Being More Forgetful As You Age Is Normal, But When Is It A Sign of Dementia?

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You don’t have to be a senior to have a “senior moment.” Dementia can affect those as young as 30. But don’t panic, there is a normal amount of memory loss as we age. Sally Armstrong investigates.

As soon as the phone rang at 12:40 p.m., she had that awful gnawing feeling that there was something wrong, and the mistake was likely hers. Sure enough, the voice on the line said, “Are we still on for lunch?” She replied, “Of course we are. I’m slightly delayed. I’ll be there in five minutes.” Then she raced through the ritual of dressing for lunch, applying makeup, grabbing an umbrella and running out the door for the five minute sprint to the restaurant, thanking her lucky stars that the eatery was close by. But all the while, she was thinking, “How could I have forgotten?” It was a lunch she was looking forward to with two good friends—one of them visiting from out of town. How do you forget a thing like that? She chastised herself all the way to the restaurant—”I should have written it down. Does this mean my brain is turning to mush?”

There are two words that strike terror in the minds of anyone over the age of 55. “I forgot.” So why do we forget, and what does it matter? Invariably, when we forget a name or miss an appointment or can’t remember a password, we use phrases such as “My Alzheimer’s is kicking in” or “I’m having a senior moment.” Is that true? How can you tell? And what can you do about forgetting?

Here’s the good news. Forgetting is normal. And being more forgetful as you age is also normal. Says Dr. Larry Chambers, scientific adviser to the Alzheimer Society of Canada, “Memory is not the main issue to worry about. Confusion is the issue.” It’s normal to forget where you left your keys, where you parked your car and what it was you walked upstairs to fetch. It’s not normal if you can’t find your keys because you put them in the freezer. “As you age, you lose some eyesight, some hearing, some ability to make decisions, some memory. That’s aging, not dementia.” He says dementia is a combination of a person’s lifelong experiences and the impact of those experiences on his or her genes. What most people don’t know is you can decrease your chances of developing dementia no matter how old you are.

Forgetting gets serious when you ask the same questions over and over again, when you get lost while shopping and can’t find your way home, when you can’t follow the plot in a book, when you experience personality changes.

But forgetting is sometimes just the result of information overload. Researchers at the Royal Institute of Technology in Sweden cite the Internet as an example of overload and claim you can manage four different pieces of information simultaneously. But if you try to manage more, the overload will cause a decline in the efficiency and quality of the mental work you are doing.

So it’s wise to keep track of your brain health and to be aware that there are things to do and things to avoid when it comes to preserving cognitive ability. Although you can be forgetful and lose lots of memory, it won’t change your life unless it’s connected to what the experts call the Big Four. Ask yourself these four questions: Can I drive my car safely? Can I manage my finances? Can I manage my health care and eat nutritiously? Can I live independently?

Dementia not a natural part of aging
The statistics and facts about dementia can make forgetting your mother-in-law’s name a walk in the proverbial park. Consider these numbers from the Alzheimer Society.

  • 564,000 Canadians have dementia today. This number is expected to increase to 937,000 by 2031.
  • 65 per cent of those diagnosed with dementia over the age of 65 are women.
  • 25,000 new cases of dementia are diagnosed each year.
  • Age remains the biggest risk factor for dementia. After 65, the risk factor doubles every five years.
  • The annual cost for dementia (direct and indirect) is $10.4 billion. This number is set to jump to $16.6 billion by 2031.

Because we don’t talk about it, says Chambers, we don’t find better strategies for dealing with it. Dementia is not a natural part of aging, even though age is a huge risk factor. It doesn’t affect just “old” people; it can strike people in their 30s, 40s and 50s. But because of the stigma—the idea of being unable to control your own life—dementia is one of the most feared and misunderstood of all chronic diseases. We’re still whispering about it rather than shouting at the top of our lungs about funding research, finding a cure and having a national dementia strategy.

Next: Watch for these seven modifiable risk factors

Chambers says up to half of cases of Alzheimer’s disease worldwide may be the result of seven key modifiable risk factors: physical inactivity, smoking, high blood pressure, cognitive inactivity or low education, obesity, diabetes and depression.

He says there is increasing evidence to support what’s known as the brain reserve hypothesis: a considerable body of biological research has documented that a number of factors including education, work complexity, social network and leisure activities may contribute to this reserve, allowing cognitive function to be maintained in old age.

The thing about dementia as opposed to forgetting is it is chronic. It creeps up slowly. It’s an ongoing condition like diabetes, not a disease you can take a pill to fix. There are three stages over the course of the disease: mild, when you forget things such as how to get home; moderate, when you become anxious and depressed about the signs proving that you can’t do what you used to be able to do. And severe, when you become dependent on other people for living. “Dementia rarely travels alone,” Chambers says. “Eighteen per cent of dementia patients have had a stroke, 32 per cent suffer from depression, 27 per cent have heart disease, 13 per cent are diabetic and 41 per cent have high blood pressure.”

Understanding cognitive aging
Most of us fear a moment’s forgetfulness will lead to irreversible dementia. That’s not true. Because dementia is caused by the degeneration of neurons and disease of small vessels in the brain, there are things you can do to avoid or slow it down.

