Normal Memory Loss or Signs of Trouble?

 

Dr. Susan Vandermorris—aka the Memory Specialist—is a neuropsychologist at the Baycrest Centre for Geriatric Care in Toronto, where she provides neuropsychological assessment and intervention services to older adults and maintains an active research program in memory and aging.

 

Forgetting words, misplacing keys, wondering why you came into this room just now… are these normal age-related glitches or symptoms of disease-related cognitive change?

How about getting lost in your own backyard?

It’s a frightening experience. But what does it it mean? Just what constitutes normal in the world of memory loss? And is there really such a thing as a “senior moment”?

The Scenario

Ms. W was a 61-year-old, highly successful entrepreneur. She ran her own business, traveling the country to deliver popular money management seminars for women. But when she arrived with her son at the memory clinic, she looked worried.

“It’s my memory,” she told me. “It’s completely gone. I go to conferences and I blank on names of people I’ve known for years. I forget to make phone calls. And the other day my dentist called to remind me of an appointment I had zero recollection of setting up.”

I asked her how long this had been going on. “I don’t know,” she said. “Years, I think, maybe decades. But now it’s at the point where I have to avoid social gatherings for fear of embarrassment, and I have to drink a couple of glasses of wine each night just so I can stop worrying and get a little sleep.” She told me that she had had to increase her traveling schedule so she could deliver seminars to new audiences. She was terrified of making a mistake in front of repeat customers, so she avoided seeing them altogether.

“Just last week, I bumped into a colleague I used to see all the time on the conference circuit,” she said. “It had been years since I’d seen her last. It wasn’t until five minutes after our conversation ended that her name came to me. I’m not sure she ever noticed that I couldn’t come up with it, but I was so embarrassed!”

Things were no better at home. She would go to the grocery store for milk and come home with everything but. She was so forgetful, she said, that she was amazed her son would leave her alone with his children.

The Evaluation

We established the scope of Ms. W’s difficulties, then reviewed her relevant medical history, day-to-day activities, personal stressors and available support system. She went on to complete lab and imaging tests to rule out possible medical causes of memory change – like a stroke or a tumor, or significant vitamin deficiencies – and underwent neuropsychological testing to evaluate her memory functioning.

While she completed testing, I interviewed her son. Yes, he had noticed an increase in his mother’s reported memory problems over the years, but he hadn’t noticed a change in her functioning. She was heavily involved in his son’s preschool. She knew the names of all the other children in his classroom. And she never missed a scheduled pickup or babysitting date.

The Diagnosis

The results of Ms. W’s testing were all normal. Not only was there no medical basis for the memory lapses, but her memory was well above average for her age.

When we reviewed the test results with Ms. W., she carefully questioned every piece of evidence put in front of her and challenged team members to make their case for exactly how they had established that she did not have Alzheimer’s disease.

In the team’s view, the most likely explanation was that she was experiencing normal age-related cognitive changes (a slowing down in reaction time, increased difficulty with timely memory retrieval), which were compounded by worry, increased workload, alcohol use and poor sleep.

The problem wasn’t what she was specifically forgetting and what she was remembering. Rather, she was overreacting to normal memory mistakes.

 The Treatment

This was not easy news for Ms. W to hear. In her view, the severity of her own symptoms could not be reconciled with such an apparently simple explanation. But the story here is not so simple. Unwinding the now-established patterns of Ms. W’s behavior to a place where she was managing a healthier workload, drinking less, sleeping better and, most critically, worrying less would require as much work on her part as any of her business ventures. The treatment was essentially old-fashioned pulling-herself-up-by-the-bootstraps. The good news: Ms. W was up for the job.

One year later, our team saw Ms. W for a follow-up. “I feel like my old self,” she said. “I realized I had let the stress of my job get the better of me and I was making some really unhealthy choices. Since we last spoke, I’ve cut back on my traveling, taken on a junior partner to keep up with the business demands, stopped drinking and rejoined a dance class I gave up years ago. I’m exercising, sleeping better and managing my stress.” Her thinking was clearer and her memory was much improved, she added: ”I still catch myself blanking on names of old friends I haven’t seen in a while,” she said, “but I know that’s normal and I don’t let myself get upset about it.”