Memory loss and aging: What’s “normal?”

Head upstairs for something and come back down without it? Find yourself struggling to remember someone’s last name or phone number? Take a wrong turn going somewhere you’ve been driving to for years? Forget to pay a monthly bill? Forgetfulness may be upsetting, but examples like these are common as we age and nothing to worry about. Yet for many older Americans, forgetting things on an increasingly regular basis may be a sign of oncoming dementia or a form of Alzheimer’s, a degenerative brain disease that affects close to one in four Americans.

Alzheimer’s disease is the sixth-leading cause of death among U.S. adults, and the fifth-leading cause among adults aged 65 to 85. In 2013, an estimated 5 million Americans aged 65 years or older had Alzheimer’s disease. This number may triple by 2050, with the costs of care already projected at over $200 billion per year, and expected to increase to more than $500 billion by 2040.

Alzheimer’s disease causes large numbers of nerve cells in the brain to die. This affects a person’s ability to remember things, think clearly, and use good judgment. It typically involves parts of the brain that control thought, memory, and language. While doctors don’t know what causes the disease, they do know that most of the time it begins after age 60.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life, and Alzheimer’s disease is the most common. It often starts slowly. In fact, some people don’t know they have it and assume their forgetfulness is just a sign of increasing age. However, over time, their memory problems get more serious. People with Alzheimer’s disease have trouble doing everyday things like driving a car, cooking a meal, or shopping or paying bills. They may get lost easily and find even simple things confusing. Some people become worried, angry or violent.

As the illness progresses, people with Alzheimer’s disease need someone to help take care of their daily needs, including feeding and bathing. Some people with Alzheimer’s live at home with a caregiver. Other people with the disease live in a nursing home or in a facility that specializes in dementia-related illnesses.

Though age is the best-known risk factor for Alzheimer’s disease, researchers believe that genetics may play a role. Changes in the brain can begin years before the first symptoms appear, and scientists are studying whether education, diet, exercise and environment play roles in developing Alzheimer’s disease. They also are finding more evidence that some of the risk factors for heart disease and stroke — such as high blood pressure, high cholesterol, and low levels of the vitamin folate — may also increase the risk of Alzheimer’s disease.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by depression, medication side effects, excess use of alcohol, vitamin deficiencies  or thyroid problems may improve when the condition is treated or addressed.

How to recognize signs of early dementia

Alzheimer’s disease is not a normal part of aging. And while memory loss affects all of us as we age, it also is typically one of the first warning signs of cognitive loss.

Different types of dementia are associated with particular types of brain cell damage in specific regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s.

According to the National Institute on Aging, in addition to memory problems, someone with Alzheimer’s disease may experience one or more of the following signs:

  • Gets lost
  • Has trouble handling money and paying bills
  • Repeats questions
  • Takes longer to complete normal daily tasks
  • Displays poor judgment
  • Loses things or misplacing them in odd places
  • Displays mood and personality changes.

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. It’s hard to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose “dementia” and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist.

Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms, and it’s important to note that other causes of dementia-like behavior – such as from head injuries, alcohol abuse and depression – can be treated.

Protecting our brains

Evidence also is growing for physical, mental, and social activities as protective factors against Alzheimer’s disease. Our brain is nourished by one of our body’s richest networks of blood vessels. Anything that damages blood vessels anywhere in our body can damage blood vessels in our brain, depriving brain cells of vital food and oxygen. Blood vessel changes in the brain are linked to vascular dementia. They often are present along with changes caused by other types of dementia, including Alzheimer’s disease. These changes may interact to cause faster decline or make impairments more severe.

We can help protect our brains with some of the same strategies that protect our heart – don’t smoke; take steps to keep our blood pressure, cholesterol and blood sugar within recommended limits; and maintain a healthy weight.

Regular physical exercise may help lower the risk of some types of dementia. Evidence suggests exercise may directly benefit brain cells by increasing blood and oxygen flow to the brain. And what we eat may have its greatest impact on brain health through its effect on heart health. The best current evidence suggests that heart-healthy eating patterns, such as the Mediterranean diet, also may help protect the brain. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits and vegetables, fish and shellfish, and nuts, olive oil and other healthy fats.

If you or someone you know has several or even some of the signs of increasing forgetfulness, it does not mean that you or they have Alzheimer’s disease. It is important to consult a health care provider regarding concerns about memory loss, thinking skills, or behavioral changes.


 

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