Do you worry that forgetting names or where you put your keys might be
a sign of impending dementia?
Some memory loss is a normal part of aging. But sometimes, forgetfulness
is an early sign of serious conditions such as Alzheimer’s disease.
During a free online health lecture, board-certified neurologist
Alan Zacharias, MD, of Associated Neurologists explained the difference between normal and
abnormal memory lapses.
Topics Dr. Zacharias’ presentation addressed:
Watch a recording of Dr. Zacharias' lecture on "Memory Loss: What’s Normal, What’s Not?"
Normal Memory Loss With Aging
One of the most common concerns of patients is wanting to understand what
is normal as we age. Dr. Zacharias shares, “Changes as we age are
incredibly variable for physical and cognitive function. It depends a
lot on genetics, environment and lifestyle. Sadly, by the age of 20, we
start to lose brain cells and many of the important chemicals for our
So, what is normal? Dr. Zacharias explains that short-term and remote memories—memories
of events that happened days, weeks or a few months ago—are usually
unaffected by aging. However, it’s common to have an issue with
coming up with a word temporarily or the name of someone whom you’ve
recently met. While Dr. Zacharias says this can be “peculiar, frustrating
or something you may laugh about with your friends or family, it should
not have an impact on your ability to function.”
Many terms have been applied to normal aging-related memory loss:
- Late-life forgetfulness
- Benign senescent forgetfulness
- Age-associated memory impairment
- Aging associated cognitive decline
Dr. Zacharias added, “When you are more aware of your memory issues
than others are, that is often a good sign of the benign nature of your
Dr. Zacharias explains the difference between normal and abnormal memory
loss is the degree that it impairs one’s daily life.
As an example, he describes a 55-year-old businesswoman who is concerned
about her memory. “She is under a great deal of stress at work and
has difficulty coming up with the names of recent clients. She occasionally
misplaces objects at home. Her mother had Alzheimer’s at age 80,
and consequently she is concerned that she may be developing symptoms.”
“In a case like this,” he explains, “the neurologic exam
is almost always normal.” This represents what is termed the “Worried
Well.” We reassure the patient that this is not dementia. “However,
we add that we have no idea if it will become dementia. We might suggest
that she modify her work schedule and slow down if possible.”
Mild Cognitive Impairment
Mild cognitive impairment (MCI) is the stage between the normal cognitive
decline of aging and the early stages of some type of dementing condition
that affects memory, thinking and social abilities to a degree that interferes
with daily life.
“MCI memory problems are more severe than normal aging-related concerns,
but not serious enough to affect daily life. The distinction, however,
is not cut and dry,” says Dr. Zacharias. There is no definitive
test or single symptom that results in a diagnosis of MCI. Dr. Zacharias
explains, “It’s a judgement that we have to make to the best
of our ability.”
Dr. Zacharias describes a 68-year-old retired schoolteacher as an example.
“He has become increasingly forgetful even as the demands on this
man have been reduced in retirement. He's having difficulty recalling
details of events, trying to recall important information such as a doctor's
appointment, luncheon engagements and golf tee times. His family has been
noticing that he’s forgetting information that he formerly would
not have forgotten.”
“This is a red flag,” Dr. Zacharias explains. “In testing
for an individual like this in the office, he (the patient) might start
missing a few words when asked to recall them from a list. The remainder
of the exam might be essentially normal. There may be some issues with
remembering new information, but it doesn’t rise to the level of
dementia.” These changes aren't enough to significantly interfere
with daily life and usual activities.
“MCI will progress to dementia, usually Alzheimer’s, at a rate
of about 10 to 15 percent per year,” Dr. Zacharias says. This would
compare to the general population incidence of a one-to-two percent risk
per year in the same age group of 65 years and older.
It’s important to note that not all of those with MCI will develop
Alzheimer’s disease. A small percentage of people with MCI improve.
Some remain stable for many years. Dr. Zacharias notes that while we are
getting better, we are not yet at a point where we can predict how a patient
Alzheimer’s disease is the most common form of dementia with 4.5
million cases worldwide. It is also the sixth leading cause of death for
Americans ages 65 years and older.
