Forgetfulness: It's Not Always What You Think
By: National
Institute on Aging
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. 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.
Resources
The
Alzheimer’s Association is a nonprofit organization offering information
and support services to people with Alzheimer’s disease and their
families. For more information, contact:
Alzheimer’s
Association
919 Michigan Avenue, Suite 1100
Chicago, IL 60611-1676
1-800-272-3900
e-mail: info@alz.org
Internet: http://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, Alzheimer’s disease patients and their families, and the
public. For more information contact:
ADEAR
Center
PO Box 8250
Silver Spring, MD 20907‑8250
1-800-438-4380
e-mail: adear@alzheimers.org
Internet: http://www.alzheimers.org
Families
often need information about community resources, such as home care, adult
day care, respite programs, and nursing homes. This information usually is
available from State and Area Agencies on Aging. For help in finding the
appropriate agency in your area, call the Eldercare Locator,
toll-free at 1-800-677-1116 or visit http://www.eldercare.gov.
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