What type of memory loss is normal? Should I be worried? Where do I go from here?

These questions – among many others – were addressed during a March 20 seminar, “I’m Having Trouble Remembering: A Discussion on the Difference Between Normal Aging and Dementia,” presented by Erin Stevens, DO, MGH geriatrician and Palliative Care physician.

The program, open to caregivers, patients and staff, kicked off a four-seminar “Conversations with Caregivers” education series at the MGH. Sponsored by the Dementia Caregiver Support Program, this new initiative was created by the Division of Palliative Care and Geriatric Medicine to offer support to those navigating the often-difficult path of caring for an aging parent, spouse, friend or loved one.

“We are here to help educate, support and provide for those caring for someone with dementia,” said Lorie Smith, MD, medical director of the Dementia Caregiver Program. “We hope, as our program continues to develop, participants will find it a source of compassion and collaboration.”

Normal aging or dementia?

“Let’s think about our cars,” Stevens said. “It can be perfectly normal to park your car in a garage and then forget where it might be parked. What is not normal, however, is to forget what type of car you have or not remember why you drove there.”

Normal memory changes – such as briefly forgetting where a car is parked – are signs of cognitive aging, a process that occurs in every individual as they age. More concerning situations are when an individual starts frequently getting lost in once-familiar places, forgetting routine tasks, losing weight, and if they seem depressed, make inappropriate comments or experience changes in their sleep or spending habits, Stevens says.

“Dementia isn’t just memory loss, it can be an impairment in any one of six main mental process domains – complex attention, executive function, learning and memory, language, perceptual-motor and social cognition,” said Stevens. “When the memory loss or behavior effects the ability to function daily or to be independent, it is more concerning for dementia.”

Causes and types of dementia

“There are many causes of dementia, but the biggest risk factor is age. The older we live, the more of a chance we have of getting it,” Stevens said.

Other causes of memory loss may include vascular disease, head trauma, degenerative disorders or a hereditary condition.  Depending on the type of memory problem – whether it be neurodegenerative or age-related – the correct specialist can then work on a management plan. Different types of dementia present differently and can be helped – or worsened – by medications or treatments.

“Depression is one of the top three causes of reversible dementia. So it is really important to have the correct initial evaluation and diagnosis so we can tease out and treat any reversible causes. It may end up the patient doesn’t have dementia at all, but instead has one of these other issues that can be treated,”said Stevens.

Diagnosis and management

“We know that early advance care planning improves care for both patients and caregivers,” said Stevens. “We want to – for as long as possible – preserve our patients’ memory, maintain their function and independence, and support them and their caregivers.”

While there are medications to help slow the progression of dementia, they do not prevent, treat or cure the disease. In addition to or in place of medication, a number of other techniques also can be used to help with symptoms. These techniques include a proper diagnosis, removing and treating any reversible causes or exacerbations, managing behavioral symptoms and promoting brain health.

“A good rule of thumb is what’s good for your heart is also good for your brain,” said Stevens. “Adopting a healthy lifestyle with exercise, a balanced diet and mental activities is the best way to maintain a healthy brain. The brain is constantly changing, so if there’s one thing I can’t stress enough it’s the importance of keeping your mind active.”

For more information about the Dementia Caregiver Support Program, contact Barbara Moscowitz, LICSW, program founder and associate director for Education and Support, at bmoscowitz@partners.org.



Read more articles from the 04/06/18 Hotline issue.