Forget Me Not
Memory loss seems inevitable once we reach a certain age, but when does it become a symptom of a disease?
By Yves Saint James Aquino, M.D.
All of us have experienced taking care of a grandparent, and we are not foreign to the idea of aging loved ones forgetting our name, or who we are to them. My Lola always mistook me for my eldest brother, while my Lolo thinks I’m my dad. Most of the time, I don’t correct them anymore, I just answer to whatever name they were going to call me whenever I visit.
Aging and memory loss seem to go hand in hand, as the brain begin to lose cells and the body start to make less of the chemicals for the brain cells to work. The older we get, the more of these changes can affect our memory. But when do we consider memory loss normal, and when do we say it’s a disorder?
Dementia, a disorder
Dementia is not a specific disease; it’s actually a syndrome, or a descriptive term for a collection of symptoms that can be caused by different conditions that affect the brain. This syndrome is characterized by: impairment in memory impairment in the ability to organize thoughts and reason, the ability to use language, or the ability to see accurately the visual world the impairments are severe enough to cause a decline in the patient’s usual level of functioning Memory loss may be a common symptom of dementia, but having it doesn’t automatically mean one has dementia. Doctors make a diagnosis of dementia when two or more brain functions, such as memory, language skills, perception, or reasoning are significantly impaired.
Many different diseases can cause dementia, with memory loss being severe enough to interfere with activities of daily living.
• Alzheimer’s disease is the most common cause of dementia, especially in people who are aged 65 years and older. Alzheimer’s is characterized by abnormalities in the brain in the tissue and cellular level, accompanied by gradual and progressive deterioration of brain function. The disease presents with initial impaired memory and judgment, which progresses to language problems, personality changes, delusions, and deterioration of motor control.
• Vascular dementia is another common cause, and it is usually a result of brain damage from vascular (blood vessel) problems, usually in the form of strokes, but it may also be caused by genetic diseases or inflammatory diseases like lupus. The symptoms of dementia begin suddenly, frequently associated with a stroke episode.
Other conditions that can cause dementia include:
• infection, which can be noted in HIV-associated dementia, a type associated with human immunodeficiency virus
• degeneration of nerve cells, as seen in fronto-temporal dementia
• genetic abnormality, exemplified in Huntington’s disease
• constant head trauma, seen in Boxer’s syndrome
It is important to have a comprehensive clinical evaluation because many disorders can cause dementia. A patient suspected to have dementia will undergo a thorough medical work up, a neurological examination that test memory and other brain functions, and a psychiatric evaluation to assess mood, anxiety, and clarity of thought.
Imaging of the brain via CT (computed tomography) scan or MRI (magnetic resonance imaging) is usually advised to check if physical abnormality or structural problems are the ones causing the symptoms. Other laboratory tests such as complete blood count or spinal fluid assessment may be requested depending on the disease entity that is entertained by your physician.
Treatments, in most cases, are not meant to reverse or halt disease progression. Patients, however, can avail of certain medications and other methods of treatments that can help slow down the disease.
A group of drugs called cholinesterase inhibitors are used for Alzheimer’s disease. These drugs slow the breakdown of acetylcholine, a neurotransmitter that is reduced in the brains of people with Alzheimer’s.
Depending on the specific cause of dementia, other medications such as antidepressants, sedatives, or anticonvulsants may also be prescribed.
Besides use of drugs, behavioral modification—or the rewarding of appropriate behavior and ignoring of inappropriate behavior—may also help. Many people with dementia, especially in the early stages, can benefit from mental exercises that improve performance in specific aspects of brain function. These are usually in the form of memory aids, mnemonics, or note taking.