Understanding Memory Loss

Few diagnoses are more frightening than hearing that one has Alzheimer’s or another disease that causes dementia. For Alzheimer’s, the Alzheimer’s Association estimates that 55 million people across the world are living with the disease. More than 6 million people with this diagnosis live in the United States.

How many of us, however, have a real understanding of what these diagnoses actually mean?

Kevin Foley, MD, Medical Director of the Trinity Health Medical Group Alzheimer’s Disease and Memory Disorders Program, explains: “Alzheimer’s disease is the most common cause of dementia. It is a neurodegenerative disease that causes memory loss and can affect decision-making, communication skills, judgment, and reasoning. It can also cause personality changes. But how these terms are used in the media and our understanding of them is not always correct.”

Is it a “senior moment” or is it dementia?

No need to panic at the first sign of memory loss, Dr. Foley says. What we often call “senior moments” can simply mean taking a few extra minutes to remember information.

“Experts believe aging by itself should not cause memory loss,” Dr. Foley says. “As we age, we should maintain most of our cognitive ability, although the processing speed to bring up memories may be slower. Remembering where we left our keys may just take a moment longer, but recall accuracy is maintained.”

What makes Alzheimer’s different is how it progresses from simply forgetting a word or the name of a movie just watched to having difficulty performing a task done repeatedly for a long time. It may mean getting confused about where one is or the day of the week. Difficulty remembering recent events and conversations and repetitive speech are common. Other warning signs that can occur over time include leaving bills unpaid, requiring help with choosing appropriate clothing and attending to personal hygiene, and wandering or getting lost in familiar places.

“Knowing when there is a problem can be challenging since memory encompasses a broad range of what is considered normal,” Dr. Foley says. “It is important to look at the usual patterns of thinking and behavior over time to understand what is normal for an individual and if there are significant changes from his or her baseline. Since everyone’s brain works differently, some memory lapses may be normal for one person but not another.”

Types of memory loss

While the terms Alzheimer’s and dementia are often used interchangeably, dementia is a specific term used to describe the outcome (dependency in daily functioning) of a brain disease, like Alzheimer’s, that causes memory loss. Although Alzheimer’s is the most common disease-causing dementia, there are many others such as Parkinsons, Lewy body, vascular small vessel, and Pick’s disease.

“Alzheimer’s is a complicated disease,” Dr. Foley says. “Even though it was discovered more than 100 years ago, we have yet to really understand what causes it, whether genes, environmental triggers, or something else. The formation of amyloid plaques is a hallmark of the disease, and the process can begin up to 10 years before a person shows any symptoms.”

Risk factors have been identified as age – usually 65 years and older – genetic predisposition, Down syndrome, head injury, and cardiovascular disease.

Preventive measures to maintain a sharp mind

As far as preventing dementia, Dr. Foley acknowledges that research so far is incomplete and not very convincing. Evidence that playing brain games, solving puzzles, reading books, exercising, using supplements, and following a special diet is far from compelling. “Maintaining good health and a healthy lifestyle are always a good idea and makes sense but does not assure that a person will escape dementia.” Prevention research is difficult to do largely because of the length of time studies must be conducted to yield believable findings. Newer prevention strategies that hold promise include correcting hearing loss, screening for and treating sleep apnea, and avoiding drugs with “anticholinergic” side effects.

Getting a diagnosis

Any adult concerned about progressive memory loss should see a specialist for an evaluation. Isolating the underlying cause of memory loss is important for prognostic reasons and occasionally, reversible conditions may be found. “In the case of Alzheimer’s, memory tests have been relied on heavily in the past to identify patterns of cognitive impairment typical of the disease. However, technology has evolved so much that we can now see the amyloid plaque in the brain with a PET scan to confirm the diagnosis,” Dr. Foley says. “Trinity Health Grand Rapids is the first hospital to offer PET amyloid scans in west Michigan. Like doing a biopsy without an incision, it will in many cases make the diagnostic process faster and more accurate. If strokes or small vessel disease are suspected, imaging with an MRI or CT is usually recommended. Testing is not always necessary and sometimes one visit is all that is required.”

Treatment after the diagnosis

The treatment offered for a memory disorder is based upon the diagnosis rendered. For dementia due to Alzheimer’s disease, oral medications are an option to slow the expected progression of memory loss. The effects in general are modest. No over the counter supplements are effective in the treatment of dementia or mild cognitive impairment (MCI), which is considered a pre-dementia syndrome.

Lecanemab is a new medication that slows the progression of MCI and mild dementia due to Alzheimer's disease by eliminating amyloid protein from the brain. It is classified as a “disease modifying" drug and the evidence thus far shows a modest effect on slowing the trajectory of decline by several months. “Lecanemab is given as an IV infusion every two weeks for 18 months,” Dr. Foley says. “Clinical trials are still ongoing, but those completed show that it can slow memory loss.

Dr. Foley recommends continuously educating and supporting caregivers to maintain their resolve and resilience. Counseling and support groups can help the primary caregiver and other family members understand how to keep their loved ones safe, maintain their quality of life, locate care resources, and prepare for further changes as the disease progresses. The Alzheimer’s Association Michigan Great Lakes Chapter is a premier source of information and support for Michigan residents living with dementia and their families and caregiver.

Read more about caring for a loved one with dementia and when a 'senior moment' might be cause for concern.

Learn more about Trinity Health Michigan Memory Disorders programs and services.