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by Moira Fordyce MB ChB, MD, FRCPE, AGSF,
Stanford University School of Medicine
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 Download in PDF format
Have you ever been introduced to someone, only to realize minutes later that you've forgotten that person's name? Before age 50 you might laugh about this, but, when it occurs after the mid-century, you might worry and wonder "Is this senility?" or worse "Could this be the first sign of Alzheimer's disease?" However, memory problems have many causes. If you are having trouble with your memory, discuss this with your health care provider.
What happens to memory with normal, healthy aging?
In normal, healthy older adults, aging alone brings little or no significant problems with memory, concentration or the ability to learn new skills. Occasional lapses like forgetting a name, taking longer to find a word or learn something new are the only constant changes, and not every elder experiences them.
But doesn't everyone's memory get worse with aging?
Your attitude and expectations have a profound effect on your memory. If you expect that growing older means losing your memory, you're more likely to lose it. But if you have a positive attitude to life, treat your body well with a healthy diet, and daily exercise, and have frequent interactions with others, your ability to remember and learn new skills will remain strong.
If you've retired or aren't working, you might have lost the incentive to really concentrate, and this can seem like a memory problem. Fortunately, there are many techniques to improve concentration and memory. We now know that our brain cells are capable of growing new connections with other brain cells throughout life. This expands our brainpower.
What causes more severe memory problems in older adults?
Sudden severe memory problems in an older adult could be delirium, also called acute confusion. This is a medical emergency and could be caused by a treatable condition such as pneumonia or urinary tract infection. This merits a trip to the emergency room. Other treatable reasons for memory problems include medication side effects, thyroid disease, uncontrolled diabetes, vitamin B12 deficiency, injury, infections, and depression.
More gradual but persistent memory loss can be due to one of the common dementias - Alzheimer's, Vascular and Lewy Body. Often caregivers are the first to notice that a family member is having problems with memory.
Should I see a health care provider if I have trouble with my memory?
Yes, you should discuss this with your health care provider. Tell your health care provider when the problems started, when they occur, whether they have been the same, worse, or better over time, and what you think is causing them. Major life events such as the death of a
loved one, and recent changes in your home environment can have significant effects. Bring all your medicines for the health care provider to review, including prescription, nonprescription, vitamins, minerals, and herbal or other "natural" remedies. Also let him or her know if you drink alcohol. Any fever, chills, pain, appetite loss, weight loss or gain, or recent changes in other medical conditions should also be discussed. Depressed mood, or loss of interest in things you enjoy should be discussed, including sleep disturbances. Be sure to tell your health care provider if you have had any falls or blackout spells or if you are no longer able to care for yourself, socialize or do errands like you have in the past.
What should the health care provider do?
After discussing these issues and performing a physical examination, your health care provider should perform memory and mood screening tests, should evaluate your daily function, balance and gait, and order a number of lab tests.
What if I complete the screening tests and the results are normal or borderline?
If all the tests are normal or borderline, the health care provider might suggest that you keep track of any memory problems over the next few months then be re-evaluated. Or the health care provider might refer you for more detailed testing. If the more detailed testing is normal, then the problems with memory are likely the mild memory or concentration problems that can occur with aging.
What if any of the tests are abnormal?
In this case the health care provider should evaluate you for other causes of memory loss, and will treat treatable conditions like infection or thyroid disease. Sometimes imaging studies of the brain, such as CT (computerized tomography) scan or MRI (magnetic resonance imaging) of the brain are necessary to detect other brain disorders.
If no treatable cause for the memory problems is found, the most common reason for memory loss is Alzheimer's disease. There is currently no lab test to confirm this diagnosis. Brain biopsy, where a small sample of brain tissue is taken, is dangerous and unreliable, so it is not done. An experienced health care provider's chances of being right about this diagnosis are better than 90%.
My father has been depressed since my mother died last year. He has also been forgetting more than usual. Why is this?
Anyone who has suffered recent loss of a loved one (and remember for solitary people a beloved pet can be the "significant other"), or if an anniversary of the death is approaching, the sadness this causes can adversely affect attention and concentration. Also, poor concentration and impaired memory can be signs of depression in older people. There are now many effective medicines and non-medicine strategies to treat depression at every age, and older folks can be greatly helped by appropriate treatment.
I started taking a new medicine 2 weeks ago. I'm much slower at remembering everyday things since taking it. What should I do?
Medicines of any kind (prescription, non-prescription, herbal and "alternative" therapies), either alone or in combination, can cause memory impairment and/or confusion in the later years.
Talk with your health care provider, and bring every pill or potion that passes your lips to him or her for review. We have many wonderful health-producing medicines, but every one has both good and bad effects. Many people think that "natural remedies" are always safe; this not so. Some of the most potent poisons are plant based, and alternative therapies have their own side effects and can interact with other medicines.
The last time I visited my mother (I visit at least once weekly), she took time to recognize me and called me by my sister's name to start with. This has never happened before. What should I do about it?
Ask your health care provider to check for illness.
If you or yours experience a sudden change in thought processes, it is wise to schedule a physical examination right away. Lung disease such as pneumonia, or a urinary tract infection, can affect brain function in older folks and cause confusion. These diseases are common, treatable, and the memory problems sometimes caused by them can be corrected. Many diseases in later life show up in more subtle ways than in younger age groups, so the practitioner must be knowledgeable about these differences, look for them and not attribute changes in mental or physical function to aging alone. Do not EVER accept the comment "Well, what can you expect at your age?"
Where can I find additional information?
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