For example, new research claims that bashing your head for 15 years when you’re playing football or hockey is not the best thing for brain heath. Nor is smoking, because it compromises your vascular system. If you’re not physically active, the hippocampus—the part of the brain that produces new neurons to make your brain work better—won’t be stimulated by the greater blood flow that physical activity brings on. So exercise is key, as are sleeping and eating properly—foods such as olive oil, blueberries, salmon, kale and tuna, for example, are being hailed as the best brain foods. The Mediterranean Diet full of antioxidants is the new panacea. Vitamin D3 is also a vital component to brain health, so sunshine, in moderation, is valuable, too. And if you aren’t socially active, which means being with a group of people—not just playing bridge or Scrabble or Sudoku—Chambers says you are inviting the slow retreat into dementia. And retirement, he says, is not the best antidote for brain health. However, those who have retired should make a point of remaining active socially, mentally and physically, he adds.

One of the best reference books on the subject is the IOM’s (Institute of Medicine) Cognitive Aging. The book is free online. “The genius of the book is that it is written about the general population rather than a specific group with memory issues,” Chambers says.

And then there’s polypharmacy—the overprescription of drugs. The statistics are shocking. On average, people over the age of 65 are on six drugs a day. The physicians who prescribe the drugs don’t talk to each other, so the patient gets one drug from the cardiologist, another one from the neurologist, a third from the psychiatrist, another from the endocrinologist, and the list goes on until a toxic mix that leads to dementia is flowing through a patient’s blood vessels. “Up to 25 per cent of Alzheimer’s cases in Canada are caused by polypharmacy,” says Chambers. There are 20 drugs that cause memory loss; the leading ones are sleeping pills and cholesterol-lowering medications. The Federal Drug Administration in the U.S. sent an urgent warning in April 2012 to all physicians to say statin drugs (for lowering cholesterol) are increasing the risk of dementia.

Next: The problem with pharmaceuticals 

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The problem with pharmaceuticals
The poster girl in Canada for polypharmacy is Betty, 86, whose story is a cautionary tale in aging and doctor care. Luckily for Canadians, Betty, a high-energy, fun-loving senior, took her story to CBC’s Go Public.

When I talked to her at her home in Ontario, here’s the frightful story she told. “It started with an ear infection. I was given Ciprodex to clear it up. Pretty soon, I had painful swollen legs. [The FDA issued a black box—its most serious—warning for Ciprodex and other antibiotics in 2008 because of an increase risk in tendonitis and tendon rupture.] I had cataract surgery two weeks later. I was given the drug prednisolone.” Three weeks after that, she was given azithromycin for ongoing pain in her ear. Then, she also used ibuprofen to deal with the pain in her leg and her ear. The polypharmacy cycle had begun. Betty went to her doctor and told him about health issues she had never experienced before. “I was confused. The noises in my head sounded like Niagara Falls. My Achilles tendon was painful and swollen. I was acting in ways I never acted before, being outspoken and saying things I wouldn’t normally say.” Without explaining what he was doing, the doctor administered a cognitive test to Betty. She failed it. He declared her incompetent and had her driver’s licence revoked. “I was sick that day. I was running a fever, feeling terrible. What’s more, I read lips because my hearing is not what it used to be, and he was looking at a screen asking me questions that I couldn’t hear or understand. I went to the doctor to ask for help. And this is what I got.” Betty was furious. “I knew I was not incompetent and decided I was going to get to the bottom of what had happened to me myself.” She started by Googling the names of the drugs she was on and almost immediately diagnosed her own problem. She met with a new doctor, who agreed that her symptoms were a result of the drug reactions. She stopped taking them and “in a matter of about 10 days, I was fine.” Larry Chambers claims this is precisely what happens when certain drugs are mixed and given to seniors. “Side effects include confusion, memory loss and aggression—symptoms that may be misdiagnosed as dementia.”

It cost Betty $2,400 to undo what the doctor did. She had to pay a fee to take another cognitive test and prove she was of sound mind and another fee to take a new driving test to get her licence back. She passed both. But the humiliation she felt, the out-of-pocket costs to get to a town where she could have the tests and the anxiety that resulted were additional expenses that Betty doesn’t forget.

The list of drugs that can potentially lead to dementia in seniors can be found here.

Chambers encourages everyone to check with their doctor before mixing medicines, including over-the-counter meds. “Some of the anticholinergics and antihistamines are very dangerous for cognitive impairment. The other really big one is benzodiazepine, which is used for helping people sleep,” he says. Over-the-counter meds can also cause problems. For example, some heart medications prescribed by your physician cannot be mixed with Aspirin and supplements such as omega-3 fish oil and garlic as they are known to cause problems with cognitive functioning.

The best news is that a new drug called aducanumab may be able to treat beta-amyloid plaques in the brain, which are the distinguishing characteristic of Alzheimer’s. In the meantime, blueberries, salmon, exercise, sunshine in moderation and plenty of socializing are the best ways to stay brain healthy and beat the “I forgot” syndrome.

For more information about Alzheimer’s, go here.

A version of this article appeared in the December 2016/January 2017 issue with the headline, “I Forgot”, p. 52-54.