Forgetfulness—a part of aging as familiar as wrinkles and graying hair—can be a source of worry for many seniors. Is the growing tendency to forget words, have difficulty recalling names, or lose track of the car keys normal or an early sign of dementia?
The good news is that in most cases, memory lapses are not a signal of impending senility. Many people live into their 80s and beyond with sharp minds.
“Any one symptom isn’t necessarily an indication of cognitive changes you should be worried about,” explains Britt Carlson Emerton, PhD, a neuropsychologist at MGH’s Psychology Assessment Center. “Other factors must be considered, such as the context within which a symptom appears, how often it occurs, and whether it is worsening over time. Lapses in memory or confusion could be the result of stress, medical problems, sleep disturbance, grief, or other issues.”
In general, Dr. Emerton recommends seeking professional advice for memory problems that:
Are consistent, rather than occurring from time to time or as isolated instances
Represent a change in your normal functioning
Cause you distress and anxiety about your memory
“Seek mental stimulation and, with your doctor’s approval, engage in regular exercise, which has been shown to boost brain health,” advises Dr. Emerton. “Get plenty of good quality sleep, eat a nutritious, low-calorie diet, and stay cognitively and socially engaged. Avoid bad habits such as smoking or excessive drinking, reduce stress, and follow your doctor’s advice on managing health conditions, such as hypertension, that can endanger brain health.”
Three Levels of Memory Impairment
Although the boundaries between the degrees of memory impairment are somewhat blurred, thinking of three distinct levels may help you to understand what to expect, when to seek medical intervention if you need it, and what strategies you can employ to help you cope with your cognitive difficulties.
1. Age-Associated Memory Impairment (AAMI). A normal part of aging, AAMI usually affects people in their 50s or perhaps a bit earlier, develops gradually, and is characterized by brief memory lapses in otherwise healthy individuals. Symptoms of AAMI include a growing tendency to:
- Misplace objects
- Forget names
- Have difficulty keeping track of lists
- Have difficulty performing tasks that require multiple actions
- Find it harder to remember phone numbers, addresses and zip codes
- Become easily distracted
“People with AAMI have a slightly harder time learning new information and retrieving information as efficiently as when they were younger,” says Dr. Emerton. “However, the ability to recognize information is still strong and a memory often comes back later. You may forget part of an experience (the name of the movie you saw last week), but you won’t forget the whole experience, and small reminders will tend to bring back the rest of the details.”
Strategies for dealing with AAMI include: organizing your daily activities to make them easier to remember; using memory aids (e.g., calendars, lists, and notes); keeping easy-to-lose items in special places (e.g., always putting car keys by the front door); learning memory techniques to help you recall important information (e.g., making up a sentence or story that includes the items on your grocery list); and exercising your memory by engaging in activities that challenge recall (e.g., memorizing a poem)
2. Mild Cognitive Impairment (MCI). The second level of memory impairment involves frequent, ongoing memory problems that are greater than average for one’s age group. About 20 percent of adults over 65 will experience this level. People with MCI often:
- Forget things they would normally have remembered
- Become more reliant on memory aids, such as lists, to recall daily tasks
- Complain of memory problems (subjective memory concerns)
- Remember much less of what they have just read or seen than people with normal age-related memory changes
- Take longer to learn new information than people with AAMI
“At this level, everyday function, reasoning, and decision-making are generally preserved, but there is evidence of cognitive changes that represent a decline,” Dr. Emerton explains. “Pursuing everyday activities may become harder, and complex tasks like cooking a holiday meal may become more challenging. Performance on memory tests among people with MCI is generally outside normal parameters for individuals of similar age and educational background. Research suggests that risk for progression to dementia is significantly higher among individuals with MCI than among those with AAMI.”
Strategies for dealing with MCI include: consulting a doctor for evaluation of memory problems and diagnosis and treatment of possible underlying causes (e.g., sleep apnea or thyroid problems); using memory aids, such as calendars and notes, to help support daily functioning; mastering and using memory techniques, such as acronyms; combating stress through the use of relaxation techniques such as yoga or meditation; asking others for help with challenging tasks; and seeking the advice of a mental health professional for any mood issues, such as depression, that may make memory worse.
“If you suspect you have MCI, you may also want to plan ahead for your own care,” Dr. Emerton suggests. “When coping with a potentially progressive condition, you may find that making decisions affecting your future eases your mind.”
3. Dementia. The third level of memory impairment—dementia—is characterized by loss of function and impairment in memory, and in at least one other realm of cognition, such as planning and decision-making, language, or spatial reasoning. Types of dementia and their symptoms include:
- Alzheimer’s disease, (early memory loss and gradual development of other cognitive losses, with characteristic plaques and tangles in the brain)
- Vascular dementia (a stepwise course of memory loss and cognitive decline caused by multiple small strokes that damage brain tissue)
- Frontotemporal dementia (early behavioral and language changes and less prominent memory loss linked to degeneration of neurons primarily in the brain’s frontal and temporal lobes)
- Lewy body dementia (early psychotic and motor symptoms, with characteristic abnormal circular bodies within brain cells)
Strategies for dealing with dementia include: seeking medical intervention, since some dementia symptoms may be caused by underlying medical conditions (e.g., nutritional deficiencies, infections, thyroid abnormalities, or reactions to drugs) that can be reversed. If no medical cause for cognitive decline is identified, a neurological evaluation and diagnosis are called for.
“Neurodegenerative forms of dementia often are treated with prescription medications, which may slow the progress of cognitive decline, or ease symptoms,” Dr. Emerton says.