Dementia or normal memory?

Doctors are often asked the question: Is my memory normal for my age? Loss of neurons (brain cells) may be a part of the normal ageing process. As we grow older we may lose certain intellectual abilities and we then become concerned that Alzheimer's disease may be developing.

Ageing is accompanied by a richness of human experience and this makes older adults much wiser. This wisdom in old age compensates adequately for an apparent loss of brainpower.

Elderly people may be losing brain cells, but they are certainly capable of forming rich interconnections between brain cells. Stimulation and interaction with the environment creates this richness of experience, which translates into the formation of new interconnections.

How to distinguish
It is difficult to distinguish impaired memory from age related memory difficulties without the assistance of a memory test. Memory tests, also known as cognitive tests, are the easiest and most reliable methods for assessment of impaired memory and intellectual ability.

It is sometimes astounding to see how family unwittingly cope with cognitive impairment in a loved one. A person may not remember the date, and a spouse or family member will unconsciously avoid asking about it. A person may forget how to use the kettle or stove and again a family member will unconsciously take over these tasks. Unknowingly, family members compensate and it is thus, only on objective memory testing, that the full extent of the problem becomes evident.

Friends and family members will deny the presence of a significant memory problem, because they say a person can remember events from long ago. However, this is long-term memory and is only affected in the advanced stages of dementia.

It is the memory engine, forming new memory, which is affected in the early stages of Alzheimer's disease. The memory engine for new memory is situated in the medial temporal lobes of the brain. This engine creates short-term memory and helps one to function on a day-to-day basis. It helps one remember scheduled appointments for the day or week and enables one not to tell the same story repeatedly.

Memory tests
A number of memory tests or cognitive assessments are available. The Mini Mental Status Examination is a clinical test which is widely used.

Another important tool to distinguish normal memory from age related memory difficulties, is to measure functioning in daily activities. An older adult should still be able to function in many complex activities. The person should be able to manage his own finances, make appointments, socialise in a way that is rewarding, and pursue hobbies. Deterioration in functioning on these activities of daily living, may indicate dementia.

Written by Dr Frans Hugo, MBChB, M.Med Psychiatry and Dr L. Van Wyk, MBChB, M. Med (Psych) from the Panorama Memory Clinic.

For more information visit: Dementia SA: http://www.dementiasa.org/ or Alzheimer’s South Africa: http://www.alzheimers.org.za