A dear friend of mine recently confided to me that she was worried about her memory. Jodi is the kind of woman who seems to do it all. She is running her own successful business, has an active social life, and is constantly running from one super cool event to another. Over the last few months she has been noticing that words were not coming to her as easily as they used to. She has also noticed that she is having more “senior moments”. She has found herself in a room, but was not able to remember what she went into the room to do. Her biggest fear is that she is developing Alzheimer’s disease.
As a neuropsychologist, I see people like Jodi every day. I, too, worry about developing Alzheimer’s because I have a family history. And it’s understandable that many are concerned. One in nine people age 65 and older have Alzheimer’s disease and as our population ages, the more people will be affected.
Alzheimer’s disease has become many people’s biggest fear. I have had very high-ranking military officers (retired) break down in tears in my office because they were afraid they would be dependent on others in their final years. Because although being diagnosed with a disease like cancer or cardiovascular disease is devastating, dementia robs you of your essence and your independence. And at this point, there is no real cure.
However, it is important to remember that there are many other potential culprits that can affect your memory. Some are actually reversible. Here are just a few:
No one would question the need for sleep. Anyone who has ever pulled an all nighter, or has taken care of a newborn baby, knows how it feels when the body needs rest. However, what might be surprising is that lack of sleep can actually have a major impact on your cognitive functioning. Sleep deprivation impairs functions such as sustained attention, visual spatial processing, and reaction time. One night of sleep deprivation has been found to have the same effect as intoxicating blood-alcohol levels on simulated driving tests.
Additionally, learning new information requires three steps, all of which can be adversely affected by sleep deprivation:
- Acquisition: acquiring and attending to new information is the first step in learning
- Consolidation: new information is transferred from short term memory to longer term memory and becomes stable
- Retrieval/Recall: pulling up the information, when needed
As you can see from above, sleep deprivation can certainly affect the acquisition stage of learning by interfering with basic sensory and attentional processes. However, lack of sleep can also affect the consolidation of new information, because our brains consolidate (file away) information while we sleep. It’s like taking the papers on your desk and filing them neatly in a file cabinet. If you don’t sleep, your brain does not have the time to file the papers into “longer-term” memory files. Thus, things that we hoped to learn, are not retained.
Alcohol, Sleep Aids, and Other Substances
Many adults enjoy an occasional glass of wine or mixed drink, and there is some support for the beneficial effects of drinking in moderation. However, few people truly limit consumption to a glass a day. Research suggests that older people, on average, are drinking more than they used to (link to CNN story). With this in mind, it is important to remember that as our bodies change, our body’s ability to metabolize alcohol (or other substances) also changes. Alcohol and other substances stay in our bodies longer, and can affect our functioning the next day. Although we may have been able to handle two or three drinks, in our 20s, we may only be able to handle one, in our 50s or 60s. This can also be true of pain medications and recreational drugs.
Additionally, the use of some typical over-the-counter medications, particularly anticholinergic medications such as diphenhydramine (the active ingredient in Benadryl and many OTC sleep medications) can cause brain fog and may possibly have more chronic effects (link to JAMA article). So can other medications. So before jumping to the worst case scenario (Alzheimer’s), cut back on your alcohol consumption , look in your medicine cabinet, and talk to your doctor.
Other Treatable Medical Conditions
There are also a few medical conditions that can mimic dementia and often these are overlooked as we rush to the worst case scenario in our minds. For example, thyroid imbalances can cause fatigue, depression, dysregulation of body temperature, headaches, anxiety, decreased concentration, and memory problems. Women have a ten-fold risk of developing thyroid conditions, and this risk is even higher during pregnancy or menopause. Both overproduction (ex. hyperthyroidism, Graves’ disease) and underproduction of thyroid hormones (ex. Hashimoto’s) can cause dementia-like symptoms, so it may be important to rule out endocrine conditions.
Other conditions often overlooked include conditions such as pernicious anemia (B-12 deficiencies), urinary tract infections (UTI), diabetes, and the list goes on. Hydrocephalus (an abnormal accumulation of cerebral spinal fluid within the brain) is usually accompanied by cognitive problems, poor balance or changes in gait, and urinary incontinence, and is sometimes mistaken for dementia. If caught early, these conditions can often be reversed.
Stress and Depression
If you (or someone you love) has been told that you have “pseudo-dementia”, this is a real thing! Pseudo-dementia is a term used to describe cognitive changes due to depression. Aside from feeling sad or down, symptoms of depression include diminished interest (apathy), insomnia (or, on the other hand, hypersomnia), fatigue, and diminished ability to think or concentrate.
I cannot tell you how many times a patient has come to me for an evaluation, and after reviewing their history and their symptoms, we find that they are depressed or under a great deal of stress. Oftentimes, they show cognitive deficits on objective memory tests, yet when they return for re-evaluation after being treated for depression, they show improvement or even a return to their baseline. Depression can interfere with working memory and attention, both important in the formation of new memories (link to NIH Depression). Deficits have also been found in studies examining explicit verbal and visual memory.
Now, I am not suggesting that being under stress or being depressed rules out dementia. People who are developing dementia offen experience stress as they are beginning to struggle with tasks they used to be able to handle well. Furthermore, depression is often a symptom during the early stages of dementia. However, depression and stress can also CAUSE cognitive problems, and looking at how much stress we are under (or how many balls we are juggling) may be enlightening. And making lifestyle changes, such as cutting back long hours at work, dividing caregiving and household chores between others, and engaging in health promoting activities such as yoga, meditation, and exercise may help.
With all this said, it is important to take cognitive changes seriously, particularly when you have a family history of Alzheimer’s disease. Although many times treatable causes are found, there are other times that these subtle signs are a harbinger of future problems.
If you are noticing cognitive changes schedule an appointment with your doctor or neurologist. Aside from the above conditions and tests, your doctor may refer you to a neuropsychologist (like myself) for memory testing, and/or suggest other tests (i.e., MRI, EEG, blood work, PET, genetic studies….) that can help you understand the changes you are experiencing. But most importantly, try not to worry too much right now. Because what you are facing is not always what you fear.