The pot you forgot boiling on the stove. The longtime neighbor whose name you suddenly can’t recall. The car keys you think you’ve lost, only to discover they’re…in your pocket.
Chances are you have had a momentary memory lapse like these, often called a “senior moment.” Though they happen to everyone on occasion, there’s a reason for the moniker—these slipups may reflect the gradual loss of one’s mental sharpness with aging.
It’s no wonder, then, that repeated lapses can be alarming, especially for those with a family history of Alzheimer’s disease or some other form of dementia. The good news is that the minor memory misfires that tend to affect people over age 50 often are caused by normal age-related changes in the brain and nervous system.
But still, memory lapses can be an early marker of Alzheimer’s or another type of dementia. So if you have been noticing more of those senior moments, it is perfectly reasonable to see your doctor about it and ask about undergoing a cognitive assessment. These tests can put your mind at ease…or help diagnose a potential problem at the earliest possible stage.
Testing 1, 2, 3
To gauge cognitive function, your physician likely will observe your responses to standardized memory and thinking exercises. Many physicians give patients the Mini-Mental State Examination (MMSE). This exam starts with a set of simple questions that measure orientation—What year is it? What season? What is today’s date? What town are we in? Next, the doctor will read a short list of words and ask the patient to repeat them back immediately and then five minutes later.
The doctor also will ask the patient to write a sentence and copy a geometric design. Finally, the doctor will ask the patient to perform a series of actions (such as “touch your left shoulder and then tap your head twice”), which gauges the ability to understand language and follow commands.
Helpful: A perfect MMSE score is 30, and a healthy adult should approach that number (anything above 27 is usually fine).
If your physician is concerned, he/she may refer you to a neuropsychologist for further diagnostic testing. Just as a neurologist and radiologist can decipher the images of a brain MRI scan, this kind of doctor examines patterns of scores on a variety of brain-function tests to try to identify specific disorders.
Among the more commonly used tests for assessing a patient with possible Alzheimer’s is the Boston Naming Test. Here, the patient looks at drawings of objects and names them. It begins with common nouns (a dog, a tree) and advances to increasingly obscure ones (a padlock, a zebra) that require the test taker to retrieve rarely used words from memory. This is valuable information, as Alzheimer’s patients tend to have trouble recalling the names of objects.
Alzheimer’s also diminishes the ability to learn and remember new things. Doctors measure this by reading a brief story and asking the patient to repeat it right away, then 20 minutes later.
Finally, since people in the early stages of Alzheimer’s tend to develop spatial confusion, we see whether they have difficulty copying, say, a geometric design or drawing common objects (for example, a daisy) upon request.
Important: Don’t look up these tests or “prepare” for them in advance. They are useful only if you don’t know exactly what to expect and haven’t “practiced.”
What a Decline Means
Many patients who visit my clinic have parents or other relatives with Alzheimer’s. They’re acutely aware of their own periodic memory failures and are understandably worried about how well their minds are working.
Good news: As often as not, after running these tests, I end up telling them, “You’re functioning like an average person your age. What you’re experiencing looks like typical age-related decline.”
That may not sound comforting, but face the facts. Your brain is affected by “wear and tear” as you age. You probably can’t run as fast at age 55 as you could at age 35, and your mind isn’t quite as efficient as it was two decades ago, either. But if you perform within the average range for your age, there’s no cause for concern.
If your results fall below that level, you might be diagnosed with mild cognitive impairment (MCI). If so, your brain function is below the norm for your age even though you don’t have dementia.
Keep in mind: MCI is a broad category and encompasses a variety of different things. A patient with MCI who finds it difficult to recall events or the right word to describe an object or who displays spatial confusion, may be in the very earliest stage of Alzheimer’s.
In contrast, someone who possesses a solid memory but struggles with executive function (for example, he can’t plan well or solve problems effectively) may be at greater risk of developing a frontotemporal dementia—a type of dementia in which personality and language changes are common.
Important: While 10% to 15% of people over age 65 who have MCI will progress to Alzheimer’s each year, the diagnosis is not necessarily dire. Many published studies show that patients with cognitive impairment in only one area—just memory or just language or just spatial cognition—have a very strong chance (perhaps as high as 50%) of returning to normal within one year.
How? It could be that the patient who fell into the MCI category was feeling ill the day of assessment…or was sleep-deprived…or drank too much (or not enough) coffee…or even was just in a very bad mood.
Although many factors affect an individual’s cognitive performance, these tests are extremely useful when interpreted by an expert neuropsychologist. Recent studies indicate that the brains of patients with Alzheimer’s disease undergo changes (observable with special brain-imaging methods) many years before a diagnosis is typically made. So getting a baseline neuropsychological assessment in middle age or a little older may help identify people who should be targeted for more active Alzheimer’s prevention.
Your Next Steps
If you do well on the cognitive tests but remain worried about memory decline, work hard to keep what you have.
To achieve this (as well as maintain good overall health), follow these lifestyle choices: Eat a healthful diet…get regular exercise…participate in brain-stimulating activities you enjoy…keep your blood pressure under control…and moderate your alcohol intake.
For a patient who is newly diagnosed with early-stage Alzheimer’s, I often recommend that he stop driving as a safety measure, advise him to keep written notes and calendars to aid recall and suggest that he talk with his doctor about whether a prescription Alzheimer’s drug might help improve mental function. I also recommend beginning a discussion of future care needs and end-of-life plans with family.
As for people who fall in the middle and display some signs of MCI, I often explain that the “senior moments” they’re experiencing might be the beginning of something more serious…or they might mean nothing at all.
Best way forward: Follow the blueprint for patients who tested well cognitively—live a healthful lifestyle, and try to avoid “stressing out.” (I frequently recommend mindfulness–based stress reduction programs.) Then I’ll reevaluate them in a year and take other measures if needed.