Where in the world are my new earrings?

I had just started writing a blog post on forgetfulness and stopped to get dressed for lunch with friends.  The new earrings I had purchased the day before in Santa Barbara and opened that morning were nowhere to be found.  I finally had to stop looking to leave for lunch.  On my way out I found my earrings on the bathroom counter right where I had left them less than an hour before.  If this were the first and only episode of forgetfulness I have had, it would not be concerning but they do seem to occur more frequently now.

When my memory fails, I and many older adults immediately start to wonder if this could be the beginning of Alzheimer’s or other type of dementia.  According to the CDC in 2014, there were an estimated 5.0 million people over 65 with dementia, projected to rise to nearly 14 million by 2060.  It is important for us to realize that dementia is not a part of normal aging.  Many people live their entire lives without developing dementia.

“Slow cognitive decline is expected as we get older” says  Dr. Joel Salinas, a neurologist at the Massachusetts General Hospital.  What is not considered a normal or expected part of aging is dementia – a disease signaled by “more rapid decline in cognitive abilities.” Many older adults worry about big causes, such as Alzheimer’s, for their forgetfulness when “many cognitive issues can result from general health problems such as thyroid issues, dehydration or lifestyle that can be reversed,” according to Dr. Salinas.

Some very basic causes of slower thinking and memory loss can be low thyroid functioning, too much alcohol, and dehydration from drinking too little water throughout the day, resulting in reduced blood flow to the brain.

Donna de Levante Raphael, director of the Alzheimer’s Foundation, says it is critical to determine what is affecting your ability to reason, remember or articulate your thoughts.  She says a Medicare-covered memory screening, should be part of seniors’ annual wellness visits.  Some cognitive issues may be caused by the following factors and can often be reversed.

Medications – Many seniors take a variety of medications (both over the counter and prescription).  Adverse health effects can result from both the individual drugs and the overall mix.  Cognitive impairment is one of the most common side effects from medications.  Tatyana Gurvich of the USC School of Pharmacy says the first thing that should be looked at when an older adult complains about memory issues is the medications they are taking.  One over the counter medication that can cause confusion is Benadryl, which is sold by itself or in combination products like Advil PM.  Dr. Gurvich says some medications for overactive bladder or incontinence, depression or sleep can in combinations also cause confusion in older adults.  Combining other drugs with opioids can result in more confusion and sometimes major changes in cognition.

Lack of exercise – Many studies have shown that our memories and thinking skills are improved by exercise.  A University of British Columbia study found that regular aerobic exercise, such as running or fast walking, boosts the size of the hippocampus, which stimulates the release of chemicals in the brain that affect the health and supply of brain cells.  On the reverse side, the study showed that the lack of aerobic exercises on a regular basis can cause brain shrinkage and lead to an increase of white matter changes or small injuries to parts of the brain cells.  A University of Maryland study of brain health in older adults shows that just one session of exercise increases activation in the brain circuits associated with memory.  Verbal fluency and other measures of brain function have been shown to improve after only 12 weeks of exercise in both people diagnosed with mild cognitive impairment as well as cognitively healthy adults, according to J Carson Smith at the University of Maryland School of Public Health.  He adds that everyone should walk or do moderately intensive exercise for 30 minutes at least four times a week to protect their brains from cognitive decline and atrophy.

Sleep issues – Dr. Salinas says that too much sleep or too little high-quality sleep can cause a problem with memory, reasoning and particularly executive function. He explains that during deeper stages of sleep, the hippocampus, the area of the brain responsible for the formation and retrieval of memories, transfers newly made memories to the prefrontal cortex, the brain area responsible for long-term storage.  This process is disrupted with sometimes noticeable results without adequate sleep.  Researchers at Michigan State University’s Sleep and Learning Lab found that sleep deprivation doubles your odds of being unable to complete a series of steps without losing your place and triples the number of lapses in attention.

Anxiety and depression – Depression or anxiety can play a major role in mental fuzziness and confusion.  The National Institute on Aging says depression, which is common in more isolated older adults, can mimic the signs of memory loss.  The serotonin levels in your brain decrease when you are depressed which can affect attention, processing speed and memory consolidation.   Neurologist Richard Isaacson, director of the Alzheimer’s Prevention Clinic at Weil Cornell Medicine, call this a “pseudodementia of depression.”  Research shows that depression and anxiety can also alter our brain physically.  A Brigham Young University study shows that subjects with anxiety and depression showed less brain growth in key areas compared with those not dealing with such mood disorders.

It is normal for older adults to forget things occasionally, but serious memory problems make it hard to do everyday things like driving, using the phone, and finding your way home.  The following chart from NIH lists some of the differences between normal aging and dementia/Alzheimer’s disease.

Normal Aging                                                    Alzheimer’s or Dementia

Making a bad decision once in a while   Frequent poor judgments/decisions

Missing a monthly payment                    Problems taking care of monthly bills

Forgetting which day it is                         Losing track of the date or time of year

Sometimes forgetting a word to use    Trouble having a conversation

Losing things from time to time            Losing things often/unable to locate

The National Institute on Aging suggests some signs that it may be time to talk with your doctor include: asking the same questions over and over; getting lost in places a person knows well; having trouble following recipes or directions; becoming more confused about time, people and places; and failure to take proper care of yourself.

The studies I reviewed all emphasized the importance of finding the causes of memory issues in order to determine the correct course of action.  Once you know the causes, you can work with your doctor to determine what, if any, treatment is needed or if there are other health, lifestyle or medication changes you can make to stop and possibly reverse your memory loss.