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The question
My 70 -year-old father is starting to be really forgetful. How can I tell if this is normal or a sign of a something more serious?
The answer
Symptoms of memory loss can be different from person to person and can vary from forgetting names and dates, to getting easily lost or having difficulty performing daily tasks such as driving or taking care of banking matters. Forgetfulness tends to increase with age and it is important to distinguish between benign changes and more serious causes of memory loss.
A memory problem is serious when it affects daily functioning. Memory loss that is not a part of normal aging can include features such as:
• A sudden onset of memory loss (over days to weeks)
• Difficulty with language such as remembering common words when speaking
• Difficulty with reasoning and concentrating on familiar tasks
• Impaired ability to bathe, eat, dress or do everyday tasks
• Getting lost in familiar places/routes
• Repeating phrases or stories in the same conversation
• Memory loss associated with change in mood or decreased level of alertness
Often the first concern that comes to mind when a family member seems to be becoming more forgetful is dementia, the general term used for a group of brain disorders that cause memory problems and make it hard to think clearly. It is estimated that eight per cent of Canadians over 65 years and one out of three people over 85 years meet the criteria for dementia. Alzheimer's disease is the most common cause of dementia and other causes include vascular dementia and Parkinson's Disease.
For your father, consider the following points to discuss with his doctor:
1. Has your father's forgetfulness come on gradually (over months to years) or suddenly (over days to weeks)? Memory loss related to aging is usually gradual, while sudden changes in memory can be a result of something more serious such as injury to brain from stroke, infection, or trauma following a fall. Sometimes with memory loss that progresses quickly, there may be a reversible cause that can be identified and treated.
2. Does your father have any medical conditions that can increase the risk of dementia? Certain medical conditions such as heart disease, high blood pressure, high cholesterol, diabetes, stroke, and vitamin deficiency (B12) can increase the risk of dementia.
3. Have you noticed any change in his mood? Stress and anxiety can cause forgetfulness, especially in the elderly. If you notice changes in mood, level of concentration, decreased energy and withdrawal from social situations - depression may be contributing to the memory loss.
4. Has there been a change in his level of alertness? This could mean something very serious such as an infection or something acute such as stroke, so immediate attention should be paid if memory loss is associated to a decreased level of responsiveness to his surroundings.
5. Does your father take any medications? Medications can have side effects and can interact with each other, which can cause confusion and memory loss. .
6. Does your father drink alcohol regularly? Long-term use of alcohol can increase the risk of dementia and interact with medications to impair memory.
7. Is there a family history of dementia? Certain types of dementia can be hereditary.
8. Is he still able to perform his daily activities safely? The intensity of memory loss can lead to impaired functioning, which can lead to unsafe behaviour such as decreased attention while driving or forgetting to turn off a stove when cooking. Understanding how severe the effect on function is can help your doctor differentiate between mild to severe memory impairment and can direct what investigations, medications and supports to put in place.
While most mild memory changes may not be noticeable to the affected individual, for some it can be embarrassing and upsetting to experience. Having family support is very important during this time. In addition to this support, I would suggest visiting your father's doctor with your father, if your father permits. Your involvement is also important when creating a plan for possible community supports and medication, and when trying to help your father maintain his independence safely.
Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
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