3 days ago
- Health
- San Francisco Chronicle
Is forgetting things ‘normal' aging or something worse? Here's first step to finding out
Millions of Americans live with mild cognitive impairment and dementia, and millions more are projected to be diagnosed in the coming years.
If you're having memory or cognitive problems, the first thing you should do is get evaluated by your doctor, medical experts said.
They stress that not all memory loss and cognitive decline are degenerative or permanent, so it's important to get tested to try to understand the underlying causes of the symptoms and seek the right treatment if applicable.
Testing for cognitive decline
Many people go first to their primary care physician or geriatrician, who may then refer them to a neurologist. Two widely used tests are the Montreal Cognitive Assessment Test (MOCA) and the Saint Louis University Mental Status Exam.
'If someone is concerned about their memory and thinking, and feel there's a change from their prior baseline, the first step is to talk to their primary care physician,' said Dr. Irina Skylar-Scott, a Stanford neurologist who specializes in memory disorders. 'They can do a basic evaluation and talk to them to see if there could be an issue.'
Testing can include taking a detailed history, asking what function was like before and what's changed, and comparing your results with what's expected in people of the same age and education level. Sometimes doctors do additional testing, such as bloodwork and brain imaging.
Bloodwork can show if someone has abnormal thyroid function or abnormal vitamin B12 levels, both of which can cause symptoms that mimic dementia. A brain MRI can show whether certain areas have tissue loss in the memory centers of the brain.
Because there are so many potential causes of cognitive problems other than dementia — such as depression, stroke, sleep apnea and other diseases — it's important to rule out other medical conditions that could be contributing to dementia-like symptoms.
The 3 types of memory loss
There are distinct categories of memory and cognition loss, and neurologists and geriatricians generally put them in three buckets:
'Normal aging' is characterized by some memory loss, often short-term, and subtle loss of cognition, especially with things involving speed or multitasking. It may take a little longer, or require a little more effort, to store or recall information. But the cognitive changes don't affect your ability to function day to day.
'As we get older, we tend to have very subtle, often slight declines in certain cognition,' said Dr. Kristine Yaffe, a professor of psychiatry, neurology and epidemiology at UCSF and a leading researcher of cognitive aging. 'That slows down a little bit but doesn't get in the way of what you can do. If you were to be tested, it'd be a mild change.'
Many people experience this, and it's not necessarily a medical problem.
'If you compare people in their 30s and 40s, by the time they're in their 70s and 80s, they're going to have small declines,' Yaffe said. 'That'd be 'normal aging.' They're not quite as fast or facile, but it's not anything major and not getting in the way of their functioning.'
If you forgot where you parked your car or where you left your glasses or keys, 'those are kind of normal things,' said Dr. Wynnelena Canio, a geriatrician at Kaiser Permanente in San Rafael. 'The most common cause of memory issues is not paying attention. When we park or leave our glasses on the table, a lot of times our mind is somewhere else because we're in a hurry so we didn't store that information to begin with.'
Mild cognitive decline (MCI) is a formal diagnosis for which the criterion is demonstrating impairment on at least one cognitive domain — language, memory, executive function, and visual-spatial skills — during testing. Being impaired means you've scored significantly below the norm for your age and education level in that domain. But you're still functioning, for the most part, on your own — though you may rely more on lists to remember things, for instance.
'Usually people have some sort of subjective sense,' Yaffe said. 'Their loved ones will say, 'Yes, they have declined on this.' Sure enough, they don't do as well on testing, but are still functioning OK. It's not enough where it's really getting in the way. They don't remember some things but are still able to do a lot of what they used to be able to do.'
MCI can, but does not always progress to dementia. An estimated 10% to 15% of people living with MCI progress to dementia each year, according to the Alzheimer's Association.
People with MCI who have certain genetic traits such as APOE4, a variant that increases the risk of Alzheimer's, may be more likely to progress than not, Yaffe said.
Dementia involves many symptoms similar to those of MCI. But the main difference is that 'a person with dementia is impaired in function,' said Canio, of Kaiser. 'They need others to help them pay the bills, get them places, get them to their appointments. Once someone is needing assistance from someone else to do some of those things, it's a warning sign it could be dementia.'
How quickly dementia may progress — from mild to moderate or severe — is not clear. But the biggest predictor is what someone's trajectory has been to date, said Skylar-Scott, of Stanford.
'A patient with early onset before age 65 will progress much more quickly than patients with late onset,' she said.
