Memory Loss: From Simple Forgetfulness to Alzheimer's Disease
Mildred and Esther represent different ends of the spectrum of memory disorders. Mildred, 85 years old, suffers from short-term memory loss - her son says she "can tell you what she had for breakfast in 1942, but she can't remember what she had for dinner last night" - but is still able to live somewhat independently in her own apartment with her family's intervention. While still "somewhat engaged," 92-year-old Esther, a resident at Hebrew Rehabilitation Center (HRC), has severe dementia, greatly limiting her ability to communicate or care for herself.
Mildred and Esther aren't alone. An estimated 10 percent of Americans over the age of 70 have significant memory problems, with countless millions more suffering from lesser forms of memory loss. Nearly 4 million Americans have Alzheimer's disease, which begins slowly with memory problems and becomes steadily debilitating.
While we all experience some memory loss as we age, memory disorders are not a normal part of aging. Rather, memory disorders are a problem of storing and/or retrieving memories and can range from simple forgetfulness, which we all experience as we get older, to Alzheimer's disease, which robs individuals of the ability to complete simple tasks, think and communicate clearly, or care for oneself. A significant problem exists when memory lapses affect one's daily activities.
The human brain stores different types of information in different places. Short-term memory involves recalling details - telephone numbers, names, faces - that have been catalogued only minutes or seconds before. The formation of these memories occurs in a distinct area deep inside the brain. Long-term memories of events that took place in the past are formed when permanent changes to cells in other parts of the brain have occurred.
As we age, our brain's memory retrieval system slows down, making it sometimes difficult to remember things as quickly as we did when we were younger. When this slowing-down process is accompanied by a loss of problem-solving skills, language difficulties, a general deterioration of thinking ability, and behavioral changes severe enough to interfere with daily activities, a memory disorder may be present.
"Misplacing your keys, for example, is normal as you age," says geriatrician Ruth Kandel, M.D., director of HRC's Outpatient Memory Disorders Clinic. "But when you forget what the keys are for once you find them, then a much more serious problem is present."
Keeping the Brain Active
Some forms of memory loss are reversible, says Dr. Kandel, and there is not necessarily a progression from milder memory loss to dementia. Thus, it is important to keep the brain active, especially when memory problems first arise. Doctors call this the "use-it-or-lose-it" paradigm.
Exercising the brain by doing puzzles and crosswords and playing board games can help to keep the brain sharper and help to retain memory. Recent studies have also shown that regular physical activity can help maintain or improve memory as we age. Eating a healthful diet is also important, especially fruits and vegetables rich in antioxidants, which protect and nourish brain cells.
For seniors experiencing milder forms of memory loss, Dr. Kandel recommends using notebooks or visual clues as reminders, as well as leaving often-used items in the same place. Treating contributing conditions like dehydration, high fever or vitamin deficiencies can also help reverse some forms of memory loss.
As dementia progresses or with Alzheimer's disease, medications are often given to treat symptoms, including agitation, anxiety and wandering. Drugs have also been developed to alleviate some of the cognitive and behavioral symptoms of Alzheimer's. Taken early enough, these drugs may help people retain higher memory and thinking skills longer.
The Family as Caregiver
"The key to dementia care," says Dr. Kandel, "is to improve the patient's quality of life. If you assume that memory loss is inevitable, then you don't allow the individual to receive the interventions necessary to improve their quality of life."
Most of this responsibility falls on family caregivers. According to the National Family Caregivers Association, an estimated 5 million Americans provide care for older adults with dementia. More than half of all Alzheimer's patients in the U.S. live in the community, and more than 80 percent of these individuals are cared for by a family member. This carries its own health risks for caregivers, including both physical and emotional stress. In fact, studies show that family caregivers suffer a higher incidence of illness, including depression, than their non-caregiving peers.
HRC social worker Deborah Good works closely with family members at the Outpatient Memory Disorders Clinic to ensure that caregivers focus on their own health and emotional well-being as they cope with their loved one's memory loss.
"We make family members feel that their own needs are part of the clinical picture," she says. "Their physical and mental health, other family responsibilities and financial pressures are important for care planning over time."
Researchers are examining ways to ease the burden on family caregivers. Social scientists at Hebrew SeniorLife's Institute for Aging Research worked with local companies to implement an innovative approach to helping employees manage the tasks of looking after and caring for a memory- or physically-impaired family member who resides at home. The project equipped eligible workers with an Internet-based e-mail support group, as well as a wireless component that allowed them to monitor their loved one's home activities without leaving the workplace.
With the death of former President Ronald Reagan from complications of Alzheimer's disease, the popular media has focused on advances in the treatment of memory loss. And while it may not help Mildred or Esther with their memory loss, current and future research holds great promise for memory-impaired individuals and those who care for them.
Download Advanced Dementia: A Guide for Families. It provides information to the family members and individuals responsible for making health care decisions for patients with advanced dementia. The information is intended to complement and encourage, but not replace, counseling by the patients’ direct health-care providers.