What You Should Know About Memory Lapses

Memory complaints do not necessarily indicate early-stage dementia, according to an MGH expert. Here's his advice to the "worried well."

For many individuals in middle age and beyond, senior moments are a cause for concern: Are occasional memory lapses normal, or are they an early indicator of mental decline that can lead to dementia?

These worries were undoubtedly heightened by a series of studies presented at the Alzheimer’s Associa-tion International Conference in July 2013 that suggest that older adults with subjective memory complaints have a higher risk for either mild cognitive impairment (MCI) or dementia. But the fact is that memory glitches become more common with advancing age, even in healthy people, says Rudolph Tanzi, MD, Director of the Genetic and Aging Research Unit at Massachusetts General Hospital (MGH) and Professor of Neurology at Harvard Medical School.

Memory problems that are more severe than normal for a person’s age group, and are increasingly appar-ent to family or friends, may indeed be symptoms of MCI, which is often an early stage of serious cognitive decline and dementia that requires medical assessment. However, only five percent of adults over 60 and 10 percent of those over 70 have Alzheimer’s disease (AD), Dr. Tanzi points out. Moreover, in about 25 percent of people who seek medical assessment, memory problems are not the result of pathologies related to MCI and dementia, and cognitive functioning eventually reverts to normal.

A recent study has identified several factors associated with this reversion that might be supported or strenghtened to help restore memory ability in many of the people who seek medical advice for memory loss.

WHAT YOU CAN DO

Ask for a thorough medical assessment if you or a loved one regularly experiences any of these symptoms of MCI:

  • Greater memory problems than normal for your age group, such as forgetting the name of a close friend, or for-getting important appointments
  • Feeling increasingly overwhelmed by tasks that involve multiple steps, making decisions, or interpreting instruc-tions
  • Having greater difficulty following conversations, or the plots of movies or books
  • Becoming more impulsive or apt to show poor judgment
  • Getting lost in familiar surroundings.

“We have known for some time that not all people with memory impairment are doomed to dementia,” says Dr. Tanzi, co-author with Deepak Chopra of the best-selling book Super Brain. “When an individual’s memory fails with age, and the memory loss is not severe enough to significantly affect the activities of daily living, forgetfulness is often related to potentially reversible issues that interfere with memory formation or recall, such as vitamin deficiency, the effect of medications, medical issues, or mental and behavioral factors such as distraction, apathy, or multitasking.

“Addressing these issues may help restore normal memory functioning and forestall progression to MCI.”

Reversible Factors

In a study published March 27, 2013 in the online journal PLOS ONE, researchers looked at data on 223 older participants in a large study of aging who were diagnosed with memory impairment. Over a period of two years, 66 of the participants reverted to normal cognition, and 157 did not. The scientists compared diagnostic features, personality, neuroimaging, sociodemographic information, lifestyle, and physical and mental health in each of the two groups at the beginning and end of the study, looking for potentially modifiable factors linked with reversion to normal cognition. They found that participants were more likely to regain normal cognition if they engaged in higher complex mental activity; had better vision and sense of smell;experienced larger drops in diastolic blood pressure (the lower number in a blood pressure reading) over the duration of the study; and had greater combined volume of the left hippocampus and left amygdala—brain regions involved in memory—as evidenced by brain scans.
“The individuals whose memory improved in this study were most likely experiencing ‘benign forgetfulness,’ a level of memory impairment that can often be reversed by altering certain lifestyle factors,” explained Dr. Tanzi. “Their cognitive changes—like those of many healthy older adults—are normal in an aging brain, and are not a sign of disease pathology.”

The study suggests that several strategies, such as lowering diastolic blood pressure, engaging in intellectually challenging activities, and maximizing vision might help promote reversion from memory impairment to more normal functioning. Paying greater attention to your surroundings might also help, Dr. Tanzi adds.

Lack of Attention

“Occasional memory lapses in older adults are often the result of inatten-tion,” Dr. Tanzi says. “In very young people, every moment is a ‘wow’ moment, but as many individuals grow older, ‘wow’ moments tend to become ‘so what?’ moments without much emotional impact. Since attention, memory formation, and learning are reinforced by emotion, forget-fulness may be more likely if experiences lack emotional impact.”

Other issues that may reduce the ability to pay attention include:

  • A wider bandwidth: With more to do, more to keep track of, and more to remember as they go through their day, older adults may have fewer cognitive resources to focus on new information.
  • Apathy: Many older adults develop a sense that they’ve seen and done it all, making it hard to pay atten-tion to something new.
  • Poor attitude: Mental laziness or assuming that memory loss is inevitable discourages people from adopting strat-egies that might help strengthen their ability to learn new information and recall it later.
  • Vulnerability to distraction: Paying attention and remembering require being in the moment, which the older adult’s increasing vulnerability to distraction makes more difficult. Being present in the moment encourages emotional involvement that consolidates memory. “You have to look around, take note of where you are, pay attention to your body and how you feel, use all of your senses, and consciously try to register information,” says Dr. Tanzi.

“Forgetfulness is often a learning issue,” he adds. “You cannot remember information that you never registered in your brain.”

Lifestyle Changes

While MCI requires professional assessment and treatment, benign forgetfulness often responds to lifestyle changes and improves over time, Dr. Tanzi says. He recommends trying yoga, meditation, and other relaxation techniques that promote mindfulness and concentration; getting regular exercise—at least 30 minutes a day, five days per week; staying socially engaged; managing medical conditions that can affect cognition; and eating a healthy, low-calorie Mediterranean-style diet rich in fruits, vegetables, fish, nuts, pulses, moderate amounts of wine, and healthy fats such as olive and canola oils and omega-3 fatty acids found in fish.

“Try to continually learn new things,” he advises. “You will naturally associate new information with what you already know and will reinforce what you have previously stored away in your memory banks.”

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