Aging and Memory: What's Normal, What's Not?

Laura Baker, PhD

• "Why did I come in here?"
• "He just introduced himself to us…can you remember his name?"
• "Did you tell me to turn right or left at the turn signal?"
• "Can you read the recipe to me again? I’ve forgotten what I should add next."
• "Wait! Can you slow down a bit? I can’t remember all of that without writing it down."

Do any of these questions sound familiar to you? As we grow older, some changes in memory and thinking abilities are to be expected. Normal changes include forgetting names (not faces), getting a little more confused or flustered when performing too many tasks at once, needing more time and mental energy to learn new information, and having more trouble finding the right words in conversation.

Although some changes are to be expected as we get older, other changes are not normal and may indicate the presence of a dementia, such as Alzheimer's disease (AD). Changes that are not a normal consequence of aging may include:

• feeling confused more often than usual
• getting lost in familiar surroundings
• repeating yourself in conversation more often than usual
• forgetting details of a conversation that occurred in the last week
• increased difficulty managing finances and other complicated tasks
• loss of interest in hobbies and social activities.

As most of us would agree, these changes are out of the ordinary and therefore are a cause for concern.

The more difficult challenge is to identify the subtle changes or "First Signs" (see figure below) that fall somewhere on the continuum between the normal difficulties we all experience (e.g., word-finding hiccups, reduced ability to multi-task) and those that signal the presence of AD or other dementia (e.g., significant memory loss, notable change in problem solving, reduced ability for self-care). The subtle signs are just that...barely noticeable. Family members and close friends may not even notice these first signs for quite some time.

The more commonly reported subtle signs of cognitive impairment include:

• increased difficulty keeping track of appointments
• feeling progressively more "overwhelmed" or stressed by daily tasks and schedules
• lower frustration tolerance
• more trouble getting organized and starting new tasks
• increasingly more uncompleted tasks
• memory lapses that have to be "managed" on a regular basis.

The latter symptom may be expressed differently from person to person. Some people are able to "cover" for a memory problem more effectively than others by keeping careful lists of to-be-remembered information, staying organized and keeping a highly structured routine, and by maintaining a manageable schedule, with certain obligations being reprioritized or even relinquished. When people "cover" their memory lapses, family members or friends may not realize there is a memory problem at all. 

These subtle signs bridge the gap between normal cognitive abilities (for age) and AD (or other dementia), representing the "gray zone" of the continuum. Adults with subtle signs and in the gray zone are at greater ultimate risk of cognitive decline and dementia. It is important to point out that a portion of people who fall in the gray zone will never progress to dementia.

As we turn more attention toward the prevention of Alzheimer's, it becomes increasingly important to identify those who are at higher risk of developing the disease so that new prevention strategies, as they become available, can be swiftly and effectively implemented. In the meantime, there are a number of other prevention strategies currently at our fingertips that could benefit at-risk adults.

One strategy is to take proactive steps to optimize physical health. What happens below the neck will most certainly affect what goes on above the neck! Physical conditions such as heart disease, type 2 diabetes, pulmonary disease, as well as kidney or liver disease can compromise brain function and thus impact cognitive health. In the interest of prevention, request fasting blood tests to measure cholesterol, glucose, insulin, thyroid function, liver function, and kidney function, as well as vitamin levels of B and D. Keep a careful record of blood pressure, maintain a healthy diet, and exercise! It is also important to monitor stress and mood, as these factors can also have negative consequences for memory and thinking abilities.

The Memory Wellness Program of the University of Washington and the VA Medical Center is conducting a number of research studies that examine the link between glucose, insulin and memory for people in the gray zone as well as for those with AD. If you or your family are concerned about memory changes and are interested in finding out more about the Memory Wellness Program and our research, please contact Julie Moorer, R.N., 866-638-8813 (toll-free) or visit our Memory Wellness Program website.

Dr. Laura Baker is Assistant Professor of Psychiatry and Behavioral Sciences at The University of Washington Medical Center in Seattle, Washington. In 1995, Laura completed her graduate training at Washington University where she received a doctorate degree in experimental psychology with a cognitive neuroscience emphasis. Laura also holds a Master's degree in clinical neuropsychology from St. Mary's University in San Antonio, Texas.