Forgetfulness and Aging: What is Normal

Many people are afraid that growing old means losing the ability to think, reason, or remember. They worry when they feel confused or forgetful that these feelings are the first signs of senility. In the past, doctors dismissed memory loss, confusion, or similar behaviors as a normal part of aging. However, scientists now know that most people remain alert and capable as they age. They also know that people who experience changes in personality, behavior, or skills may be suffering from a form of brain disease called dementia.

The term dementia describes a group of symptoms that usually are caused by changes in the normal activity of very sensitive brain cells. Dementia seriously interferes with a person's ability to carry out daily activities. Dementia is irreversible - it cannot be cured. However, there are many conditions with symptoms that seem like dementia but aren't. These reversible conditions can be caused by problems such as a high fever, poor nutrition, a bad reaction to a medicine, or a minor head injury. Although not dementia, medical problems like these can be serious and should be treated by a doctor as soon as possible.

Sometimes older people have emotional problems that are mistaken for dementia. Feeling sad, lonely, worried, or bored may be more common for older people facing retirement or handling the death of a relative or friend. Adapting to these changes can leave some people feeling confused or forgetful. Emotional problems can be helped by supportive friends and family, or by professional help from a counselor.

People who think they might have a form of dementia should have a thorough physical, neurological, and psychiatric evaluation. They also should have a complete medical exam, as well as tests of mental abilities. Some tests, such as a brain scan, can help the doctor rule out a curable disorder. Such a scan also may show signs of normal age-related changes in the brain. It may be necessary to repeat the scan at a later date to see if there have been further changes in the brain.

A complete medical exam also includes getting information about the person's medical history, including use of prescription and over-the-counter medicines, diet, and general health. Because a correct diagnosis depends upon recalling these details accurately, the doctor also may ask a close relative for information.

The two most common forms of dementia are multi-infarct dementia (sometimes called vascular dementia) and Alzheimer's disease (pronounced ALTZ-hi-merz). In multi-infarct dementia, changes in the brain's blood vessels result in widespread death of brain tissue. Symptoms that begin suddenly may be a sign of this kind of dementia. Telltale signs of multi-infarct dementia include vision or speech problems, and/or numbness or weakness on one side of the body. 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.

Scientists once thought that multi-infarct dementia and other types of vascular dementia caused many cases of irreversible mental impairment. They now believe that most older people with serious mental problems suffer from Alzheimer's disease. In Alzheimer's disease, nerve cell changes in certain parts of the brain result in the death of a large number of cells. Symptoms begin slowly and become steadily worse. Both forms of dementia can exist together, making it hard for the doctor to diagnose either.

If the doctor diagnoses an irreversible disorder, there is still much that can be done to treat the patient and to help the family cope.

Family members and friends can help people with dementia maintain their daily routines, physical activities, and social contacts. People with dementia should be kept informed about the details of their lives -- the time of day, where they live, and what is happening at home or in the world. This may help stop brain activity from failing at a more rapid pace. Memory aids can help in day-to-day living. 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 can be very helpful.

Proper diet is important. Although no special diets or supplements have been found to prevent or reverse dementia, a balanced diet helps maintain overall good health. In cases of multi-infarct dementia, changes in diet may prevent more strokes.

Many people with dementia do not need medication. For some, the careful use of drugs can reduce troublesome symptoms. The doctor may prescribe medications for people with dementia who experience agitation, anxiety, depression, or problems sleeping.

Although family and friends can help, a person with multi-infarct dementia or Alzheimer's disease should be under the care of a physician. A neurologist, psychiatrist, family doctor, internist, or geriatrician may be the primary care doctor. The doctor will continue to treat the patient's physical and emotional problems and answer the many questions that the person or family may have.

Dementia patients lose their abilities at different rates. Even so, patients and their families have many common experiences -- loneliness, frustration, and lack of information and resources. Family support groups around the country provide a valuable resource for patients and their families. For example, they can help family caregivers learn how to cope with the behavior changes patients may experience.

The Alzheimer's Association has more than 200 chapters across the country. It sponsors support groups, encourages research, provides family services, and distributes information and education on all forms of dementia.

Accurate, current information about dementia also is important. The Alzheimer's Disease Education and Referral Center (ADEAR) is a clearinghouse supported by the National Institute on Aging. It provides information about Alzheimer's disease and multi-infarct dementia.

Diet, the development of new medications, and lifestyle may someday help prevent or reverse the damage caused by multi-infarct dementia or Alzheimer's disease. Some doctors believe it is very important for people suffering multi-infarct dementia to try to prevent further damage by controlling high blood pressure, monitoring and treating high blood cholesterol, and not smoking.

Developing interests or hobbies and staying involved in activities that keep the mind and body active are among the best ways older people can remain sharp and keep their mental abilities. Careful attention to physical fitness, including a balanced diet, also may go a long way to help people keep a healthy state of mind. Some physical and mental changes occur with age even in healthy persons, but much pain and suffering can be avoided if older persons, their families, and their doctors realize that dementia is a disease, not part of normal aging.

Courtesy of the U.S. Department of Health and Human Services, National Institutes of Health.