Further Considering Elders' Working Lives
Sex Among Residents of Care Homes

Senior Moments and Dementia

There was a big conference of the Alzheimer's Association in Boston last week and the news being reported is that you and I are now responsible for diagnosing our own dementia. From The New York Times:

"...in a significant shift highlighted at the conference, leading Alzheimer’s researchers are identifying a new category called 'subjective cognitive decline,' which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

“The whole field now is moving to this area, and saying ‘Hey, maybe there is something to this, and maybe we should pay attention to these people,’ said Dr. Ronald C. Petersen, chairman of the advisory panel to the federal government’s new National Alzheimer’s Project who is also director of the Mayo Clinic’s Alzheimer’s center...

“'Lo and behold, those who had a concern about their memory in fact had more likelihood' of later developing mild cognitive impairment, an early phase of dementia, he said.

"He said study participants with memory concerns were 56 percent more likely to be given a diagnosis of such impairment, even when results were adjusted for factors like education, genetic risk and psychiatric issues like anxiety and depression."

Dr. Rebecca Amariglio, a neuropsychologist at Brigham and Women's Hospital in Boston, quoted in The Times says

“'[A patient] insisted that things were changing, but he aced all of our tests.” But about seven years later, he began showing symptoms of dementia. Dr. Amariglio now believes he had recognized a cognitive change so subtle 'he was the only one who could identify it.'”

I'm pretty sure there is hardly one among us at this blog who, when having forgotten why he or she entered a room or arriving home from the market without the most important item on the list, hasn't felt a frisson of fear about incipient dementia.

For years, the experts have told us that senior moments are a normal part of aging. Now they are saying, hold it – not so fast: those irritating lapses may be “a potential precursor to a precursor” according to The Los Angeles Times which also reported on the Boston conference:

”There are still some serious hurdles to these connections, among them the recognition that some people with measurable cognitive declines don’t develop Alzheimer’s, and sometimes recover.

“Senior moments could also be related to stress, depression and cardiovascular disease. A consortium of researchers has been trying to come up with a framework that would negotiate those pitfalls and come up with workable data.”

In other words, they still don't know if a senior moment means anything serious or not.

Nevertheless, the direction the research is taking - even if it is preliminary in the extreme – gives me heartburn because I regularly notice small-bore changes in my thinking capabilities.

Such things as taking a tick longer than in the past to find a word I need or slight trouble organizing the order of chores for the day or losing the thread in the middle of what I'm saying.

Nothing big (yet). Let's call them mental hiccups - pinholes or small delays in the continuity of my thinking that I notice even if other people do not.

Dr. Amariglio gave The New York Times one of those lists of what is normal aging and what is not – pretty much like the ones you've read elsewhere:

Normal Aging
Walking into a room and forgetting why you entered
Having trouble retrieving the names of unfamiliar people
A change in memory compared with young adulthood
Memory changes similar to others of the same age

Abnormal Aging
Getting lost in familiar surroundings
Having difficulty remembering important details of recent events
Having difficulty following the plot of a television program or book because of memory
Memory changes that are worse than others of the same age

But how do we know we can trust these lists when the researchers have only now admitted that they haven't taken patients' complaints of senior moments seriously. Oy. We're on our own, my friends.


At The Elder Storytelling Place today, Joanne Zimmermann: Ruffled Fenders


Comments

Just a note to this: When I entered college, the disabled student services gave me the full battery of tests. They showed that I was brilliant in all but the math and languages area. Four years later, they gave me the tests again as a part of my graduation. This second battery of tests showed a dramatic decline in all areas especially in the hand eye coordination area. I found that frightening, but I found no one who would pay attention to me until years later.

Just when I had decided that my memory lapses were a normal part of aging I read this article and started worrying again.

I am concerned to the point that I made my good friend, a psychologist, promise me she would tell me if she noticed that I was losing my cognitive ability.

I have forgotten names all my life so that did not worry me. When I started forgetting simple words I wanted to use I became alarmed, but when I became confused and could not think on my feet during a business transaction I became really frightened.

I also notice that I am making more errors when I type. Before when a word I wanted to use failed to come to mind I would think of it later. Now I sometimes never remember it.

So, yes, I am acutely aware of a declining mental ability and this article gave me pause. I have been trying to pay attention in the hopes that I can analyze whether this is just a hiccup or something to be concerned about. I have noticed that I am reasonably sharp in the morning and my memory lapses occur more frequently when I am tired. And, so far I don't think I am showing any of the abnormal signs of aging. Fingers crossed.

