Recognize When Memory Issues Are Moving Beyond Normal, Age-Related Changes
Occasionally forgetting where you put your glasses, taking longer to recall a name, and walking into a room only to arrive with no idea why you entered in the first place… these and similar memory lapses are frustrating butusually not reasonsfor concern.
But what if those moments are occurring more often? What if that name never comes tomind or you start to forgetdoctor appointments or how to cook your favorite dish? The shift from expected, age-related memory loss to memory problems that interfere with your daily functioning or even your independence can be gradual and often hard to identify. In many cases, a loved one may have a clearer sense of your memory changes.
Massachusetts General Hospital clinical neuropsychologist Eliana Pasternak, PhD, suggests that when memory changes are noticeable enough to spark concern, either by the individual or family members, it may be time to address them with a medical professional.
“Concern tends to be a pretty good indicator,” she says. “This is because, as intangible and difficult to define as it may be, we tend to have a prettygood sense of what our ‘typical’ expectations are for our own thinking and memory skills, as well as those of our peers.”
In other words, everyone’s “normal” is a little different. You may be someone who has always struggled to keep names straight or find the right word in the middle of a sentence. You may have to go on a hunt for your keys at least once a week. When those moments come and go, they may not register and may not reflect anything other than a lifetime of being easily distracted or a little disorganized.
However, if you always had a pretty solid memory, but are now grasping for the name of a neighbor or are constantly misplacing items that always used to be in their place, these changes can be of concern.
Concerning Indications
As Dr. Pasternak suggests, you may have a good idea of what types of memory lapses or moments of confusion are normal for you. Keep that in mind if you start to worry about any change in your thinking skills or memory. Are you really experiencing a change, or are you just more aware of your usual behaviors?
“Frequency and severity of symptoms tend to be two predominant factors that inform the generation of concern,” Dr. Pasternak says. “Examples might be if you feel you or a loved one is forgetful of more things more often or struggling to find words with a frequency that is starting to impact your or their ability to communicate and/or result in social withdrawal. Are changes in thinking and memory skills impacting your or their ability to go about previously routine daily activities, like driving, managing finances, taking medications as prescribed, keeping track of medical appointments, preparing meals, etc.?”
She adds that it’s important to maintain perspective. “We all repeat ourselves with questions or stories every now and again, but a person with a memory disorder will probably repeat themselves or ask repetitive questions with much greater frequency, usually without recollection or recognition,”
Memory changes of any kind can be concerning as you get older, so it’s helpful to recognize normal changes and those that should be discussed with your doctor.
Dr. Pasternak explains. “The type of information that poses a challenge to recall is new or recent information, like a recent conversation or last night’s dinner, while memories from childhood or earlier adulthood tend to be as strong as they’ve always been.”
Many early “signs” of memory difficulty tend to be things we all do every now and again, but the key or differentiating factors that tend to generate concern relate to the frequency, severity, and persistance or progression of these symptoms.
Normal vs. Concerning
Examples of memory issues that fall into the normal or expected category and those that might raise red flags can certainly vary from person to person. But there are some guidelines to consider. Misplacing your keys, for example, is normal. Forgetting what your keys are for, however, is problematic. Missing the turn to your home when driving can happen if you’re distracted or chatting with a passenger. However, becoming lost in your own neighborhood is obviously a concern.
Dr. Pasternak says one way to make the distinction between “normal” and “concerning” memory changes is to think of those changes as you might evaluate whether symptoms of a health concern should be evaluated by a medical professional or be monitored by yourself.
“It’s similar to principles we may use when deciding when to go to the doctor for symptoms, like a cough or cold, pain, or a rash,” Dr. Pasternak says. “There are some specific symptoms that pose a safety risk, like getting lost, disorientation, forgetting the stove is on, etc. And these most certainly warrant seeing a doctor if they represent a change for the individual or are occurring with any regularity.”
She adds, however, that you don’t need to wait until such specific symptoms occur, especially if there are other symptoms or changes present. “This is because there are different types of disease-related changes that can occur in abnormal aging, and many of them do not initially present as a memory problem. It is also important to note that not all ‘memory’ changes in older adults are due to a neurodegenerative process, and it is critical to evaluate for/rule out other potentially reversible causes like metabolic toxicity, vitamin insufficiency, infectious process, tumor/mass, and so on.”
What’s Next?
If you are concerned about memory change because of obvious symptoms, you should see a doctor and communicate your concerns. “It is helpful if the doctor you see is one who is known to you, follows your care with some regularity, and is someone you feel comfortable with,” Dr. Pasternak advises. “For many, this is their primary care physician, but it can just as well be your psychiatrist, cardiologist, or other medical specialist who treats you and whose guidance you trust.”
Dr. Pasternak adds that a sudden or acute and notable change in cognition, behavior, or movement should be brought to medical attention immediately, as sudden or acute changes raise concern for certain medical conditions that may require immediate medical intervention, such as a stroke or infection.
“More gradual changes may take more time to become apparent, and the doctor you see will likely gather more information about when symptoms started and how they have changed over time to help inform their differentials and any indicated further workup,” she says, adding that other brain changes are also common as we get older. “While memory concerns tend to be most common, they are certainly not the only presenting sign of abnormal aging, and the above principles apply to uncharacteristic changes in any/other areas of cognition, movement, personality, and behavior.”
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