Forgetfulness: It’s Not Always
What You Think
older people worry about becoming more forgetful. They
think forgetfulness is the first sign of Alzheimer’s
disease (AD). 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.
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.
AD 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
- becoming lost in familiar places,
- being unable to follow directions,
- getting disoriented about time, people, and places, and
- neglecting personal safety, hygiene, and nutrition.
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 AD, 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.
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.
two most common forms of dementia in older people are AD
and multi infarct dementia (sometimes called vascular dementia).
These types of dementia are irreversible, which means they
cannot be cured. In AD, nerve cell changes in certain parts
of the brain result in the death of a large number of cells.
Symptoms of AD 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
multi infarct dementia, a series of strokes or changes
in the brain’s blood supply may
result in the death of brain tissue. The location in the
brain where the strokes occur and the severity of the strokes
determine the seriousness of the problem and the symptoms
that arise. Symptoms usually begin abruptly and progress
in a step-wise fashion with repeated strokes. At this time,
there is no way to reverse damage that has already been caused
by a stroke. However, treatment to prevent further strokes
is very important.
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
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.
infarct dementia and AD 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.
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.
some people in the early and middle stages of AD, the drugs
tacrine (Cognex, which is still available but no longer
actively marketed by the manufacturer), donepezil (Aricept),
rivastigmine (Exelon), and galantamine (Razadyne, formerly
known as Reminyl) are prescribed to possibly delay the
worsening of some of the disease’s symptoms. Another
drug, memantine (Namenda), has been approved for treatment
of moderate to severe AD. 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
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.
healthy diet is important. Although no special diets or nutritional
supplements have been found to prevent or reverse AD 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.
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 useful aids.
Advice for Today
Scientists are working
to develop new drugs that someday may slow, reverse, or prevent
the damage caused by AD 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.
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
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.
For More Information
Disease Education and Referral (ADEAR) Center is a service
of the National Institute on Aging, part of the Federal Government’s
National Institutes of Health. The Center provides information
to health professionals, patients and their families, and
P.O. Box 8250
Spring, MD 20907- 8250
is a nonprofit organization supporting AD research and offering
information and support services to people with AD and their
225 North Michigan Avenue
Information about community resources is available from State
and Area Agencies on Aging:
For more information on health
and aging, contact:
National Institute on Aging Information Center
P.O. Box 8057