The disease is an irreversible, progressive brain disorder that slowly
destroys memory and, eventually, a person’s ability to perform even
the simplest tasks such as bathing, feeding and dressing.
Dr. Zacharias explains, “This condition causes atrophy or loss of
tissue volume that begins in the brain’s hippocampus, the area involved
in the formation of new memories. It then spreads to affect other parts
of the brain.”
The major risk factor for Alzheimer’s is age, with about one to two
percent of those age 65 having the disease. According to Dr. Zacharias,
the numbers roughly increase by another 10 percent per decade, and by
the time you're 85, there's a 40 percent risk of having Alzheimer’s disease.
Twenty percent of patients will have one or more siblings, or a parent
affected with the disease. Alzheimer’s is also a little more common in women.
Dr. Zacharias added that increased education and exercise are associated
with a lower risk of the disease, and those who are more religious and
spiritual seem to have a lower risk as well. Diabetes, high cholesterol,
high blood pressure and being overweight increase the risk for Alzheimer’s.
Anti-inflammatory medicines, like Advil once thought to be protective,
probably are not.
According to Dr. Zacharias, “We’re starting to say that Alzheimer’s
starts 10, 15, maybe 20 years before it’s diagnosed.” He adds,
“In the next 10 years, we’re probably going to have data that
will reliably indicate our risk for this disease, and hopefully there
will be more that we can do about it.”
Symptoms of Alzheimer’s Disease
Alzheimer’s disease, as well as dementia of any form, doesn’t
begin abruptly. This is a key indicator when distinguishing dementia from
other changes in cognition.
It is diagnosed when there's a significant change in one’s ability
to function, in addition to memory loss and other areas of impairment.
Some key indicators of Alzheimer’s disease include:
- Repeating conversations
- Significant trouble expressing one’s self
- Getting lost while driving or in a parking lot
- Trouble with a checkbook or finances
- Writing bad checks
- Not paying the mortgage (receiving an overdue notice)
- Trouble following a recipe or planning a trip
- Apathy such as not wanting to go out
- Loss of motivation
- Signs of depression (occurs in 30 percent of patients during early stages)
- Anxiety when alone or forced to interact in large groups
- Paranoia and delusions as the disease progresses (“You’re cheating
on me, who’s stealing my things, the kids want all of our money,
- Agitation and aggression
- Strange or inappropriate jokes or behavior
Prevention and Treatment
Dr. Zacharias says, “It’s important to stay physically active,
intellectually engaged, eat well and keep your eyes open for new therapies.”
Currently, there are no FDA-approved drugs or treatments for MCI—a
precursor of Alzheimer's disease. “This doesn’t mean that
there aren’t options and strategies. Donepezil (Aricept) may slow
down the development of Alzheimer’s a bit for about two years, but
after 36 months there is no difference when compared to a placebo,”
says Dr. Zacharias.
There are approved therapies for Alzheimer’s disease; however, they
provide only mild beneficial effects in most cases. “All of the
current therapies are primarily for treating symptoms; none have been
proven to delay the progression of the disease,”Dr. Zacharias explains.
Four approved drugs for symptom management include Aricept, Razadyne, Exelon
and Namenda. Most of the benefits of these current therapies are mild
but are appropriate to consider.
There are also no FDA-approved drugs for treating behavioral symptoms associated
with dementia. “However, we can treat depression, anxiety, obsessive
behavior and insomnia for patients with dementia,” he says.
“Vitamin E can also be considered. It has mixed results but is reasonable
to consider at a dose of 2,000 units per day for those with Alzheimer’s,”
explains Dr. Zacharias. “We are all still learning. If a strategy
is not yet proven, but seems reasonable to you, you might consider trying
Contact your primary care physician, psychiatrist or neurologist for more
help with and understanding of memory loss.
Please click here to view a PDF of slides shown during this lecture.
To make an appointment with Dr. Zacharias, call