If you’re in your sixties, you may be terrified by your cognitive decline because you don’t know the difference between normal aging, mild cognitive impairment, and dementia. You’re eager to make exercise and dietary choices that might slow the decline. You may even consider medication if that’s the best route. More than anything, you want to be informed rather than left in the dark.
My concerns about memory loss began in my late fifties when I noticed that if I didn’t play one of my piano compositions every couple of weeks, I would forget parts of it. Around sixty-four, I noticed more forgetfulness. I would share a story with my wife and then repeat it several hours later until she interrupted me to explain that she’d already heard it. In my college classes, I might tell an anecdote in the third week and repeat it in the tenth, only to hear students laughing and pointing out my redundancy. Once I left the burner on low after making pasta sauce, and another time I left my work keys in the door at work. In both cases, I was multitasking. Doing several things at once has become more of a liability than ever.
Like many people in my age bracket, I became fearful. I didn’t know what constituted normal cognitive aging and what might point to something more serious.
I needed a guide, so I did some research and came upon Seven Steps to Managing Your Aging Memory: What’s Normal, What’s Not, and What to Do About It, by neurologist Andrew Budson and neuropsychologist Maureen O’Connor. They begin with Step 1, an explanation of normal and abnormal memory loss. They write “that the difference between normal and abnormal memory isn’t necessarily the type of problems that occur but rather the frequency and severity of those problems.”
They describe memories as episodes: having a meal, completing a workout, going to a movie, and so on. These episodes create coherent stories full of sensory details. No one has perfect memory or recall, so let go of that myth. There are many reasons we fail to remember things. If you’re not paying attention to your surroundings but are going through the motions on autopilot, or you’re distracted, you’re less likely to remember what happened.
The authors observe that anxiety and depression can interfere with memory. So if you’re a self-absorbed depressive who spends too much time living inside his own head, you may not be particularly attentive to the external world.
As I read Seven Steps to Managing Your Aging Memory, I see an ongoing theme: You need to train yourself to pay attention. As the frontal lobes age, certain aspects of attention and executive function can become less efficient. The result may resemble some symptoms of ADHD. I was never diagnosed with ADHD, but I’m convinced I’ve had some of its traits all my life. If that’s the case, my aging frontal lobes have given me a new layer of ADHD-like symptoms over an already existing layer.
The authors discuss strategies for improving attention, including the use of stimulants such as coffee. I drink my morning coffee religiously. My attention is at its best in the morning, when I do my best reading and writing.
At the end of Chapter Two, titled “How Does Memory Change in Normal Aging?,” the authors explain that spending over an hour trying to find your car in a parking lot is not normal. This made me wonder whether I’ve been cognitively impaired all my life. Like my maternal grandmother, I have a horrible sense of direction. In 1980, during my sophomore year in college, it took me nearly half an hour to find my car. For the last decade or so, whenever I park in a giant garage, I photograph the identifying numbers so I can find my car later.
My wife has known me for nearly thirty years. Throughout that time, she has observed that I live too much inside my head. We’ve all heard the cliché of the absent-minded professor. I’ve lived up to that cliché since I was in my thirties. I’ve shown up to class wearing slacks with tags and vertical strips of tape still affixed to them or wearing my shirt inside-out, only to be made aware of these sartorial violations by my attentive students. Old age may simply make the absent-mindedness more pronounced. In more serious cases, however, memory and navigation problems can point to Alzheimer’s disease. Warning signs include getting lost while driving and being unable to use familiar visual cues to find your way back, regularly forgetting appointments, repeatedly losing things, and asking the same questions or telling the same stories without remembering having done so. Such patterns can reflect the rapid forgetting associated with Alzheimer’s disease.
I do repeat myself. For two consecutive weeks, I forgot that Thursday evening was when I was supposed to take one of my daughters to see her therapist. I also left a stovetop burner on, although that happened only once. So I’m not sure where I stand.
I called my doctor to arrange a phone consultation and a cognitive assessment.
One screening questionnaire discussed in the book is the AD8. Answering yes to two or more questions can indicate possible cognitive impairment that warrants further evaluation. It does not, by itself, establish Alzheimer’s disease or any other brain disorder.
I answered yes to exactly two questions. Number 3 states: “Repeats the same things over and over (questions, stories, or statements).” I repeat myself, but usually only once. Does that count as a yes? Then there’s Number 7: “Trouble remembering appointments.” I forgot my daughter’s therapy appointment twice in a row and was so mortified that I doubt I’ll forget again. Does that count?
Ambiguity is not helpful here, but the authors make a statement about dementia that is not ambiguous. They write that “Dementia indicates impairment of daily function due to problems with thinking and memory.”
So the question is this: Is my daily functioning impaired? And that leads to a second question: How severe does the impairment have to be before it crosses the threshold into dementia?
I suspect the next chapter of my life will involve exploring that second question more rigorously through cognitive testing, medical consultation, and lifestyle changes designed to protect my memory.
I need to find out whether I have something called subjective cognitive decline, a condition in which people perceive a deterioration in their cognitive abilities even though standardized testing may show normal performance. I know I’m not the same person I used to be. I feel compromised, and I worry that this compromise may point to greater memory loss later in life.
Or perhaps I have mild cognitive impairment, in which measurable cognitive difficulties don’t substantially interfere with independent daily functioning. Some people with this condition develop dementia, while others remain stable or even improve. The risk depends on the underlying cause, so I can’t assume that I face a fifty-fifty chance of developing dementia.
Dementia is a general term for cognitive decline severe enough to interfere with independent functioning. It isn’t synonymous with Alzheimer’s disease, which is one possible cause. The authors define Alzheimer’s more specifically, writing that “Alzheimer’s is a brain disease characterized by amyloid plaques and neurofibrillary tangles.” The disease often affects memory-related structures, including the hippocampus, before progressing through other regions of the brain.
Regular aerobic exercise, a healthy diet, and an active social life are among the habits associated with better cognitive health and a lower risk of dementia. Addicted to exercise and partial to a Mediterranean-style diet, I do reasonably well in the physical health department, although I could stand to lose thirty pounds.
But the social component is more disturbing. Antisocial, introverted, and depressive, I’ve failed considerably in the social health category.
My wife began worrying about my lack of a social life a few years ago. She was also the first to express concern about my memory loss. So I got off my butt, started doing some research, called my doctor for an appointment, and decided to become proactive about my cognitive health.
I know a retired martial arts instructor who used to be an officemate at the college. I need to reach out to him and see whether he’ll join me for an hour-long walk at the beach every week. That kind of social routine could be a first step.
I’m not hopeless. I didn’t dismiss my wife’s concerns. I took them seriously and responded appropriately. I just hope I haven’t done too little too late. If I do have a serious form of memory loss, my goal, as the authors advise, is to manage it so that it doesn’t take over my life.
One thing is clear. Memory loss can lead to anxiety and depression, and anxiety and depression can produce cognitive symptoms that resemble dementia. So I may be dealing with a recursive loop, one condition feeding the other in a vicious cycle of what has sometimes been called “pseudodementia.”
One thing I know that fights depression and learned helplessness is knowledge.
I must continue the deep dive.