Darlene...
I've known all my life that I get more stupid as the day goes by. In fact, people even noticed it at work. Way back when I was still in my late 30s, my boss once said, "If you need Ronni to get anything done in a day, don't ask her after 3PM."

She was laughing but not entirely kidding. We both knew that.

It's even more true today at age 72 - I have ALL my mental and physical energy in the first half of the day and if I don't get tomorrow's blog post written by about 2PM, along with any physical stuff - even something as simple as vacuuming the house - it isn't going to happen at all that day.

It makes for a frantic first half of the day and it really irritates me.

Until they come up with a cure - or effective treatment to stop the progression of dementia, it's all moot anyway, isn't it?

What distresses me is, not only are we on our own, but so are our families. Almost everything I read about the onset of dementia, particularly Alzheimer's Disease, discusses memory loss. For a spouse and/or children, the memory loss isn't always what shows up first. Memory loss can be hidden by the sufferer, covered up very effectively, in fact.

What showed up first in my husband were things that had nothing to do with memory: a white-hot anger at me for things I hadn't done; a compulsion to buy lots of moderately expensive things that amused him; romantic obsessions with professional young women, followed by abject depression when he was rejected. You can imagine how I felt in those months.

Eventually, of course, I figured it out. (He lost his car in the mall parking lot. Twice. He couldn't find the dentist's office.) In a caregivers' support group I learned that all the above were classic symptoms of AD -- but most news stories talk only about memory loss.

And while I'm on my rant . . . . There was a "good news" story the other day about how the dementia rate in Europe seems to be going down, probably because of better stroke care and less vascular disease. But that affects vascular dementia. The most common form of dementia is Alzheimer's Disease, which doesn't seem to be caused by vascular disease. The story didn't make that clear.

And you know the stories that tell you exercise and crossword puzzles and friends and fatty acids and whatever will help you stave off Alzheimer's? It won't. It might keep vascular dementia at bay, but Alzheimer's will either hit you or it won't.

My dear, dear, brilliant husband was slender and a walker all his life. His risk factor was a mother with Alzheimer's. My husband's sister, who is 83, is fine.

Well, these days we are not really 'on our own'.... at least we can readily communicate with this blog.

As for memory, I don't worry if I occasionally lose my train of thought or forget a word: these have happened all my adult life (albeit less frequently.)

But when in doubt I always try to get on the web to jog my memory via Google or a Merriam-Webster look-up... however I DO use a lot of Post-Its! ;-)

I think that the more you focus on something, the more likely you are to experience it. We've all had memory lapses or hiccups all through our lives. At age 20 or 30, you don't think twice about them, but suddenly at age 60 or 70 or 80, they forcast the doom of dementia. You worry about it and become stressed - stress brings about more hiccups, and suddenly you're in a loop.

So my formula is to focus more on the things that bring joy to my life, pay attention to the important things, and laugh at the hiccups. Drink plenty of water (dehydration and hiccups go together) and exercise my brain.

The rest is all "que sera sera" anyway and as Scarlet said "I'll worry about that tomorrow. I don't have time today."

I recently met a man who said that he had put his 90-year old father in a rest home last year due to dementia. His father had paid long-term care insurance for many years, but due to dementia he had forgotten to make a payment and his policy was cancelled. Something to think about!

I hear all of you, but especially Melinda. Ask any caregiver/spouse & you will know that many drs. will not listen or give credence to a spouse's concern & some will even suggest marital counseling or a therapist for the "complaining" spouse only to have some critical event occur that gives family or physician pause & say maybe there is something to what he/she says about a loved one. Dementia spares no one & it is a dreadful condition for all. Dee

And may I add (I forgot, LOL)that more listening & less judging is called for when people talk to healthcare professionals & also to family about their concerns with cognition. Dee

Could we step back a moment? For some time it's been clear that negative aspects of aging have gained a larger footprint in the media. My take: so much fear among younger writers about the terrors of aging. Add that to the explosion of negativity in reporting everything.

It's not too late for us, the elders, to find more ways to validate our everyday lives? To focus on a narrative that keeps the positive and negative in balance? When I began Elderblogging in 2006, I understood that WE would write our story, that this was central to Elderblogging.

Thank you, Dee. My husband's neurologist diagnosed him with Mild Cognitive Impairment, then said he "definitely" didn't have Alzheimer's because "Alzheimer's is about a lot more than memory."

