Normal Forgetfulness or Alzheimer’s?

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While many people over 60 say they have "senior moments" when they forget a neighbor's name or look for eyeglasses that are perched on top of their head, most age-related forgetfulness doesn't significantly interfere with daily life. However, memory loss and confusion due to Alzheimer's disease is more severe and can wreak havoc on the lives of both the patient and their loved ones.

But how can one distinguish between age-related forgetfulness and the early signs of Alzheimer's disease, a progressive form of dementia that affects an estimated 4.5 million older Americans? Below, Dr. Ronald Petersen, director of the Mayo Alzheimer's Disease Research Center in Rochester, Minnesota, discusses the signs and symptoms of Alzheimer's disease and how doctors, patients and their families can work together to ensure an early and accurate diagnosis is made.

Is memory loss a part of normal aging?
Some forgetfulness is common and felt to be a part of normal aging. If you forget incidental items, like where you put the checkbook or the car keys, that is probably normal. Since many people don't spend a lot energy paying attention to this type information, it can be easily forgotten.

Another common forgetfulness of aging is having trouble remembering the names of people that are in your outer social circles, like acquaintances you rarely see. Struggling to come up with their name is common, and it might take several minutes before the epiphany of "Oh, of course, that was Bill."

However, when you start forgetting pertinent information, this can be a sign to seek advice from a healthcare professional. This applies to any information that you actually spent time and effort trying to remember such as doctor appointments or a family member's name.

Forgetting one appointment, as an isolated event, is not necessarily abnormal. But when you look back and there's a pattern of forgetting appointments or to meet friends for lunch, this might be sign of early Alzheimer's. And if close family members or friends are starting to notice your recent forgetfulness episodes, then this matter deserves further attention.

What about people who were always forgetful?
Some people are characterized by others as being absentminded, and, if that's been a lifelong pattern, then that's not too worrisome. However, if a close family member or good friend notices a recent or dramatic change in your thinking ability or forgetfulness, then you should visit your doctor to have it checked out.

What are symptoms of Alzheimer's disease other than memory loss?
Outside of the loss of memory, you may experience changes in your ability to carry out certain daily functions. For example, if you were the finance person in the family that balanced the checkbook and filed the taxes, and now you're having difficulty paying the bills that might be significant.

Another symptom is a loss of navigational skills. Everyone takes it for granted that they can get around town, or get to a favorite neighborhood restaurant. But if you're becoming disoriented or lost in previously familiar environments that might be a warning sign of Alzheimer's.

You may also notice a change in your ability to concentrate. So, it might be difficult to sit through a long movie or read a novel. Unfortunately, many people start avoiding time consuming activities they once enjoyed.

How do doctors make the assessment?
There's a fairly standard approach to evaluating somebody for Alzheimer's disease or another type of dementia. Generally, a doctor will take your medical history and ask for examples of behavior changes or forgetfulness.

According to Petersen some common questions you might hear during this type of examination:

  • Have you been noticing this change for days, weeks, months or maybe even years?
  • Has your behavior changed?
  • Has it actually changed your functional activities now?
  • Are you now altering your daily routines or your behaviors because of these cognitive changes?

Equally important are the testimonials of others who have noticed the cognition and behavioral changes. So interviewing a spouse, adult child or good friend is invaluable.

What does the medical evaluation involve?
Based on your initial evaluation, your doctors might conduct a medical examination if they believe there might be a serious underlying cause triggering your cognitive problems. This examination involves cardiovascular and respiratory tests to confirm that your heart and lungs are in good condition. Also a neurological examination is performed to make sure that there's nothing else affecting the nervous system, such as a stroke, Parkinson's disease or brain tumor.

Physicians will also do a mental status exam. Petersen says he will ask his patients to do brief mental exercises in the office by asking questions like: "What's the date? Where are we? Try to remember these numbers. Here are a few words to remember." Petersen also asks patients to solve math problems to help him gage their mental function.

The next step is laboratory testing that can eliminate other medical causes, like abnormal blood counts, thyroid function, vitamin B12 level deficiencies. All of which can alter your thinking ability and memory. A CT scan or an MRI scan of the brain may also be performed to see if there's any physical evidence of a stroke, tumor, blood clots or, more importantly, if the actual size of the brain has decreased and no longer corresponds with the person's age. If the shrinkage is significant it implies that there might be a degenerative process.

There are a variety of other tests that can be used, depending on the medical history. The Alzheimer's is a complex puzzle and your doctor will use the results from both your lab work and mental and physical examines to piece together a possible diagnosis.

How does one distinguish between Alzheimer's and other forms of dementia?
In people in their late 60s, 70s and 80s, dementias are usually degenerative; it comes on slowly and insidiously. And anywhere from 50 to 75 percent of all dementias of aging are due to Alzheimer's disease.

But there are some degenerative dementias other than Alzheimer's disease. One is called dementia with Lewy bodies, which is seen in Parkinson patients. People with this condition may have daytime visual hallucinations and a particular type of sleep disturbance where they actually act out dreams at night. Although their information-processing speed is slowed and their ability to navigate in the environment is impaired early on, their memory is relatively spared, which is the hallmark of Alzheimer's.

The next most common form of dementia is so-called frontotemporal dementia. Like Alzheimer's, the frontal and the temporal lobes of the brain are involved but frontotemporal dementia causes a different type of behavior reaction. The frontal lobe controls motivation, aggression and mood, while the temporal lobe plays an important role in memory. So people with this dementia may engage in improper behavior, like making an inappropriate comment in social settings that normally they would never say.

There is also the rarer, abrupt onset of so-called vascular dementia. This usually involves a precise timeframe when a cognitive change takes place. So if you said "Oh, my problems started last Wednesday at 11 a.m.," that would imply there was a stroke, blood clot or other event that caused the problem. The specific and abrupt timeline is not consistent with the degenerative pattern of most dementias.

At what point would a doctor initiate treatment?
The Food and Drug Administration (FDA) has approved medications for both mild to moderate and moderate to severe Alzheimer's disease. So, technically, if you follow FDA guidelines, you should only use the medications when you actually meet the criteria for Alzheimer's disease.

However, doctors do have some latitude when prescribing medication. If your physician feels that you are heading towards Alzheimer's, he or she may explain to the risks and benefits of starting a medication regimen.

If you are concerned about yourself or about your loved one, you should consult your doctor and start the ball rolling because sometimes there are treatable causes behind dementia problems.

In essence, distinguishing the difference between Alzheimer's and age-related forgetfulness or other forms of dementia involves early recognition of the signs by you and your doctor. Forgetting your spouse or child's name should not be accepted as a "normal" part of the aging process. There is nothing shameful about seeking treatment for cognitive problems, and by understanding Alzheimer's more thoroughly, you and your family can have an easier time identifying the difference between this disease and a "senior moment".

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