We’ve all been there. You walk into the kitchen, and as you cross the threshold you’re suddenly at a loss to remember what it is you were intending to do there. Mostly these moments are fleeting, infrequent and laughed off as you remember to put the kettle on. But there comes a time with increasing age, when everyone starts to think, ‘What if it’s actually something more?’ I am often asked in clinic how to tell when forgetfulness becomes more than simply a senior moment. It’s an important question: senior moments are to be laughed at; dementia, on the other hand, far from it.
A degree of memory loss can be normal as we age, particularly beyond 60. This is simply called age-related memory impairment and is the occasional absent-mindedness when you lose your keys or forget a word. Dementia, on the other hand, is a gradually worsening memory loss that is not helped by keeping the brain active. Dementia can also be associated with an inability to cope with looking after yourself: forgetting to wash, not caring so much about having a clean shirt. It can be difficult to definitively diagnose dementia in the early stages when it is mild.
Dementia is characterised by a different type of memory loss from those ‘senior moments’ — people with dementia tend to have recall of things and people from the past without knowing where or who they are in the present. So yes, people with dementia lose their keys, but they also forget who the Prime Minister is or what year it is. Despite this, they can often tell you where they lived as a child or who with — the earliest memories are the last to go. Dementia also makes it hard to understand new instructions or new situations and causes people to get lost easily and lose track of time. There may be other clues which you wouldn’t see with age-related memory loss — for example, changes in mood or personality, or even physical elements such as falling and even weight loss. But often people don’t recognise this in themselves and it’s a relative who starts to see the signs that could indicate dementia.
Typical age-related memory loss can be reduced by keeping your brain active. The more you use your brain by trying to learn new skills or even simply reading, the more likely you are to retain your memory. Working and staying mentally agile preserves your mental function in this way and protects you from age-related memory loss. Oh well, at least there’s a plus side to having to work until your seventies!
Dementia is a cruel and frightening condition and as our population ages it has become a far more tangible fear than it ever was. Dementia is not one single illness but a variety of conditions. Alzheimer’s is probably the best known, but there are other common causes including vascular dementia and Parkinson’s. Vascular dementia is like a series of minute strokes, each knocking out some of the memory function. In reality as a sufferer or carer, the background has little impact on such a significant diagnosis. But it can be central in the treatment.
Memory loss also has other culprits. Certain medicines, including some painkillers or mental health drugs, can affect memory; and in the elderly acute infections can cause a temporary loss of memory and brain function. This can be pretty profound, but treating the infection reverses it. GPs like myself also see a condition called pseudo-dementia, as the result of depression; this loss of memory is reversible as the depression is treated or resolved.
So all in all there’s good news and bad news. The good news is, we all have senior moments which in themselves mean nothing other than we’re getting old (actually is that good or bad news?). The bad news is that dementia is certainly very prevalent now: it is estimated that by 2021 there will be a million sufferers in the UK. Right now there is no cure. Some medications slow the progression of Alzheimer’s symptoms, but they do not cure the disease or reverse the changes. These medicines are approved by Nice for use in those with diagnosed Alzheimer’s disease. People with vascular dementia will be put on the same medication that we use to prevent strokes, for example blood pressure control and statins, with the aim to reduce chances of further episodes.
Keeping your brain active reading, doing Sudoku or working for your pension is going to be your best investment to prevent age-related memory loss. It is not going to prevent dementia — we know of nothing so far that will. But at least it will reduce the number of times you feel your pockets, before you actually remember the keys are already in the drawer.