I went home and wrote the dr. a long letter detailing all my husband's behaviors, and took it back to the office. I never got a response, even after two follow-up phone calls.

I found out in my support group that other families had been treated the same way by that doctor.

I don't think I am getting dementia, because I still function extremely well in most intellectual areas, BUT since I had open heart surgery, C-Diff, Thrush, and spent 6 1/2 weeks in a hospital/nursing home, I have begun to have a frightening loss of familiar words and names. Some I remember in a few minutes; some not at all.I feel a small loss of cognitive function, but that just may be the effect of being bombarded with new technical things to learn: camera, computers,phones, etc..
2 of my 4 grandparents had dementia (one brought on by heatstroke). So it is a bit unnerving. Does any reader have any experience of having a temporary (I hope) memory problem after surgeries or illness?

It sounds as if the experts at this conference are grasping at straws. The reality is that there is no cure and no effective treatment for Alzheimer's.

To make matters worse--and how much worse can they be?-- there are other conditions, which mimic AD but can be easily and quickly cured.

One of these is the build-up of fluid on the brain. However, as long as the condition is diagnosed as Alzheimer's, it won't be treated.

Right now I know a woman who is losing her mind as her husband descends deeper and deeper into Alzheimer's. I want to help her and him, but she is very proud and trying to keep up appearances. She is losing weight and getting frantic. Her husband can walk and that's about it. He's a big guy and she is tiny.
My cousin had to hire three orderlies in shifts to control her husband when he developed raging Alzheimer's. She could afford that, but it still was awful.
This is life in hell.

I watched the husband of a dear friend NOT suffer my memory loss but do peculiar, oddball things (like Melinda has said in her comment). He lost the ability to distinguish the colours of traffic lights and also started to ingest aspirin at an alarming rate to counteract "electricity in the air".
All this and more while he told stories and played the piano and read books.
XO
WWW

*any

XO
WWW

So, if there's nothing we can do to stave off getting Alzheimer's, no cure and no treatment, that's one less thing to worry about, right? If impairment begins interfering with vital aspects of my life like working, paying bills, (including my LTC premium), getting around, etc., that's time enough to start worrying.

One thing I've noticed about so-called cutting-edge medical information is that 6 months later, another study comes out saying, "Oops, so sorry, but we were wrong about that!" In many cases contradictory data comes out not long after the original data is published.

I'm not sure where that leaves potential patients (or should I say "victims") when information on vital medical issues is incomplete, contradictory or inconclusive. It seems that we are indeed on our own except for fellow travelers along the road to old age.

I've signed up and may be chosen for a research study at Vanderbikt on effects of exercise on memory loss. I'm hoping to participate.

One thing they asked lots of questions about was whether I had noticed any memory changes so far. They must have been informed by this study you mention..

Interesting subject, but on what theory can we really hang our hat. I've read more than once and probably here from Ronnie, too, that our memory changes as we age. We have less responsibilities than when working and raising families which changes our pace and priorities. It's not critical to remember a new acquaintance to retain their business so we slip into complacence, for example. Is this just a slippage we could avoid by concentrating on using it so we don't lose it? This spring I started doing "luminosity.com" training to train my brain into recouping or sustaining mental sharpness. I have always enjoyed crosswords and sudoku type games, but experience the same lapses. This program is fun because it is new. The question is will concentrating on memory and mental acuity help as much as physical exercise, eating right, and luck?

I've noticed a decline in my ability to retain names, books I've read and a real slowing down in absorbing instructions for new appliances or technology.

I too am at my best in the mornings but I think I always have been. As so many of you have said, there's very little we can about it if we do get Alzheimer's, so I try to keep an eye on myself and make sure my "Advance Directions" are up to date!

I recently heard a documentary about how people with dementia are treated in Denmark, basically with respect and caring. It is illegal there to put someone with dementia in a locked ward. It was a heartwarming documentary, leaving me with the sense that dementia does not have to be the end of the world, people with dementia can live relatively happy lives if treated decently.

Also, a friend told me a story of her aunt who knew she had dementia and was determined to `beat` it. She left notes for herself everywhere, she followed a rigid routine during her day, ate the same food at the same time of day, was downright obsessive about creating routines for herself that never varied. She managed to live independently that way until the last weeks of her life.

I think rather than scare ourselves half to death we should be focussing on how to live with dementia, how to ensure we have the right supports available to us when the time comes. We have one thing going for us, we know enough about this disease to see it coming and prepare for it.

