Alzheimer’s disease (AD) and dementia stand out as the most feared health conditions that can strike as we age. But if you notice that your memory or cognition isn’t what it used to be, put the brakes on that panic: Memory loss and cognitive challenges can come from a host of other disorders, the majority of which are treatable. Because the myth that memory loss is a normal part of aging persists, even among some health-care professionals, you may need to advocate for yourself or your loved ones to rule out the following common causes of reversible cognitive impairment.
Adult ADD or ADHD
People associate attention-deficit disorder (ADD) and attention-deficit hyperactivity disorder (ADHD) with children, but these conditions also affect 2 to 4 percent of adults— and most are never diagnosed. This neurobiological disease makes it difficult to focus or pay attention and, as a result, difficult to learn and remember new information. People with ADD are easily distracted, may have a history of work problems, and often don’t follow through on tasks at home. (Editor’s note: See the July 2021 issue for a detailed look at adult ADD/ADHD.)
Memory fix: These symptoms are reversible with stimulant medications such as methylphenidate (Ritalin) and amphetamine-dextroamphetamine (Adderall).
Who to see: Some primary care doctors will screen and treat patients for ADD/ADHD, but you may want to see a neurologist for a more thorough examination and treatment.
Obstructive sleep apnea
In this common sleep disorder, the muscles in the back of the throat relax too much and block the airway. When oxygen levels drop, the sleeper wakes up enough just enough to move and take a breath. These episodes can occur hundreds of times per night, but most sufferers don’t know they’re happening. Diminished nighttime oxygen and excessive daytime sleepiness can impair memory and concentration. Patients with sleep apnea also have a higher risk for stroke and heart disease.
Warning signs include gasping, snorting, or loud snoring during sleep, a dry mouth in the morning, morning headaches, and/or difficulty staying alert during the day. People who are overweight or who have thick necks have an elevated risk, but sleep apnea can strike anyone.
Memory fix: Obstructive sleep apnea can be treated with a small bedside device called a continuous positive airway pressure machine that delivers mild air pressure through a hose to help keep the airways open.
Who to see: Your primary care doctor can refer you to a sleep specialist to arrange for testing and treatment.
Medication
If you’re taking codeine or another opioid medication for pain, you expect to be a little groggy, 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. These include statins to lower cholesterol, benzodiazepines to treat anxiety, antiseizure drugs, antidepressants, and dopamine agonists for Parkinson’s disease (see table). Over-the-counter decongestants and antihistamines, recreational drugs, and alcohol can cause cognitive problems, too.
Memory fix: 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. The cognitive effects can be amplified when you take multiple drugs, so make sure all of your physicians have a complete list of the drugs you take.
Who to see: Talk to any physician who prescribes medication for you. Your pharmacist can also tell you if any of the medications you are taking, or have been prescribed, has cognitive side effects.
Mental health
When you meet people at a party, do you remember their names? Or are you so nervous that their names don’t register? Anxiety and stress cause distraction, and it’s difficult to form memories when you’re not paying attention. Some people become so worried about memory problems that every slip causes them to freeze and stop paying attention to what’s happening around them.
Depression is also linked to cognitive lapses, especially since it interferes with concentration, interest in activities, and sleep, all essential factors for good memory.
Memory fix: These conditions can be treated with medication, therapy, and lifestyle changes, such as getting more exercise and practicing relaxation techniques.
Who to see: If you notice a problem with stress, anxiety, or depression, talk to your primary care doctor or a mental health provider for a thorough evaluation to assess your mood, thinking, and behavior.
Thyroid disease
Cognitive dysfunction is a little-known effect of thyroid disease and one that can easily be missed, especially since people over age 60 may have no other symptoms of thyroid disease.
Memory fix: Medication can restore proper thyroid levels and cognitive performance.
Who to see: Your primary care doctor can use a simple blood test to look at how your thyroid is functioning.
Vitamin B12 deficiency
People who don’t eat animal foods and those who take medications called proton-pump inhibitors for acid reflux have a higher risk of developing a vitamin B12 deficiency, which can cause confusion and memory loss.
Memory fix: The cognitive effects of a B12 deficiency are reversible by restoring your levels of the vitamin.
Who to see: Your primary care doctor can check your B12 levels with a blood test and recommend supplementation.
