people or remembering where we learned something: Where do I know that person from? Why did I come into this room? These are kind of normal manifestations of the normal decline with aging.”
Autopsies conducted on the brains of elderly people considered to have very good memories show some evidence of the plaques and tangles noted in the brains of Alzheimer’s patients, just not as many.
“It almost looks like Alzheimer’s dementia is sort of a spectrum from very good to very bad,” says Dr. Mullen, “depending upon how much of the bad stuff you got, but we all get some with time.”
Although there have been cases of people getting Alzheimer’s in their 30s and 40s, most Alzheimer’s disease doesn’t start until people are older. “At age 65 it’s something like 3%, by age 80, it’s 40%. So it’s a function of age,” says Dr. Kean. “The older you get, the more likely you’re going to have Alzheimer’s changes.”
When Do These Changes Become Abnormal?
“We really don’t know what’s going on with Alzheimer’s,” says Dr. Kean, “but it appears that it is a more rapid decline of the normal aging of the brain. People who have Alzheimer’s—there’s something going wrong—their nervous system is actually aging quicker, it’s the normal cognitive decline going at a much faster pace.”
The time to become concerned is when memory loss impairs your daily functioning and begins interfering with your life. “When you’re forgetting to take your medicines, to go to doctors’ appointments, to take care of yourself… when you’re forgetting the names of important people in your life … that’s when we define it as becoming an illness,” says Dr. Kean.
There are screening tests that doctors use to measure the degree of cognitive decline and how much it impacts a patient’s life. An important part of a dementia workup is lab testing to make sure the forgetfulness is not due to underlying medical conditions such as an infection, lung, liver or kidney failure, Vitamin B-12 deficiency, thyroid disease, diabetes or depression.
“Somebody that comes to my office and says, ‘I’m worried about my memory,’ probably does not have Alzheimer’s,” says Dr. Kean. “The person who has Alzheimer’s frequently isn’t aware of it. The family is aware of it, and they are bringing in mom or dad or grandpa and saying ‘They are forgetting things,’ but they are unaware of it. Most of the time when somebody comes to me and says, ‘I’m worried about my memory,’ they probably have something else, frequently depression. Depression in older people causes pseudo-dementia (false dementia), and the effect is that they are slowed, not able to focus, not able to concentrate, not able to summon up something right then.”
Stress and anxiety also contribute to forgetfulness, along with alcohol and medication. Any medicine that slows us down, such as tranquilizers or pain pills, also slows down our thought processes. Memory loss from these other causes is not dementia, and it is reversible.
Ways to Stay Ahead of the Curve
Learning to ride a bicycle, playing an instrument, or working crossword puzzles can pay big dividends. It doesn’t change the physiology of the brain, says Dr. Mullen, but it builds brain reserves to offset the declines. “By doing cognitive, intellectual activities, you’re building up your savings account of intellectual ability so that as dementia knocks it down, you’ve got some extra in the bank. And it’s fun learning new things with other people. Learning a new skill stretches the brain, improves the function and will help delay dementia.”
As we age, there are things we can do to protect our brain and enhance its performance:
• Eat a healthy diet which includes five to seven servings daily of fruits and vegetables, along with whole grains and nuts. The antioxidants provided will inhibit free radical damage to cells. Tests have shown that people who have high levels of vitamins in their body from eating these foods are at decreased risk for developing Alzheimer’s disease.
• Exercise to diminish stress, improve the quality of sleep, and keep the blood flowing to all parts of the body. One study confirmed that regular physical activity three or more times a week delayed the onset of dementia and Alzheimer’s disease. If you don’t like to exercise, learn to dance.
• Don’t smoke. Smoking is associated with a higher risk of Alzheimer’s.
• Maintain healthy blood pressure, cholesterol, and blood sugar levels. These levels tend to be elevated in dementia patients.
• Reduce stress to improve memory processing.
• Get a good night’s sleep, at least seven hours. The brain stores encoded information during sleep. Fatigue during the day affects memory and concentration.
• Focus on one thing at a time. Multi-tasking robs us of the concentration our brain needs to encode information so it can be stored and retrieved.
• Get organized. Use a calendar, daily planner, electronic organizer, sticky notes or lists to help you keep on top of tasks and appointments. Have a place for your keys and your glasses. Try to park in the same spot.
• Stay mentally active. Research has shown that even an aging brain can grow new neural pathways when it learns new things. The Seniors Institute at Chattanooga State offers a class in mental aerobics to improve mental agility. It features practical memory strategies for daily living. To register call (423) 697-3100.
• Stay socially active. Tests show that people who maintained a large social network reduced their likelihood of dementia by 26 percent over those with smaller social networks. Alexian Brothers Senior Neighbors offers a variety of free and low-cost activities for older adults in our area.
• Keep a sense of humor. Laughing at your “senior moments” is more fun than worrying about them and also healthier. You may not be as sharp as you used to be, but you’ve still got a lot to offer.
When to See A Doctor
If you’re wondering whether you should see a doctor, here is an informative guide from WebMD on normal vs. abnormal forgetfulness:
• Forgetting parts of an experience.
• Forgetting where you parked the car.
• Forgetting events from the distant past.
• Forgetting a person’s name, but remembering it later.
• Forgetting an experience.
• Forgetting how to drive a car or read a clock.
• Forgetting recent events.
• Forgetting ever having known a particular person.
• Loss of function, confusion, decreasing alertness.
• Symptoms become more frequent or severe.
So if you’re worried, says Dr. Mullen, see your doctor. There’s no harm in getting it checked out just for your peace of mind. Worrying is bad for your health.
Marcia Swearingen has lived in Chattanooga for 30 years. She has a Bachelor of Science degree in journalism from the University of Tennessee at Knoxville and is currently a board member of the Chattanooga Writers Guild. Marcia and her husband, Jim, have one daughter and live in Hixson, Tenn.