Chapter 1: Is It Dementia or Alzheimer''s? CHAPTER 1 Is It Dementia or Alzheimer''s? What''s a good memory worth? It''s being able to remember that unforgettable first encounter with someone special. Your child''s first words and steps. A loved one''s last words before passing. These priceless moments are memory''s greatest gifts, but they''re not its only purpose. It also keeps us safe and efficient: Swerving just in time to avoid the pothole that wrecked your car last week. Those precious minutes you save not having to search for your phone. Avoiding another trip to the grocery store on a stormy night to pick up that item you forgot. Beyond the mundane task of recalling a grocery list, our memory makes up the essence of who and what we are--the basis of our identity, the defender of our convictions, the keeper of our dreams.
Our memory enables us to find our way through the maze of the city. To recognize a friend''s face in a crowded room. Propel our minds to a cherished past upon hearing the first notes of a song. This is why when our memory starts to falter, we become fearful of losing our identity and our lived experiences. The word dementia has its origins from the Latin word demens , which means "loss of mind." This unfortunate term and the stigma that it carries have caused some people who start losing their memory to feel a sense of shame and dread. But a decline in one''s memory ability is certainly not tantamount to losing the entirety of one''s mind. Beyond memory, the mind is a symphony of other cognitive abilities--attention, impulse control, planning and sequencing, short-term recall, and procedural skills.
In fact, many who have dementia can navigate the world with imperfect memories--living, loving, and thriving for many years even in the face of neurological adversities. In this book you will find answers to questions you may have about memory loss and what to expect when someone gets diagnosed with Alzheimer''s disease or another form of dementia. But first, let''s start with the basics: How do you know if forgetfulness is just a sign of normal aging, or if it is the first sign of Alzheimer''s? Anxious Andy and Forgetful Susie Andy stared at the ceiling unable to sleep for the second night in a row. The summer night had been balmy, but it wasn''t the heat that kept him up. Lying next to him, Susie was snoring softly, oblivious to the distress that has haunted her husband of four decades. In his mind, Andy replayed Thanksgiving dinner, when Susie asked about her sister Julie''s new job for the third time that night. He convinced himself that it was just the wine talking and had even made a drinking gesture when Susie wasn''t looking that made Julie stifle a chuckle. Last summer, he''d been surprised when Susie started sticking copious Post-it notes around the house--"pick up milk," "lock door," "plumber coming tomorrow"--to remind herself of daily tasks.
Andy would get mildly irritated whenever she asked him to help locate her cell phone, which she''d left in some odd places--in the pantry, under her pillow, in the car''s glove compartment. Andy had initially blamed it on Susie''s chronic absentmindedness, then on her carelessness. But when she failed to show up at their daughter''s house to babysit earlier in the week and did not answer her phone, he was certain that something was amiss. Andy called the police, who found Susie in tears parked by the side of the road just a couple of blocks from their house. When she finally got home, Susie claimed that the main road to their daughter''s house had been closed and she had to take a detour, which got her hopelessly lost. She tried to call Andy but had forgotten to charge her phone the night before, so it ran out of battery. Andy accepted that the sum of the seemingly benign episodes that he had observed in the past year could no longer be ignored. But how was he going to talk to her about her memory? Doing so would almost certainly anger and scare his wife, who had cared for her mother during her last years with Alzheimer''s.
"Just shoot me," Susie had told him once. "If I ever got dementia, you know what to do." Andy looked over at Susie sleeping and sighed. The Earliest Signs of Memory Loss Middle age--roughly the two decades between the ages of forty and sixty--is said to be the old age of youth and the youth of old age. For many it is the time of peaks of professional achievements and the troughs of personal losses. It is also the period in our lives when parts of our bodies that we never even gave a moment''s thought to start to demand our attention. For some the wake-up call comes subtly in the form of a sore back after a long drive or the weight gain of winter, and for others it''s the new diagnosis of an age-related condition like high blood pressure, diabetes, or cancer. But for many--especially those who take pride in their physical health, strong intellect, and optimal lifestyle--the call comes with that dreadful feeling of forgetting to show up for an important appointment, blanking on the name of a close friend, or losing a priceless heirloom.
When people with confirmed dementia are asked to describe the very first time their memory started failing, they will typically give a non-specific and vague response. The reason for this is that memory problems are like thieves in the night who steal one or two insignificant items each time. The loss is not detected for many months, or even years, until after a lot of things are gone. This is especially true for well-educated and smart people, just as a person who has many precious items in their home is likely to notice losses later than someone who only has a few. So how does one know whether forgetfulness is caused by aging or dementia? Misplacing Things Everyone has misplaced or lost something at some point in their lives--sunglasses, the TV remote control, pens, or even money. If our memories were infallible and limitless, this would not happen. But the fact is that our memories are imperfect and subject to distractions, which results in the common memory failure of misplacing or losing something. Misplacing an item may take the form of absentmindedly putting your phone atop the kitchen cabinet as you are replacing the lightbulb and then spending a frustratingly long time searching for it.
More seriously, misplacing may also mean putting your keys in the refrigerator or your wallet in the pantry. While similar, the implications and causes of these two examples are not the same. In the Misplaced Objects Tests, a person is asked by a psychologist to place pictures of ten common objects--keys, glasses, billfold, for example--on a board depicting the rooms of a house. The person is instructed that no more than two different items can be placed in a single room. After a few minutes, the person is then asked to recall the location of the articles. As one can surmise, people who have true memory loss will rapidly forget where they had "placed" the objects, while people with intact memories will remember the placement of most items accurately. Many people who claim they misplace items all the time in their real lives do well on this test. This is because in a controlled environment of a testing room, free of noise and distractions from our busy lives, our memory is optimized to be more efficient and effective.
The truth is, most people who occasionally misplace an item but eventually find it usually have normal memory. This is because our divided-attention abilities tend to decline with age, and when we''re distracted by extraneous things like the television or conversations, or even our own wandering and random thoughts, we''re more likely to forget where we set something down. However, when the episodes of misplacing or losing objects start becoming a regular occurrence, such as several times a week, it becomes more telling. Misplacing valuable items such as jewelry, money, credit cards, and keys is also more suggestive of a real memory issue than losing items of insignificant value like coins or glasses. Finally, when a person places objects in bizarre places, like loading their phone in the dishwasher, a memory evaluation may be prudent. Repeating Questions or Conversations One of the most common--and most distressing--symptoms of a failing memory is repeating conversations or asking the same questions that were recently answered to one''s satisfaction. This is typically caused by a failure of episodic memory, aggravated by a poor attention span and a tendency for easy distractibility. When a question is asked and an answer is provided, that new information must be stored in our memory banks and be available for retrieval when the same thought or query arises again.
A person who has a memory or attention deficit will encounter difficulty absorbing and retaining new information, which then leads them to ask the same question minutes or hours later. To be clear, forgetting details of a conversation or the response to a question happens even to people with normal memory. This is particularly common when the person asking the question or having the conversation is distracted, stressed, or anxious. A common situation nowadays is checking our smartphones while we''re having another conversation or processing our response to someone''s question. In these situations where we are "half listening" while multitasking, our mind is unable to form efficient memories and is more likely to fail. However, when a person regularly repeats questions or stories even when relaxed, paying attention, and not distracted, a primary failure of memory should be suspected. Forgetting Names or Words Word- and name-finding difficulty can be a sign of certain conditions that affect cognition, such as frontotemporal dementia, where language.