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Now, What Was I Going to Do?: Screenings Find Line Between Normal Forgetfulness and Dementia

Posted on: Wednesday, 3 May 2006, 15:01 CDT

By Thomas Goldsmith, The News & Observer, Raleigh, N.C.

May 3--The line between an older person's normal absent-mindedness and early dementia can be a thin one.

It's a key distinction, though, and one that the person may try to obscure.

Finding out early about a condition that affects memory may allow medications to slow the course of dementia. Also, the forgetful person could have a treatable problem or no problem at all. It's normal for people to get a little bit forgetful as they age and occasional lapses of memory aren't necessarily worrisome, said Dr. Daniel Kaufer, director of the memory and cognitive disorders program at UNC-Chapel Hill.

"It's a really important question," Kaufer said. "As people get older, they tend to have a little more difficulty recalling specific names."

That can manifest as the tip-of-the-tongue phenomenon, where names or words simply don't come when needed.

Losing memory starts to worry professionals when episodes go beyond forgetting names and become more frequent and consistent.

It's a problem "if they forget something they were told over and over," Kaufer said.

Two public events this weekend will give people a chance to have a memory screening that could give some indication of whether he or she needs further evaluation. Registered nurse Sherie Kemp-Bruce will offer screenings at an event at the Northern Wake Senior Center in Wake Forest, organized by the Stay at Home Care Center.

"If they suspect something, they should come," Kemp-Bruce said. "If there's any doubt, they should come."

A caregiver should accompany the person who may be having memory loss, but the caregiver can't help during the test.

"They can't say, 'Mama, you know how old you are!' " she said.

Screenings of the kind given this week are different from the more intensive memory evaluations given in doctor's offices or clinics. Another way relatives or caregivers can get an early indication involves a series of questions called the AD8, designed by Dr. James Galvin and others at Washington University in St. Louis. The AD8 asks informants, family or caregivers, whether the older person's behaviors are noticeably different.

"The questions are basically asking an informant to rate change in an individual," Galvin, director of the university's Memory Diagnostic Center, said via e-mail. "For example, if Grandma always repeated stories, this would be rated as 'No change.' On the other hand, if Mom is now having trouble with family finances and forgets doctors appointments then this would be rated as 'Yes, a change.' "

Distractions crop up

Teepa Snow, education director at the Alzheimer's Association, Eastern North Carolina, offers an example of the line between absent-mindedness and dementia.

"I start toward the kitchen, but the phone rings on the way to the kitchen and it's Betty, someone I really want to talk to," Snow said, recapping a scenario she often uses. "We make these plans to meet for coffee at 2 o'clock and I look up in the kitchen and then I can't think what I came in for. But then I remember."

That situation plays out OK; there's no real memory loss involved. But dementia is different.

"It starts out the same," Snow said. "I talk to Betty. Then I'm in the kitchen and I'm like, 'I ought to clean this place up.' About 10 minutes after 2, Betty calls and says, 'Where are you?' And I don't remember talking to her."

The conversation had not made it into working memory.

There's an ironic twist about evaluating people for memory problems, Kaufer said.

"Those who complain about forgetting things are more likely to have identifiable causes or don't have memory problems," Kaufer said. "The people who really do have clinically significant memory problems, Alzheimer's disease, for example, often only have very limited awareness that they do have a problem. It rests on family members to identify that and make an appointment to be evaluated."

The main reason to have a memory problem evaluated is to see if there is a treatable cause, Kaufer said.

"For someone to go around with memory problems that are otherwise treatable is a tragedy," he said.

What could be wrong

It's important to note that someone who shows up as having memory loss does not necessarily have Alzheimer's disease, Kaufer said. A variety of other conditions can cause memory problems: Medication side effects, depression, anxiety, silent strokes, head injuries, brain cancer and vitamin deficiencies are some of them.

"One of the difficult things about memory evaluation is that it takes a fair amount of time to do it," Kaufer said. "The way we obtain the Alzheimer's diagnosis in 2006 is to obtain a history of cognitive difficulties that are clinically significant and have occurred over a period of time."

Other tests -- such as blood work and MRI scans -- are principally used to rule out other causes, he said.

Smaller-scale screenings sometimes result in misleading results.

"If they score in a range that would be considered a positive screen, all that indicates is that it needs to be looked into further," Kaufer said. "There may be an explanation that is readily identifiable. It could be a low level of education, language, vision problems."

Snow, with the Alzheimer's Association, says the organization conducts screenings at its office, but is cautious about public screenings because they can cause distress for the person being examined.

"It can be a pretty scary proposition," she said.

Kemp-Bruce adopts a low-key approach in giving out results to those who are screened.

"I would say, 'According to the screening, you did miss a couple of questions,' " she said. " 'Have you thought about going to your doctor about the things you've been forgetting?' "

If diagnostic tests indicate Alzheimer's disease, patients may be put on two varieties of newer drugs that can slow its progression and in some cases improve symptoms. Patients with vascular dementia can be treated for risk factors such as high blood pressure and diabetes.

"The medications are more effective if you can start them really early," Snow said.

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Source: The News & Observer

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