Dear Dr. Garner,
My mother is becoming more and more forgetful. I would like to know how to tell the difference between forgetfulness due to old age and that due to Alzheimer’s disease. I thank you for addressing my question and I really enjoy your column each week in The Tablet.
Concerned about Mom in Maspeth
 
Dear Concerned,
This is a question I am frequently asked. Normal aging of the brain is a very different process from what happens in Alzheimer’s disease. Unfortunately, there is no test that conclusively verifies a patient has Alzheimer’s disease.

The old thinking regarding the aging brain is that the normal changes are due to loss of brain cells. We now know that while there is small amount of brain cell loss due to aging, the main culprit for forgetfulness is a decrease in chemicals in the brain. This causes the “wiring” in the brain to go awry, and people become forgetful.

In Alzheimer’s disease, there is a great loss of brain cells, particularly in the part of the brain which controls memory. Eventually it spreads throughout the entire brain.

In Alzheimer’s disease, short-term memory is affected first. The short-term memory refers to information recently learned, such as an interesting comment you’ve heard, or an important idea you recently learned for your job.

Later symptoms of Alzheimer’s include confusion, anger, mood swings, language breakdown, long-term memory loss and general withdrawal from social situations.

There are conditions which can mimic Alzheimer’s disease, which a doctor can check for. These include, depression, side effects of drugs, strokes, head injury and alcoholism.

Here are some differences between memory loss related to aging and that related to Alzheimer’s.

• In age-related memory loss, one might forget part of an experience, but a person with Alzheimer’s disease will forget the whole experience.

• In age-related memory loss, a person who forgets something usually remembers it later. In Alzheimer’s, a person won’t recall the information at a later time.

• In normal age-related memory loss, a person can usually follow instructions (verbal or written) without difficulty, but a person with Alzheimer’s disease is less able to follow instructions over time.

• In normal age-related memory loss, using notes and other reminders is helpful; people with Alzheimer’s gradually become less able to benefit from memory aids.

• In normal age-related memory loss, people clan still manage their personal care (bathing, dressing grooming etc), but with Alzheimer’s disease, patients lose the ability to engage in these daily takes. 

Interestingly, with Alzheimer’s disease, patients often experience a loss of smell. This can be tested for by your doctor.

Anyone worried about memory problems should see their doctor, who can work up the problem. While there are no known causes, age (over 65), stress, and genetics seems to play a role in the development of the disease.

While not a substitute for bringing your mother to a doctor, there is a simple word test you can try at home. Ask your mother to name all types of fruit she can remember in one minute. Then ask her to name all types of animals she can in one minute. Someone without Alzheimer’s can usually list 20-25 words.  

The following are not part of normal aging and indicate possible Alzheimer’s disease:

• Forgetting things much more often than one used to.

• Forgetting how to do things you’ve done many times before.

• Trouble learning new things.

• Repeating phrases or stories in the same conversation.

• Trouble making choices or handling money.

• Not being able to keep track of what happens each day.

For general help in memory, the following may be of use:

• Keep lists

• Follow a routine

• Make associations (connect things in your mind), such as using landmarks to help you find places.

• Keep a detailed calendar.

• Put important items, such as your keys, in the same place every time. 

There is one final tip from my wife, who is a psychiatrist and often evaluates early Alzheimer’s cases. It is not typical for an Alzheimer’s patient to come to a doctor complaining of memory loss. Typically, they try to hide it and work around it and it is usually the family that brings the memory loss to the attention of the family doctor. 

I thank you for your question and hope you will bring your mother to her doctor to be evaluated.

Have a great week and until next time, be well.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also is the host of the popular call-in cable TV show “Ask the Doctor” seen on The Prayer Channel.