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Forgetfulness
It's
Not Always What You Think
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Many older people
worry about becoming more forgetful. They think forgetfulness
is the first sign of Alzheimer's disease. In the past, memory
loss and confusion were considered a normal part of aging. However,
scientists now know that most people remain both alert and able
as they age, although it may take them longer to remember things.
A lot of people experience
memory lapses. Some memory problems are serious, and others
are not. People who have serious changes in their memory, personality,
and behavior may suffer from a form of brain disease called
dementia. Dementia seriously affects a person's ability to carry
out daily activities. Alzheimer's disease is one of many types
of dementia.
The term dementia
describes a group of symptoms that are caused by changes in
brain function. Dementia symptoms may include asking the same
questions repeatedly; becoming lost in familiar places; being
unable to follow directions; getting disoriented about time,
people, and places; and neglecting personal safety, hygiene,
and nutrition. People with dementia lose their abilities at
different rates.
Dementia is caused
by many conditions. Some conditions that cause dementia can
be reversed, and others cannot. Further, many different medical
conditions may cause symptoms that seem like Alzheimer's disease,
but are not. Some of these medical conditions may be treatable.
Reversible conditions can be caused by a high fever, dehydration,
vitamin deficiency and poor nutrition, bad reactions to medicines,
problems with the thyroid gland, or a minor head injury. Medical
conditions like these can be serious and should be treated by
a doctor as soon as possible.
Sometimes older people
have emotional problems that can be mistaken for dementia. Feeling
sad, lonely, worried, or bored may be more common for older
people facing retirement or coping with the death of a spouse,
relative, or friend. Adapting to these changes leaves some people
feeling confused or forgetful. Emotional problems can be eased
by supportive friends and family, or by professional help from
a doctor or counselor.
The two most common
forms of dementia in older people are Alzheimer's disease and
multi-infarct dementia (sometimes called vascular dementia).
These types of dementia are irreversible, which means they cannot
be cured. In Alzheimer's disease, nerve cell changes in certain
parts of the brain result in the death of a large number of
cells. Symptoms of Alzheimer's disease begin slowly and become
steadily worse. As the disease progresses, symptoms range from
mild forgetfulness to serious impairments in thinking, judgment,
and the ability to perform daily activities. Eventually, patients
may need total care.
In multi-infarct
dementia, a series of small strokes or changes in the brain's
blood supply may result in the death of brain tissue. The location
in the brain where the small strokes occur determines the seriousness
of the problem and the symptoms that arise. Symptoms that begin
suddenly may be a sign of this kind of dementia. 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 if more strokes occur. In many people with multi-infarct
dementia, high blood pressure is to blame. One of the most important
reasons for controlling high blood pressure is to prevent strokes.
People who are worried
about memory problems should see their doctor. If the doctor
believes that the problem is serious, then a thorough physical,
neurological, and psychiatric evaluation may be recommended.
A complete medical examination for memory loss may include gathering
information about the person's medical history, including use
of prescription and over-the-counter medicines, diet, past medical
problems, and general health. Because a correct diagnosis depends
on recalling these details accurately, the doctor also may ask
a family member for information about the person.
Tests of blood and
urine may be done to help the doctor find any problems. There
are also tests of mental abilities (tests of memory, problem
solving, counting, and language). A brain CT scan may assist
the doctor in ruling out a curable disorder. A scan also may
show signs of normal age-related changes in the brain. It may
be necessary to have another scan at a later date to see if
there have been further changes in the brain.
Alzheimer's disease
and multi-infarct dementia can exist together, making it hard
for the doctor to diagnose either one specifically. Scientists
once thought that multi-infarct dementia and other types of
vascular dementia caused most cases of irreversible mental impairment.
They now believe that most older people with irreversible dementia
have Alzheimer's disease.
Even if the doctor
diagnoses an irreversible form of dementia, much still can be
done to treat the patient and help the family cope. A person
with dementia should be under a doctor's care, and may see a
neurologist, psychiatrist, family doctor, internist, or geriatrician.
The doctor can treat the patient's physical and behavioral problems
and answer the many questions that the person or family may
have.
For some people in
the early and middle stages of Alzheimer's disease, the drug
tacrine (also known as Cognex or THA) is prescribed to possibly
delay the worsening of some of the disease's symptoms. Doctors
believe it is very important for people with multi-infarct dementia
to try to prevent further strokes by controlling high blood
pressure, monitoring and treating high blood cholesterol and
diabetes, and not smoking.
Many people with
dementia need no medication for behavioral problems. But for
some people, doctors may prescribe medications to reduce agitation,
anxiety, depression, or sleeping problems. These troublesome
behaviors are common in people with dementia. Careful use of
doctor-prescribed drugs may make some people with dementia more
comfortable and make caring for them easier.
A healthy diet is
important. Although no special diets or nutritional supplements
have been found to prevent or reverse Alzheimer's disease or
multi-infarct dementia, a balanced diet helps maintain overall
good health. In cases of multi-infarct dementia, improving the
diet may play a role in preventing more strokes.
Family members and
friends can assist people with dementia in continuing their
daily routines, physical activities, and social contacts. People
with dementia should be kept up to date about the details of
their lives, such as the time of day, where they live, and what
is happening at home or in the world. Memory aids may help in
the day-to-day living of patients in the earlier stages of dementia.
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 are very useful aids.
Scientists are working
to develop new drugs that someday may slow, reverse, or prevent
the damage caused by Alzheimer's disease and multi- infarct
dementia. In the meantime, people who have no dementia symptoms
can try to keep their memory sharp.
Some suggestions
include developing interests or hobbies and staying involved
in activities that stimulate both the mind and body. Giving
careful attention to physical fitness and exercise also may
go a long way toward keeping a healthy state of mind. Limiting
the use of alcoholic beverages is important, because heavy drinking
over time can cause permanent brain damage.
Many people find
it useful to plan tasks; make "things-to-do" lists; and use
notes, calendars, and other memory aids. They also may remember
things better by mentally connecting them to other meaningful
things, such as a familiar name, song, or lines from a poem.
Stress, anxiety,
or depression can make a person more forgetful. Forgetfulness
caused by these emotions usually is temporary and goes away
when the feelings fade. However, if these feelings last for
a long period of time, getting help from a professional is important.
Treatment may include counseling or medication, or a combination
of both.
Some physical and
mental changes occur with age in healthy people. However, much
pain and suffering can be avoided if older people, their families,
and their doctors recognize dementia as a disease, not part
of normal aging.
Having accurate,
current information about dementia also is important. The Alzheimer's
Disease Education and Referral (ADEAR) Center is a clearinghouse
supported by the National Institute
on Aging. For more information about Alzheimer's disease
and multi-infarct dementia, contact:
ADEAR
Center
PO Box 8250
Silver Spring, MD 20907-8250
toll-free 800-438-4380
e-mail: adear@alzheimers.org
Internet Web site: http://www.alzheimers.org/adear
Families often need
information about community resources, such as home care, adult
day care, respite programs, and nursing homes. This information
usually is available from State and Area Agencies on Aging.
For help in finding the appropriate agency in your area, call
the Eldercare Locator, toll-free at 800-677-1116.
National Institute
on Aging
U.S. Department
of Health and Human Services
Public Health Service
National Institutes of Health
Published in 1996
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