21st Century Aging

Living longer and better.

Minding Your Brain

November 17th is National Memory Screening Day

Coinciding with National Alzheimer’s Disease Awareness Month, the Alzheimer’s Foundation of America has organized free, confidential memory screenings on November 17th.  

More than 2,100 sites across the country will offer memory screenings, educational materials about memory concerns, and tips on successful aging.  The screening day is sponsored by over 22 professional organizations, including the American Psychological Association and the American Psychiatric Association. 

I interviewed Richard E. Powers, M.D., chairman of Alzheimer’s Foundation of America Medical Advisory Board and chief of the Bureau of Geriatric Psychiatry, Alabama Department of Mental Health and Mental Retardation and Eric J. Hall, president and chief executive officer, Alzheimer’s Foundation of America, regarding memory concerns and tips on how to take care of our minds and bodies as we age: 

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Many older people worry about memory loss.  Can you briefly describe some differences between normal forgetfulness (related to aging) and memory loss that might signal dementia?

The central distinction between age associated memory impairment (AAMI) and significant memory loss is the loss of function.  AAMI is annoying but not disabling.  Dementia will disable a person in multiple domains of life.  Age associated memory loss is frequently manifest as difficulty with acquiring large amounts of new information.  For instance, 55-year-old people do not ‘cram’ for a test because that technique does not work.  On the other hand, pervasive inability to remember everyday information can be a sign of dementia.  If I go to the store without a list and return with nine or 12 items, that is AAMI.  If I return with only one item or I get confused about why I went to the store, that is a potential problem.

What are some factors that prevent people from getting memory screens?

A pervasive fear factor as well as enormous stigma and denial continue to surround Alzheimer’s disease. This prevents people with memory problems and even their family members from talking about it, let alone taking action. Add to this, many people have misperceptions about Alzheimer’s disease. They wrongly think it’s a normal part of aging or that nothing can be done about it since there is no cure; it’s a ‘what’s the point’ kind of attitude.

AFA studies have shown that these same factors—fear, stigma, denial, misperceptions—can significantly delay diagnosis. That translates into wasting precious time and preventing people from ultimately getting the help they need. Keep in mind that memory screens are not a diagnostic tool, but they are a significant first step toward finding out if a person may have a memory problem. Memory problems could be caused by Alzheimer’s disease or other medical conditions. Some memory problems can be readily treated. If in a follow-up to a screen, the person with the memory problem receives a diagnosis of Alzheimer’s disease, yes, there is no cure, but yes, there are steps that can be taken to improve quality of life.

What are some things people can do to prevent memory loss? Are you endorsing exercise?  Some recent studies suggest it could be preventative.  What are other health behaviors you recommend?  

Cognitive wellness should be part and parcel of overall successful aging. Helping to reduce the risk of memory loss all boils down to lifestyle choices.

In general, what’s good for your heart is good for your head. Physical exercise is paramount, and it’s okay to keep it simple; in fact, there’s something to be said about walking 30 minutes daily.

Brain-stretching activities, from Sudoku to going to a museum, can pack a powerful punch. Research points out that mental activities help reduce risk factors by enhancing brain reserve.

There’s also growing evidence that stress management and socialization are vital components of brain health.

All of these things are important strategies for successful aging at any age. Our new Web site, www.alzprevention.org, is full of information about risk reduction and includes a to-do list for people 65+, the age group at greatest risk for Alzheimer’s disease.

What can family members do if they notice that an older parent or loved one is experiencing memory loss?

Take action. When someone is showing symptoms of memory loss, that’s a red flag and the person should be evaluated by a qualified healthcare professional. A person’s primary care physician is a logical start.

Another important message is to speak up about memory concerns. Don’t be afraid to start the dialogue with a professional even if he or she doesn’t raise the issue with you. Unfortunately, there’s a disconnect taking place. An AFA survey of participants in National Memory Screening Day in 2007 found that fewer than one in four with self-reported memory complaints had previously discussed them with their physicians despite recent visits. National Memory Screening Day or community screenings held throughout the year often serve as a catalyst for people to then raise the issue of memory concerns with their primary care providers. That is valuable in and of itself.

Various factors can affect memory loss so it’s critical to get to the root of the problem, to see if the memory loss is a result of a condition that can be reversed or treated. The earlier any of these conditions are diagnosed and treated, the better.

Family members should also not face this alone. When an older parent or any family member has memory loss, reaching out for help can make a world of difference. Knowledge is empowering so families should take advantage of national and community resources and embrace support services.   

Can you tell me what instruments you use and who they are administered by?

On National Memory Screening Day, the memory screenings are administered by qualified healthcare professionals, including social workers, pharmacists, psychologists, physician assistants, nurse practitioners and physicians. They’re administered face-to-face in a private setting, and are free and confidential.

While screening sites use a variety of instruments, AFA makes available the GPCOG, the Mini-Cog and the MIS (Memory Impairment Screen) to sites participating in National Memory Screening Day. These tools meet specific criteria, as determined by AFA’s Memory Screening Advisory Board, including being validated by research, effectiveness and ease to administer.

Finally, what about depression worsening memory loss?  What if someone has both symptoms of depression and memory problems?  

Depression and memory impairment go together.  Depression often produces memory symptoms although individuals will often recognize the problem and complain about the symptom.  People with mild dementia will often cover up the memory loss. Depression is a risk factor for dementia in older persons. Depression in persons with mild cognitive impairment is a risk factor for progression to dementia.  Depression also worsens health problems like cardiovascular disease that can shorten your life.  The stress and stress hormones produced by depression are bad for your memory.  We know that stressed animals have reduction of brain resilience and antidepressant medications improve that resilience.

Depression screening is commonly done, and we believe that this intervention is part of a global cognitive wellness program.  We view depression as worsening memory by itself and increasing the risk of neurodegenerative diseases.

People with both depression and memory symptoms have twice the incentive to seek help.  Treatment of the depression may improve memory and reduce risk for subsequent memory difficulties.  If the person has mild dementia causing the memory loss and depression, the person can receive treatment for both disorders - a win-win for the individual.  

To locate a screening site, visit www.nationalmemoryscreening.org or call 866-AFA-8484.

 

 

Tamara McClintock Greenberg, Psy.D., M.S., is an Associate Clinical Professor of Psychiatry at the University of California, San Francisco.

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