Memory: To Worry or Not to Worry

You forget to pay a bill once, twice, a dozen times
………………to worry or not to worry?

You forget where you put your car keys, where you parked your car, how to drive the car
………………to worry or not to worry?

You forget how to get to the shopping center, you get lost coming home
………………to worry or not to worry?

With increased attention on Alzheimer’s Disease, also known as Dementia of the Alzheimer’s Type (DAT), comes increased focus and concern as to whether one has “it” or will get “it”.

“Use it or lose it”.  Our mental faculties are important, in fact crucial.  We need them to function and manage at home, work and in the community.  Any threat to that ‘core’, whether real or perceived, becomes worrisome.   With age comes a slowing of mental faculties and a tendency to misinterpret and elevate “normal” changes associated with aging to the level of disease and dysfunction.  We need to know what is normal and what is not normal. Slip-ups happen to everyone now and then.  If a pattern of slip-ups develops, it could indicate something more.  Let’s look at 4 scenarios:

DIAGNOSIS:  NORMAL AGING
Aging is marked by expected changes in memory and cognition; changes that are considered normal and part of the aging process. The expected changes are more related to a slowing of functions than to actual loss of function.  You misplace your car keys or miss an appointment.  These may be normal – let’s call them “senior moments”.
CONCLUSION:  NOT TO WORRY

DIAGNOSIS:  WORRIED WELL
A condition in which one complains of failing memory, there is no corroborating objective evidence to support their belief, yet they worry.
CONCLUSION:  NOT TO WORRY

DIAGNOSIS:  MILD COGNITIVE IMPAIRMENT (MCI)
A condition involving complaints in a single area of cognitive functioning, such as memory, that is corroborated by impaired performance on standardized testing and is a significant decline from a previous level of functioning.  As MCI progresses to dementia, cognitive problems other than forgetfulness become apparent (i.e increased difficulty concentrating, completing tasks and making decisions).  Those with MCI are at increased risk for developing DAT.
CONCLUSION:  WORRY

DEMENTIA OF ALZHEIMER’S TYPE (DAT)
A disease in which there is widespread and progressive worsening of cognition including memory in addition to one or more other areas of cognition, is a significant decline from a previous level of functioning, and causes significant impairment in social or occupational functioning.  You have trouble keeping track of appointments, figuring out and taking your medications and recalling recent and past events (even hints don’t help jog your memory).
CONCLUSION:  WORRY

The prevalence of DAT is expected to double over the next 30 years.  Those with MCI will develop Alzheimer’s 10 times above the rate healthy elderly persons do.

WHAT TO DO IF & WHEN WORRIED
Seek evaluation.  Evaluation can rule out other causes of memory and cognitive impairment (i.e. reversible causes) as well as detect problems early so that maximal benefit can be made of treatments designed to impede the onset of DAT and/or slow down the degenerative process.    Seek medical evaluation by an MD or DO to rule-out reversible causes.  Then, seek cognitive evaluation by a neuropsychologist (a licensed psychologist with specialty in neuropsychology which is the field specializing in understanding and evaluating relationships between the brain, cognitive function and behavior).

FOR THOSE WHO FALL IN THE “NOT TO WORRY” CATEGORY
•    Go for annual cognitive health check-ups and get baseline cognitive testing to compare future performance
•    Stay active – exercise both your mind and body
•    Use strategies and techniques to maintain performance such as: keeping lists; following a routine; making associations; keeping a detailed calendar, etc.

FOR THOSE WHO FALL IN THE “WORRY” CATEGORY
•    Make appointments to see your medical doctor as well as a neuropsychologist
•    Seek treatment with the goal being to improve or maximize functioning, slow progression of the disease and conversion to DAT, and control secondary symptoms and behaviors
•    Start addressing issues regarding competency with regards to decision-making; management of personal and financial affairs; driving; and long-term care planning.