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Forgetfulness: It's Not Always What You Think
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.
Diagnosis
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.
Treatment
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 drugs
tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine
(Reminyl) are 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.
Advice
for Today
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.
Resources
The Alzheimer�s
Association is a nonprofit organization offering information and support
services to people with Alzheimer�s disease and their families. For more
information, contact:
Alzheimer�s Association
919 Michigan Avenue, Suite 1100
Chicago, IL 60611-1676
1-800-272-3900
e-mail: [email protected]
Internet: http://www.alz.org
The Alzheimer's Disease
Education and Referral (ADEAR) Center is a service of the National Institute on
Aging, part of the Federal Government�s National Institutes of Health. The
Center provides information to health professionals, Alzheimer�s disease
patients and their families, and the public. For more information contact:
ADEAR Center
PO Box 8250
Silver Spring, MD
20907‑8250
1-800-438-4380
e-mail: [email protected]
Internet: http://www.alzheimers.org
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 1-800-677-1116 or visit http://www.eldercare.gov.
National Institute on Aging
U.S. Department of Health
and Human Services
Public Health Service
National Institutes of
Health
2002
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