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It May Not Be Alzheimer’s After All

Date: March 1, 2017      Publication: Bottom Line Health      Source:  Marc E. Agronin, MD, Miami Jewish Health      Print:

People joke about having the occasional “senior moment,” but the humor partly deflects an unsettling concern: What if this memory lapse—forgetting an appointment, calling someone by the wrong name, losing your car in the parking lot, etc.—marks the beginning of an incurable mental decline? Not so fast.

Some middle-aged adults (defined roughly as ages 40 to 65) do develop early-onset Alzheimer’s or other forms of dementia, but it’s rare. Their flagging memories are much more likely to have simpler—and very treatable—explanations. If you have memory or other cognitive changes, it’s critically important to seek early diagnosis and treatment before more serious problems ensue…or the changes become irreversible.

FORGETFULNESS HAPPENS

The fear of mental decline makes sense for older adults. While the prevalence of Alzheimer’s disease and other types of dementia is nearly 10% at age 65, it jumps to up to half of those age 85 and older.

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However, many patients in their 50s and 60s are convinced that the mildest mental slips mean that the worst is just around the corner. This is usually not the case.

Once you reach your mid-40s, your brain processes information more slowly. Memories are more transient than they used to be. Forgetting facts or incorrectly recalling details becomes more common. These are normal changes.

If you’ve noticed that you’re more distracted or forgetful than usual, ask your doctor to perform a general checkup to rule out any obvious medical issues, such as a vitamin B-12 deficiency or a thyroid problem. If nothing is uncovered, it’s still possible that something other than dementia is causing your cognitive symptoms. Possible suspects…

• Medications. If you’re taking codeine or another opioid medication for pain, you expect to be a little fuzzy. But some of the drugs that affect memory aren’t the ones that most people are aware of—or think to discuss with their doctors.

Examples: Cholesterol-lowering statins. A small percentage of people who take these drugs describe mental fuzziness as a side effect. The benzodiazepine class of sedatives/antianxiety drugs (such as Valium, Xanax, Halcion, etc.) can also cause cognitive problems and frequently affect memory. The mental effects are amplified when you take multiple drugs—say, one of these medications for sleep and another for daytime anxiety.

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Don’t overlook the possibility that some over-the-counter drugs—decongestants and antihistamines are common offenders—can also cause mental fuzziness.

Dr. Agronin’s advice: Pay attention (and tell your doctor) if your cognitive symptoms seem to get worse after starting a new medication. You might need to change drugs or take a lower dose.

• Mental health. When you meet people at a party, do you remember their names? Or are you so nervous about making a good impression that their names don’t register?

Anxiety and stress cause distraction, and it’s impossible to form memories when you’re not paying attention. Some people become so worried about memory problems that every slip causes them to freeze up and quit paying attention to what’s happening around them. It becomes a self-fulfilling prophecy.

Depression is also linked to cognitive lapses, especially since it interferes with concentration…interest in activities…and sleep—all essential factors for good memory.

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Dr. Agronin’s advice: If you notice that your memory has good days and bad ones—and some days when it’s horrible—it’s reasonable to suspect that the problem is benign and you might just be going through an emotionally difficult time.

Talk to your doctor about what may be bothering you emotionally. If there’s a problem with stress, anxiety or depression, get a referral to a mental health provider for a more thorough evaluation to assess your mood, thinking and behavior.

Important: Your doctor or a mental health professional should also talk to you about potential alcohol or recreational drug abuse, which can have a significant impact on cognition.

All of these conditions can be treated with medication, therapy and/or a variety of lifestyle changes, such as getting more exercise and practicing relaxation techniques. 

• Obstructive sleep apnea. It’s a common sleep disorder, particularly among those who are overweight. A blocked airway during sleep impedes the flow of oxygen to the brain. This can occur dozens or even hundreds of times a night. Diminished nighttime oxygen can impair memory and concentration. Patients with sleep apnea also have a higher risk for stroke and heart disease.

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Warning signs: Gasping, snorting or loud snoring during sleep…a dry mouth in the morning…morning headaches…and/or difficulty staying alert during the day.

The good news is that obstructive sleep apnea can be overcome almost completely with the use of a continuous positive airway pressure (CPAP) machine, a small bedside device that delivers mild air pressure through a hose to help keep the airways open. These machines can be noisy, and the mask or nose piece that connects to the air hose can be somewhat uncomfortable—but CPAP does work. And it’s definitely preferable to a lifetime of brain fog. 

• Adult ADD. People associate attention deficit disorder (ADD) with children, but it also affects 2% to 4% of adults—and most are never diagnosed. It’s a lifelong neurobiological disease that makes it difficult to focus or pay attention.

People with ADD are easily distracted…may have a history of work problems…and often don’t follow through on tasks at home. It’s easy to confuse these symptoms with cognitive impairments. 

ADD is usually diagnosed by taking a history from the patient and family members. If the patient then responds to medication such as methylphenidate (Ritalin), he/she is considered to have ADD.

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Source: Marc E. Agronin, MD, vice president for behavioral health and clinical research at Miami Jewish Health and an adult and geriatric psychiatrist and affiliate associate professor of psychiatry and neurology at the University of Miami Miller School of Medicine. Dr. Agronin is also the author of How We Age. MarcAgronin.com