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.
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.
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
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
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
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
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.
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