Memory and Forgetfulness: What’s Normal, What’s Not

As we grow older, it’s not unusual to have trouble finding the right word or recalling a name on occasion. If trouble with wordfinding or recall persists, or performing everyday tasks like meal preparation or managing bills becomes uncharacteristically difficult, it might be a sign of something more serious.

It’s important to stress two things: Not every older adult with memory problems has dementia; and Alzheimer’s and other forms of dementia are not a normal part of aging.

What is dementia?

Dementia is an umbrella term that describes a broad range of symptoms caused by changes in the brain. Dementia is a syndrome, not a disease. Dementia is a decline in cognitive function that is significant enough to interfere in one’s daily life and activities.

Dementia is chronic, progressive, and typically irreversible. Alzheimer’s disease is the most common cause of dementia.

Some conditions that can look like dementia, but aren’t:

• Hearing loss or difficulty hearing
• Dehydration
• UTIs and other infections
• Poor or disturbed sleep, and fatigue
• High stress and anxiety
• Medication interactions and side effects
• Depression
• Poor diet and nutrition
• Normal pressure hydrocephalus
• Pernicious anemia (B12 deficiency)
• Disorders of the heart, lungs, liver or kidneys, or thyroid problems
• Alcohol and drug abuse

As we age, we all experience changes throughout our body, including the brain. One of these changes might be occasional forgetfulness.

What’s normal

• Using lists, calendar alerts, and notes to help you remember.
• Forgetting where you placed things on occasion.
• A slip of memory, like a “tip of the tongue” moment, that you remember later.
• Absent-mindedness when you aren’t paying close attention to what’s happening at the moment. Example: remembering where you parked at a shopping mall.
• Forgetting details and facts over time.
• Memory lapses aside, if personality and mood remain the same, it’s a likely indicator that it’s not something more serious.

What’s not normal

• Repeating the same question or conversation, over and over.
• Consistent and frequent pauses to retrieve words and details.
• Trouble tracking conversations, as well as TV programs and movie plots.
• Difficulty performing simple, routine tasks, like paying bills, preparing a meal and/or getting dressed.
• Forgetting recently learned information or remembering recent events.
• Repeatedly missing appointments and scheduled meetings. Confusion about date, time, and/or place.
• When family or friends notice memory loss and lapses before you do.
• Mood swings and personality changes.
• Loss of interest or apathy towards things that used to bring joy.
• Getting lost in familiar places such as your neighborhood. Sometimes a detour can cause confusion.

What’s “not normal” is more complex

With Alzheimer’s disease and other dementias, a person’s memory is affected, along with other abilities. As shared before, early signs of dementia often include memory loss that interferes with daily living.

The earliest signs of Alzheimer’s and other dementias are often difficult to diagnose. At times, everything seems normal, including communication, daily functioning, and personal care. But sometimes you sense that something is different, a bit off: memory lapses, emotions, struggling with driving directions, paying bills, following a recipe, managing medications.

If these cognitive or behavior changes are uncharacteristic and consistent for you or a person you care for, it may be caused by a health or medical issue.

Next steps

If you or someone you care about has concerns about cognition, it’s important to schedule an appointment with a primary care provider. The provider will determine if a more comprehensive evaluation from a neurologist is needed. An exam can help answer many unknowns and may identify treatable conditions such as a B12 deficiency or depression.

Dementia diagnosis

The type and cause of dementia is determined through medical and/or neurological testing, with the goal of finding out what changes are occurring in the brain and what caused those changes. Diagnosis is not always straightforward since symptoms can be similar among different types of dementia. Some dementia diagnoses are non-specific, meaning the exact type is unknown but there are obvious impairments in cognition. Some people are diagnosed with more than one form of dementia.

Benefits of an early diagnosis

If changes in memory and thinking are getting in the way of doing what you or the person you care about needs or wants to do in life, schedule a checkup. Even if the source of your problem is not curable, getting a diagnosis as soon as possible has benefits.

You can make lifestyle changes that might help slow disease progression and take advantage of medications that can lessen troublesome symptoms. You may also become eligible to participate in clinical trials, which puts you in line for cutting-edge treatment.

And knowing sooner rather than later gives you time to prioritize what you want to do in the near future, and to complete paperwork and make plans with your family about your wishes for later in the disease.

Contributor Sheila McKannay, MA, BA, CMC, is the New Client Services Care Manager at Aging Wisdom, an Aging Life Care (care management) practice based in Seattle, serving King County. Sheila has worked in the field of aging for over 30 years. It gives her great joy to help individuals and families navigate resources, find solutions, and gain peace of mind.

Living with Memory Loss?

If you or someone you know is living with memory loss, learn about these dementia-friendly community resources:

• Dementia Friendly Recreation (Seattle Parks and Recreation)
• Momentia Programs & Events
• The Memory Hub

Also, the Alzheimer’s Association operates a free 24/7 helpline to provide answers to questions and information about support groups, programs, and resources. Call 800-272-3900 for confidential information and referrals.