General Medical · Health

Memory, Aging and Dementia

Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

September is Healthy Aging Month. Today, Gayatri Devi, MD, MS, FAAN — Director of The New York Memory & Healthy Aging Services Center and an Attending Physician at Lenox Hill Hospital who is  specialized in the early diagnosis and treatment of memory disorders related to aging, head injury, and menopause — addresses memory, aging, and dementia.

 

“Am I getting demented? Am I getting Alzheimer’s disease?” Such questions sometimes pop up unbidden into our minds when we forget something in the increasingly multi-tasked, smart-phone toted, urban lives we lead.

“I can’t believe I forgot his name, he was my next door neighbor for twenty years!” says Alison, a pretty woman of 64, her face scrunched into a giant frown, sitting across from me at my office. “That’s when I decided I needed to know for sure. Tell me, am I going to become like my mother? We have the same color hair, the same eyes, the same temperament. . .” her voice trails off. Alison tells me she was recently made partner at her law firm, sat on three not-for-profit boards and was chairing an upcoming benefit, all this leading to a hectic social calendar involving many nights out and at least two glasses of wine most nights. She was also charged with organizing the care of her increasingly infirm mother who at 92 has advanced dementia and is living at home with round-the-clock care.

Here are some facts about memory:

  1. We are all evolutionarily wired to forget. We forget most of what we are exposed to, most of the time. Trying to remember everything we encounter is neurologically impossible.
  1. Forgetting of names as we get older is normal. The average person 100 years ago was exposed to maybe 200 people in their lifetime. Today, the average New Yorker may be exposed to that many people in a day.
  1. Episodic memory is memory for events and episodes. It is “when” and “where” memory, as in “Where did I leave my keys?” or “When am I scheduled for that meeting?!” This type of memory is very friable and prone to erasure. It seems as though our memory for the sundry and mundane episodes in our life did not do much for our survival as organisms. But throw some emotion on an episode and watch it flame up and into our consciousness.
  1. As we get older, our memory gets worse and we have more trouble remembering and learning new things. When do these difficulties start? In your late 20s and early 30s.
  1. Some women in their late 30s into their 50s may have more trouble with words, short-term recall and – perhaps as a result – irritability. This may have to do with declining levels of estrogen.

So when to worry about your memory and possibly get an evaluation?

  1. When there are consistent difficulties that appear to be worsening.
  2. When cognitive difficulties interfere with functioning.

So what happens with dementia?

Dementia comes from the Latin “de,” a prefix that means “to depart,” and “mens,” which is “mind.” In other words, to take leave of one’s mind. There are different kinds of dementia, with Alzheimer’s being the most common type. The symptoms of dementia vary depending on type, but all of them are characterized by nerve cell death that results in loss of memory, language, and other cortical functions, including the ability to communicate, reason and participate in daily activities. Some patients, particularly in the frontotemporal type of dementia, may display disinhibition. Others, particularly those with Lewy body dementia, may be prone to hallucinations.

Most dementias appear to be spectrum disorders, with many affected people continuing to live in the community until death, although the image conjured up in our minds on hearing the term, is often of someone severely impaired. Behavioral and medical treatments are helpful in delaying onset and preventing progression. Simple techniques to keep our brains vibrant and promote healthy neuronal aging include aerobic exercise, which was found to stimulate cell growth in the hippocampus, the prima ballerina in the memory ballet, and indulging in Mediterranean diets.

I set about telling Alison all this after we evaluated her and confirmed what I suspected, that she was smart as a whip but was having cognitive issues related to being overworked and under-rested. A thorough cognitive evaluation revealed no difficulties in Alison’s cognitive performance. In Alison’s situation, meeting as many people as she did, it was OK, I told her, to “outsource” some of her memory to her secretary, her cell phone, and to the more liberal use of  a “my dear,” when a name cannot be recalled. This was not a failure on her part, it was a healthy adaptation given the immense challenges she faced.

We then went over risk factors that she could modify to prevent her developing her mother’s condition, including switching to red wine from white and from two glasses to one. Alison left the office with a bounce in her step and I watched her leave with a smile on my face.

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