Is My Memory Going Away or Is It Just Normal Aging? Sara Manning Peskin - The Washington Post
go to original March 6, 2022

Understanding the Normal Aging Process (CareChannel)

Think back to the last time you walked into the living room and forgot what you came for, or tugged on the car door handle only to realize your keys were on the kitchen counter. Each week, patients in my memory clinic recount similar stories and ask me: Is this normal?

Surveys show that half of middle-aged adults worry about getting dementia. People who feel isolated, get less sleep or have taken care of someone with memory loss tend to be particularly concerned. Fear of cognitive maladies is widespread; scientists have found that people are more scared of dementia than of other top causes of death, such as heart disease and strokes.

Decades of research has made clear that cognitive change with advancing age is perfectly normal. Most adults become worse at recognizing faces and remembering new information beginning in their 30s, and then continue to decline over the rest of their lives. This means that the typical retiree can recall fewer items from a long grocery list than her 20-year-old grandchild, even if both are cognitively normal. Memory for well-learned facts last longer, but these skills eventually wane, too. So the question of whether something is amiss in the brain is not “Have I declined?” but rather “Have I declined too much?”

We are notoriously inaccurate in assessing our own cognition. Studies illustrate that we have particularly poor insight when quantifying our processing speed and dexterity. When Alzheimer’s disease or other afflictions are present, our ability to self-judge our cognitive aptitude becomes even less reliable, starting in the earliest stages of disease. Loss of self-awareness is so common in these conditions that it is sometimes included in the diagnostic criteria for the maladies.

So how should someone figure out whether they are experiencing normal aging-related memory process, or something more significant?

Rather than trying to assess yourself, enlist a close friend or family member to detect whether you are having a problem. Studies show that a spouse’s description is more reliable than a person’s own opinion of their memory and thinking skills. The most useful questionnaires for measuring cognitive impairment are not filled out by patients, but rather by someone who knows them well. In my own memory clinic, we compensate for imperfect self-awareness by asking patients to come to the visit with a friend or family member whom we can talk to separately.

As cognitive specialists, we evaluate brain health along two planes.

First, we consider the macroscopic: How well does a person function in the real world? We ask whether a patient forgets to pay bills, gets lost on familiar driving routes, or leaves ingredients out of recipes. We discuss word-finding difficulties and changes in behavior.

Second, we try to predict what is happening at a microscopic scale inside the head: Do we suspect that the patient’s brain has accumulated damaging molecules? Our brains are made of more than a septillion molecules, each formed by connected atoms, akin to Lego blocks clicked together. Most of these molecules help us thrive, but some can turn on us, wreaking havoc on the organ they were meant to serve. We don’t always know the exact molecules that cause Alzheimer’s disease and similar conditions, but in many cases we know which abnormal molecules tend to be associated with the afflictions.

To assess whether a dangerous molecule may be accumulating in a patient’s brain, we use tests of thinking, similar to brain games, that can quantify memory, multitasking ability, language skills and spatial judgment.

Read the rest at The Washington Post

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