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Forgetfulness:
It’s Not Always What You Think
Many older people worry about becoming more forgetful. They think
forgetfulness is the first sign of Alzheimer’s disease.
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.
A 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. Alzheimer’s
disease 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 repeatedly; becoming lost in familiar places;
being unable to follow directions; getting disoriented about time,
people, and places; and neglecting personal safety, hygiene, and
nutrition. People 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 Alzheimer’s disease, 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.
Sometimes 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.
The two most common forms of dementia in older people are Alzheimer’s
disease and multi infarct dementia (sometimes called vascular
dementia). These types of dementia are irreversible, which means
they cannot be cured. In Alzheimer’s disease, nerve cell
changes in certain parts of the brain result in the death of a
large number of cells. Symptoms of Alzheimer’s disease 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 total care.
In multi infarct dementia, a series of small strokes or changes
in the brain’s blood supply may result in the death of brain
tissue. The location in the brain where the small strokes occur
determines the seriousness of the problem and the symptoms that
arise. Symptoms that begin suddenly may be a sign of this kind
of dementia. People with multi infarct dementia are likely to
show signs of improvement or remain stable for long periods of
time, then quickly develop new symptoms if more strokes occur.
In many people with multi infarct dementia, high blood pressure
is to blame. One of the most important reasons for controlling
high blood pressure is to prevent strokes.
Diagnosis
People 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 the person’s
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.
Alzheimer’s disease and multi infarct dementia 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.
Treatment
Even 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.
For some people in the early and middle stages of Alzheimer’s
disease, the drugs tacrine (Cognex), donepezil (Aricept), rivastigmine
(Exelon), and galantamine (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 smoking.
Many 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.
A healthy diet is important. Although no special diets or nutritional
supplements have been found to prevent or reverse Alzheimer’s
disease 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.
Family 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 very useful aids.
Advice for Today
Scientists are working to develop new drugs that someday may
slow, reverse, or prevent the damage caused by Alzheimer’s
disease 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.
Many 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 of both.
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
The Alzheimer’s Association is a nonprofit organization
supporting AD research and offering information and support services
to people with AD and their families. Contact:
Alzheimer’s Association
225 N. Michigan Avenue, Suite 1700
Chicago, IL 60611-1676
1-800-272-3900
e-mail: info@alz.org
Website: www.alz.org
The Alzheimer’s 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 the public. Contact:
ADEAR Center
P.O. Box 8250
Silver Spring, MD 20907 8250
1-800 438 4380
e mail: adear@alzheimers.org
Website: www.alzheimers.org
Information about community resources is available from State
and Area Agencies on Aging. Contact:
Eldercare Locator
1-800 677 1116
Website: www.eldercare.gov
For more information on health and aging, contact:
National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
E-mail: niaic@jbs1.com
To order publications (in English or Spanish) online, visit www.niapublications.org
Please visit NIHSeniorHealth.gov (www.nihseniorhealth.gov),
a senior-friendly website from the National Institute on Aging
and the National Library of Medicine. This website features popular
health topics for older adults. It has large type and a 'talking'
function that reads text aloud.
National Institute on Aging
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health July 2004
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