Raise your hand if you’ve ever lost your car keys. In this age of constant distraction, it would be unusual if you hadn’t lost your keys at some time or other. But for older adults, losing keys and other objects more often may be a sign that something more serious is going on. Many of our patients arrive at our practice with a similar question: Is this normal memory loss or is it dementia?
It’s true that some memory loss is to be expected with normal aging. Our role is to help patients get to the root of their memory loss. There’s a difference between normal aging and dementia. And many people don’t know the difference between dementia and Alzheimer’s disease.
Dementia is an umbrella term that really encompasses several different disorders that cause memory loss. Dementia is defined as a marked decline in memory with at least one other cognitive domain that’s affected – such as language, judgment, attention span or visual-spatial functions. The causes of dementia vary almost as much as the symptoms of dementia.
Alzheimer’s disease is the number one cause of dementia, with vascular and stroke-related issues being the second-most common cause. Some of the other causes of dementia include brain injury and tumors as well as alcoholism. Having a memory problem doesn’t mean you have Alzheimer’s and we recommend further testing to pinpoint the cause of memory loss.
The Neuropsychological Evaluation
The neuropsychological evaluation diagnoses, treats and manages patients with cognitive and emotional problems. The tests measure memory loss, learning, concentration, language skills, visual-spatial skills and executive functioning. The testing provides data that to compare the patient’s functioning to peers with similar age and education.
Testing helps establish baseline cognitive functioning and assist with improving outcomes in the patient’s daily life. Many times there are some techniques to help the patient and their family or caregivers in dealing with memory loss.
Dementia and Depression
The psychological aspect of our work comes into play in many ways, but what may come as a surprise is the relationship between dementia and depression. Recent studies estimate that 30-50% of people with dementia also have depression. We know that dementia and depression are biologically linked.
A diagnostic interview helps tease apart some of the emotional and social functioning issues so the neuropsychologist has a comprehensive picture. For patients who have dementia and depression, we may suggest that the patient’s treating physician prescribe medication to treat both. Behavioral techniques may also be effective. Treating the depression does not cure the dementia, but it can improve some of the symptoms of dementia such as memory loss since those symptoms may have been exacerbated by the depression.
Can Dementia be Treated?
Depending on the causes of dementia, there are medications that can potentially slow down the process of decline. This is why early detection is so valuable. Some patients benefit from rehabilitative strategies as well, but these are not quick fixes or cures. Medication may treat an underlying condition that is contributing to the dementia and there are medications now that treat the dementia itself. Unfortunately, medicines can only slow, not stop, the progression of dementia.
Can Dementia be Prevented?
One of the most common patient questions is whether dementia or memory loss can be prevented. The literature shows there are some things you can do to help buffer your protection.
Some of the protective measures can even be fun. We tell our patients to keep the brain active and challenged on a daily basis through activities such as crossword puzzles, card games, reading and other brain-engaging activities. And watching television doesn’t count!
Other steps to help protect against memory loss include:
- Maintaining heart health (e.g. managing blood pressure, cholesterol)
- Regular exercise
- Proper diet
- Stay socially active
What to Do if Dementia is Suspected?
We know from experience that many times family members notice symptoms of dementia before the patient may notice, or become aware of changes. It’s a good idea to start with the patient’s primary care doctor.
There can be metabolic problems, sleep problems and other issues that need to be evaluated and ruled out first. From there, the primary care doctor will make a recommendation for additional evaluation if needed. That’s when neurological evaluation and/or neuropyschological testing comes into play. Much like a mechanic, a physician may look under the hood for problems they can visualize, but neuropsychological testing is like taking the car out for a test drive to pick up on the more subtle functional symptoms like memory loss.
The Alzheimer’s Association offers excellent resources for families as well, such as a comprehensive resource manual and assistance with legal issues.
Signs it May be Something More:
Here are some guidelines to gauge the difference between normal memory loss associated with aging and red flags that it could be something more. If you suspect that you or a family member may be dealing with something more than normal memory loss, make an appointment with their primary care physician.
Probably Normal Memory Loss |
Get a Second Opinion |
| Forgetting an appointment occasionally. | Memory loss that disrupts daily life. Memory loss, especially recently learned information, is often the top sign of a potential problem. |
| Not sure what day of the week it is while on vacation. | Not sure what day of the week it is during a routine schedule is outside the normal memory loss |
| Getting lost occasionally or in new circumstances. | Getting lost in familiar places could be a sign of dementia. |
| Trouble with vision or spatial issues that can be corrected with glasses or cataract surgery. | Difficulty judging distance which may result in falls or minor car accidents. |
| Inability to remember a word that’s on the tip of your tongue. | Routine inability to recall words. Or calling a person or animal by the wrong name regularly. Also includes finding ways to describe an object because the person can’t recall the object’s real name. |
| Losing things occasionally. | Routinely losing things – particularly losing the same thing over and over. |
| Temporary agitation or anxiety in normally stressful situations. | Regularly becoming easily agitated and anxious over small things. |
| Making a regretful decision every once in a while. | A marked change in judgment resulting in poor decisions or even being taken advantage of by a scam, etc. |
Resources:
- Alzheimer’s Association – http://www.alz.org/index.asp
- Caring for Alzheimer’s – http://www.alz.org/living_with_alzheimers_caring_for_alzheimers.asp
About the Authors:Melissa Pence, PsyD & Bethany Gilstrap, PsyD
Melissa Pence , PsyD, and Bethany Gilstrap, PsyD, are clinical neuropsychologists at Sentara Neurology Specialists in Norfolk, Virginia. They work to evaluate and recommend care for patients with cognitive and emotional problems.