Now I'm wondering whether I should be concerned or not. I find I'm becoming more dependent on my Kindle's xray feature to remind me who some character is, especially when I'm reading mysteries with convoluted plots. I've rationalized the lapses because I generally do my recreational mystery reading in bed at night and frequently fall asleep in the middle of a page. I think I'll stay with rationalization until someone tells me I've totally lost it.

Lyn, there is an article in the Science Section of NYT today about this and other problems after ICU stays. Briefly, they're blaming the sedatives a patient receives - benzodiazpines & opioids. Tho this article is mostly about those who had serious hallucinations & PTSD, it does refer to cognitive problems.

This whole question about dementia and Alzheimer's in particular is one that I have been focusing on for a while. I don't know when Alzheimer's became the number one cause of dementia. I do know that they have a lot of money and a lot of that has to do with their marketing acumen. This may be the only reason that Alzheimer's has become the #1 disease of dementia. There are many other forms of dementia. It used to be called hardening of the arteries. Alzheimer's used to be defined as a dementia that occurred to people when they were still relatively young. Now, apparently, it occurs to all ages pf people.
One time, the Alzheimer's Association was doing a campaign. They claimed, in this campaign, that someone would develop Alzheimer's every 7 minutes. I called the official center for the Study of Alzheimer's Disease and asked them where this statistic came from. They replied that a study had been done back in the early '80's and that this figure was actually a projection from that study. So they were making claims that had nothing to do with reality.
Medications (and we in the United States use a lot of medications) can interact and mimic dementia like symptoms. A loss of a loved one will cause memory loss, or the brain becoming a sieve for at least a year after the loss. Undergoing surgery (as one commentator said they did) can have side effects that are associated with memory loss.
It is true that as we age, our synapses slow down (as does everything). This manifests as not remembering someone's name or not being able to bring up that word or forgetting why one has entered a room. Someone mentioned Luminosity.com. For a period of time, I represented a brain exercise called The Brain Fitness Program. I do think that these exercises do help to re-stimulated our synapses. But so does Brain Gym, wherein one does exercises physical and mental at the same time. Getting oxygen to the brain is important.
Yes, of course, people develop dementia and we all shudder to think that we might be the next victim. But we need to look at our lifestyles. What are we doing that may encourage these symptoms and pharmaceutical drugs might be one of the culprits.
The other thing that no one mentions is our environment. What does breathing in all the poisons that have been allowed in the environment do to us? Just because an insect spray is supposed to cause paralysis of the nervous system in a bug does not mean that it won't have the same effect on us. But no one ever talks or thinks about that. By poisoning our earth, we are poisoning ourselves. How could we not? and so we need to reflect on what might be causing this "increase" in Alzheimer's. I think it is all of the above: from marketing to the poisons we inhale.
As you may tell, this is a topic that I have focused on quite a bit.

So many good comments and questions to consider, especially as I often saw parts of myself! Ronni, this like so many subjects you bring to us is very helpful.
As for those lapses, I believe my mind is filtering out the less significant, less useful information in my living. They're somewhat bothersome, but they are ME and I'm at peace with them.

Lyn - I've noticed quite a bit of foggy brain post anesthetic for anything, a kidney stone, colonoscopy. Quite disconcerting when alone taking care of myself. After the stone the forgetfulness seemed to last 2-3 months. I also found I had to reread pages of the novel I was reading at the time as the meaning would escape me. That was disturbing, but went away. I can't imagine what it would be like for something major.

I saw that Medicare recommends a memory check to our doctors. Mine performed a brief one last time I saw her. It was laughable. She gave me three words to remember, such as apple, briefcase and towel and then asked me to repeat them later in reverse order.

Oops, talk about fading memory, my Dr. also asked me to draw a clock with numbers and a particular time of day on it.

There should be more discussion about how to cope with dementia, instead of regarding it as the end of the world. I highly recommend the Blog, Watching the Lights Go Out, by David Hilfiker. He describes his blog as a memoir from inside Alzheimer's Disease. http://davidhilfiker.blogspot.com

Of course it was scarey even to read this, but read it I did. It is preposterous to believe our brains won't change as we age...everything else does...and so sorting out Alzheimer's ( a disease) symptoms is difficult. Aging brings all kinds of happenings that effect our memory....and our memory ability does fluctuate even as young adults.
Going down is tough! Rising was also!

I appreciate Mary Joan Koch's link to davidhilfiker.blogspot.com. That is an awesome blog. Thanks for the link. I am an RN and appreciate the honest sharing.

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