Is it dementia, or just aging?

By Melissa Healy

Nov. 17, 2008 12 AM PT

Healy is a Times staff writer.

Where are the keys? What did I go into the kitchen for? Should I be worrying about my -- you know, that thing, memory? Or is this just what happens to everyone with age? Below are answers to common questions about memory loss, gleaned from interviews with three experts: neuroscientist James McGaugh of UC Irvine; Dr. Gary Small, director of the UCLA Memory Clinic and the UCLA Center on Aging; and Dr. William H. Thies, vice president of medical and scientific relations at the Alzheimer’s Assn.

I think I’m losing my mind. I agree to a meeting and then completely forget about it. I’m introduced to someone and five minutes later don’t remember his name. Do I have Alzheimer’s disease?

Forgetting things you have recently learned is a red flag for early Alzheimer’s disease, our three experts say. “The ability to consolidate and store new memories is the first thing to go,” McGaugh says. “Established memories hang out for a long time.”

Alzheimer’s sufferers may still have a rich recall of childhood memories, beloved songs and complex activities, such as playing tennis, but not remember the name of a grandchild.

But the significance of such memory lapses depends on how forgetful you always have been and whether you were focused and paying attention when you learned someone’s name or set off to get something in the next room. Distraction often causes lapses in people with perfectly intact cognition -- mainly because the initial stimulus was incompletely processed.

“You never really learn it if you don’t pay attention,” says Small, author of “The Memory Bible” and a new book, “iBrain.”

When a person who has always been meticulous about keeping appointments starts missing them, that is a worrisome change. A person who has always been a bit disorganized or easily distracted may have other problems, including attention deficit disorder or chronic depression.

If the memory lapses are consistent with a lifelong pattern, our experts say it’s unlikely to be Alzheimer’s disease.

Maybe I’m just getting older. But at work, what used to take me two hours to do now takes four. I’ve always been sharp and fast on the job, but I’m not performing at my peak.

Struggling with familiar tasks and experiencing problems with abstract thinking can be early indications of Alzheimer’s disease. The aging brain can compensate for its declining performance for many years: It knows more about the world and its patterns than a younger, swifter brain. But if established work routines don’t come as easily as they did, perhaps the benefits of age are being undermined by disease.

For example, if you’re failing to detect and recognize patterns on the job -- say, anticipating from experience where production bottlenecks will happen -- it’s worth raising the issue with your doctor.

Finding numbers difficult to add up in your head or the route to your next appointment difficult to visualize could be signs of stress and distraction -- things all of us have plenty of at work. But if things you’ve always done on the job now stump you, that is a problem warranting medical evaluation.

Sometimes, making mistakes doing things that are virtually automatic gives us a sign that something’s wrong. When Dad takes a left turn instead of a right to head home from the grocery store, that should not be dismissed as absent-mindedness. Those with early Alzheimer’s often become disoriented in the performance of familiar tasks.

The speed at which those difficulties have set in is important to note. The onset of Alzheimer’s symptoms is generally gradual and insidious -- making them easy to dismiss as the mental decline that comes with aging.

In the case of a person who has suffered a stroke or fallen into depression, difficulty with routine chores and mental calculations can be relatively sudden.

I misplace things. And when I’m talking, I am sometimes at a loss for the word I need. What’s wrong?

Putting your glasses in the refrigerator or a pantry cabinet rather than on your bedside table may be a sign of a problem: Misplacing things in inappropriate places is an early sign of Alzheimer’s disease.

It is also time to consult a memory specialist when you ask your spouse if she’s seen your glasses and you have trouble thinking of the word for them, or if the word that comes out is not the right one. Sometimes, those with early Alzheimer’s disease say they will get close, but a tad off the mark, to the word they’re looking for -- “that thing for my nose” instead of “glasses.” Sometimes they’ll just find themselves stumped.

The way in which problems appear can give clues to the cause. Sudden word-retrieval difficulties might be a sign that a stroke is taking place or has occurred. A barking dog and ringing telephone that jangle your concentration while you’re looking for those, those . . . whatchamacallits might signal that distraction is to blame.

The “tip-of-the-tongue” phenomenon, in which a word or a name is there one moment and vanishes the next, is a common and normal sign of age-related memory loss. But when the words for familiar objects are elusive, and word substitutions, particularly those that seem peculiar, start happening with regularity, there may be cause for concern.

My spouse/partner/close friend/family member says I’m behaving differently and is concerned about my memory lapses. I don’t think anything has changed. Should I worry?

Memory problems that signal the possible presence of disease are usually evident first to those around the sufferer. “You’re not always going to be the one to notice it, your spouse is,” McGaugh says.

Physicians rely heavily on the observations of friends and loved ones -- after all, doctors are often seeing a patient for the first time, whereas a close relative is able to detect changes in behavior, mood or everyday habits and to report how abrupt or dramatic their onset has been.

At the same time, those in the early stages of Alzheimer’s -- especially those with a lifetime of mental agility, or “cognitive reserve,” to fall back on -- often are adept at hiding the fact that they can’t remember what happened yesterday. In those cases, the increasingly forgetful person may be the first to notice his failing cognitive functions but the last to admit it.

There’s a lot of denial -- both by patients and family members -- when signs of dementia appear. Many people can compensate for their growing confusion and forgetfulness because they are clever and resourceful. When changes in behavior and memory become too obvious to deny, it’s time to pay attention.

My mother has always loved to go out and see friends and was never one to fritter away a day. But now she can go days without ever getting started, and she’s not eager to spend time with others. She can become suddenly angry or sad, or confused and suspicious. What’s going on?

Changes in motivation and personality often come with Alzheimer’s disease, even early on. Frequently, physicians see such changes as signs of depression -- and, indeed, depression is the most common psychiatric disorder in geriatric populations.

But sudden mood swings and erratic or irrational emotional reactions toward loved ones may be a sign of Alzheimer’s. And often before they have recognized a problem, those who have early Alzheimer’s report that they have become far less motivated -- either because they fear the failure and disorientation of going out or . . . just because.

We all slow down as we age. But if a formerly energetic person is spending hours in front of the television and forgoes long-standing hobbies or interests, an evaluation may be in order.

Changes in hygiene are sometimes a tip-off. If your normally perfectly turned-out mother shows up for a visit with no lipstick on, or your fastidious father takes to wearing mismatched socks, those could be changes worth discussing with a physician.

Finally: Any noticeable change in your memory or mental function is worth seeing a doctor about, say Thies, Small and McGaugh. In many cases, a patient will go home with reassurance, not a diagnosis.

For more information about the signs of dementia, visit the Alzheimer’s Assn. website at www.alz.org

melissa.healy@latimes.com

latimes.com/health

Is it dementia, or just aging?

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