How to Tell the Difference Between Normal Age-Related Memory Changes and Dementia

Have you ever walked into your kitchen only to forget why you went in there in the first place? It's unlikely you're developing dementia because forgetfulness is a normal part of aging.

It is also normal to struggle with a task you don't do very often, said Lisa Billars, MD, chief of neurology and sleep medicine at Kaiser Permanente in Atlanta. (Think: reprogramming your thermostat after the power goes out.)

However, if forgetfulness or other cognitive changes happen frequently or interfere with your daily life, like getting lost when driving to a store you frequent, you shouldn't brush them off as age-related memory changes. Although your ability to recall information changes as you get older, some cognitive and memory-related changes may be an early sign of dementia – some of which you may struggle to recognize on your own.

How Memory Changes with Age

Just as the rest of your body ages, so does your brain. As you get older, your brain shrinks, including a part of the brain known as the frontal cortex. The frontal cortex is involved in higher cognitive activities, like thinking, decision-making, and memory. Once the frontal cortex undergoes brain changes with age, it may require additional help to sustain its cognitive abilities.

Your brain compensates for this reduction in brain functioning by recruiting other neurological networks to help you remember things as you age. However, when different brain networks start mixing together, you may notice an increased decline in your ability to focus and recall information.

"We know that as we age, the organization of our brain networks changes," said Carolyn Fredericks, MD, an assistant professor at the Yale School of Medicine whose research focuses on Alzheimer's disease. "Essentially, networks that typically work separately from each other when we are completing a task get a little more mixed together—less functional segregation, in more technical terms."

Sometimes, normal age-related changes in memory may worsen. Some people may be diagnosed with a condition called mild cognitive impairment (MCI). This condition is a step beyond normal memory loss or cognitive decline but not to the extent of dementia-related decline. Someone with mild cognitive impairment may:

• Frequently lose objects
• Forget to attend important events
• Struggle to come up with the right word more than a peer of the same age

Although not as severe as dementia, it may be worth keeping an eye out for signs of mild cognitive impairment. People with MCI may be at higher risk for developing dementia. "About half the people with MCI do progress to developing dementia, but half don't," said Dr. Billars.

Early Signs of Dementia

It is important to note that dementia is not a normal part of aging. Although your brain normally undergoes age-related changes, the neurological changes associated with dementia are different from normal aging processes. According to Dr. Fredericks, researchers are still investigating potential causes of dementia.

The Alzheimer's Association suggests consulting your doctor if you notice any of these warning signs of dementia associated with Alzheimer's disease:

• Memory loss that disrupts normal activities of daily living
• Trouble solving problems
• Difficult completing familiar tasks
• Confusion with dates, times, and places
• Problems with understanding images and spatial relationships
• Trouble with spoken and written words
• Misplacing items and an inability to retrace steps to find them
• Poor judgment or decision-making
• Isolation or withdrawal from other people
• Changes in mood and personality

For example, it could be a warning sign if your father, who loves to cook and is always in the kitchen, starts having trouble reading and following a recipe.

Alzheimer's disease isn't the only kind of dementia, although it is the most common type. Other types of dementia include:

• Vascular dementia: A type of dementia that can develop after a stroke, a condition that affects blood flow to the brain. This dementia can range from mild to severe and often worsens after multiple strokes.
• Parkinson's disease dementia: Although the exact cause of this dementia is unknown, experts believe that abnormal deposits of a protein called alpha-synuclein begin to clump up in nerve cells in the brain, eventually killing those nerve cells. As the disease progresses, people begin to experience trouble with problem-solving and memory.
• Lewy body dementia: Also called dementia with Lewy bodies, this form of dementia is known for a progressive decline in function. People with Lewy body dementia may also experience visual hallucinations and sleep disturbances that can lead a person to try to act out their dreams.
• Frontotemporal dementia. A less common form of dementia that damages nerve cells in the frontal and temporal lobes and leads to loss of function. Personality changes, deterioration in behavior, and trouble with language often occur.
• Mixed dementia: Someone can also have different kinds of dementia at the same time called mixed dementia. Symptoms of mixed dementia tend to vary as this form can affect different parts of the brain depending on the person.

While there is no known cure for dementia, understanding which type of dementia someone has can be important for symptom management.

When are Memory Issues a Cause for Concern?

While an occasional lapse in memory is an unlikely cause for concern, it's important to be proactive when it comes to frequent memory issues or memory lapses that disrupt daily life.

"Everyone misplaces their keys occasionally, but when any of these things begin happening much more frequently than before, it could potentially indicate the beginnings of a brain problem," said Dr. Fredericks.

Early signs of dementia can extend beyond lapses in memory or cognitive functioning. Unfortunately, people in the early stages of dementia tend to be more aware of the cognitive changes but are less likely to recognize other signs, such as personality and relationship changes.

Although it can be difficult to talk about these things if you notice these changes in your loved one, it's worth suggesting they get evaluated as a precautionary measure.

"Either way, it's a good idea to be assessed sooner rather than later in order to get counseling about treatment that may help you and to plan for the future," said Dr. Fredericks. Delaying a visit to a healthcare provider may put your loved one's health and well-being at risk.

"If there is any question of a safety issue or potential for harm, that is absolutely when you would mention it," said Dr. Billars.

Ruling Out Other Possible Causes

While changes in memory and relationships can serve as early signs of dementia, other times they may indicate mild or reversible health conditions.

Because other medical conditions can mimic dementia, it's important to see a doctor and get evaluated if you or someone you love starts noticing signs of forgetfulness or confusion. These types of "reversible dementias" include sleep apnea, infections such as encephalitis and meningitis, tumors, hypothyroidism, and medication side effects.

Research also suggests that some chronic medical conditions might elevate your risk of developing dementia. For example, people with diabetes who have chronically high blood sugar levels are at increased risk for developing signs of dementia.

Diabetes is also one of 12 modifiable factors in a report issued by the Lancet Commission on Dementia Prevention that is shown to increase the risk of dementia. The other 11 risk factors are:

• Hypertension
• Hearing impairment
• Lower education levels
• Obesity
• Depression
• Smoking
• Physical inactivity
• Low social contact
• Air pollution
• Excessive alcohol consumption
• Traumatic brain injury

Your doctor can evaluate you—or your loved one—to find out if one of these risk factors and chronic conditions is a culprit for memory changes. If that is the case, they may recommend treatment of the condition to see if it reduces or eliminates the symptoms of memory loss. For example, if chronically elevated blood sugar levels are a likely culprit for memory changes, you can develop a plan for bringing them back down to a safer range. And once you do, you may notice that the signs of memory loss disappear.

In fact, those modifiable risk factors may be the best place to start. "If someone is 35 or 85, if they are having memory loss, looking for treatable causes is really important because it could be a modifiable cause," said Dr. Billars.

Summary

It may be tempting to dismiss some of the early signs of dementia and write them off as just mere forgetfulness. But it's better to let an expert make that determination.

As Dr. Fredericks notes, "If you are concerned that what you are experiencing may be more than 'normal aging,' bring that concern to your doctor—sooner rather than later."

Sources

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3. National Institute on Aging. Memory, forgetfulness, and aging: What's normal and what's not?

4. Alzheimer's Association. 10 early signs and symptoms of Alzheimer's.

5. Alzheimer's Association. Vascular dementia.

6. Alzheimer's Association. Parkinson's disease dementia.

7. Alzheimer's Association. Dementia with Lewy bodies.

8. Alzheimer's Association. Frontotemporal dementia.

9. Alzheimer's Association. Mixed dementia.

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