Judd Matsunaga
If you’re lucky enough, you’ll live a long life and grow old. Getting old is not an option. If you live long enough, you’re going to get old. However, you don’t necessarily have to get senile.
The word senile describes a person who is experiencing dementia brought about by old age. Senile can refer to a loss of physical abilities in old age, but it usually refers to decreased memory and mental faculties, e.g., he’s showing signs of senility.
So, just how long has it been since you lost your mind? According to a special health report out of Harvard Medical School, “Improving Memory,” many people begin to notice changes in their ability to remember things around age 50.
As you get older, certain characteristic changes take place. In fact, it’s common to become somewhat more forgetful as you age. You are likely to experience delays in your ability to recall things, which explains why you have to rack your brain to remember a name or word that is familiar to you.
Hopefully, many of these “senior moments” are signs of normal aging, not dementia. These changes may sound disturbing, but they are relatively minor and may simply represent slower processing speed. The changes associated with normal aging may make life frustrating at times, such as when you can’t remember the name of someone you just met, but they don’t tend to interfere with your ability to go about your daily life.
After 50, changes take place in the brain that may account for these difficulties. Brain regions involved with memory processing, such as the hippocampus and especially the frontal lobes, undergo age-related structural and neurochemical changes. For example, the hippocampus shrinks in size. Some receptors may cease to function normally. The loss of receptors and neurons may also make it harder to concentrate. And the integrity of white matter (the wiring between neurons) often declines, which slows processing speed.
The result is that as you age, it takes longer to absorb new information and form new memories. In other words, age-related changes in the brain may slow down your learning and your recall, but they don’t necessarily impair your ability to function effectively. Your ability to make sense of what you know and form reasonable arguments and judgments is well-preserved. Moreover, the wisdom that you’ve gained from experience over the years remains unscathed.
Furthermore, just because your memory seems to be getting worse with age doesn’t necessarily mean that age is directly responsible or that there’s nothing you can do about it. Your memory can falter as a result of stress, fatigue or being overloaded. Some memory difficulties may also be caused by medications, poor vision or hearing, sleep disturbances or depression — in other words, things you can take steps to correct.
Neuroscientists and physicians have identified some key differences between normal memory lapses and those that occur with dementia. For example, word finding can become problematic for everyone. You know the word or the name you want to recall; you just can’t quickly retrieve it (it’s on the “tip of your tongue”). With normal forgetfulness, the information is not lost. It may require some context, a reminder or even time, but you should remember it.
By contrast, people with dementia have a loss of memory and other mental function severe enough to impede their ability to operate independently at home, socially and at work. The source of the dysfunction often is some type of injury to the brain that goes beyond normal changes. For a variety of reasons, neurons, neural networks and brain regions are damaged to the point that they fail to work effectively.
For a person with dementia, the word is usually lost for good. People with Alzheimer’s disease often can’t name common objects. They also forget names and not just the names of acquaintances. They often can’t remember the names of their relatives and other people they know well. Depending on the severity of the disease, a person with dementia may be unable not only to retrieve the names of people but also recognize who they are.
Some causes of serious memory impairment are reversible. For example, certain medications can cause memory problems, and stopping the medication will restore mental function. But many causes of dementia, like Alzheimer’s disease, are permanent. The following are some examples of conditions that prevent neurons from functioning normally, causing a variety of mental impairments, including memory loss.
People with mild cognitive impairment (MCI) have either memory loss or a decline of other mental functions, or both. These problems are more persistent and severe than normal age-related changes but don’t meet the criteria for dementia. MCI has two major subtypes: amnestic (when memory is impaired) and nonamnestic (which affects other types of cognitive functioning, such as language, attention or spatial processing). Impairment in both categories is called multidomain MCI.
If you suspect that someone you know has dementia, arrange for a medical evaluation. The question is, how can you tell whether your memory lapses are within the scope of normal aging or are a symptom or something more serious? The primary objective of an evaluation should be to distinguish MCI from normal aging or dementia and look for underlying causes that are potentially reversible.
Establishing the cause and scope of the impairment is also helpful in setting a baseline for future evaluations to determine if the condition is progressing to dementia. Making a diagnosis of dementia requires a thorough examination by a physician.
Many forms of dementia are not reversible, but early detection provides an opportunity to minimize other medical conditions that may bring out severe dementia symptoms earlier than they might otherwise show themselves.
Before evaluating your cognitive health, your doctor will look for clues that your memory problems may be a symptom of an underlying health problem. To help explore this possibility, the physician will frequently order a complete blood count and blood chemistry tests to detect anemia, infection, diabetes and kidney and liver disorders. Other lab work will include routine tests for thyroid function and vitamin B12 deficiency.
Although your regular doctor is a good place to start the process because he or she knows you and your medical history, most primary care physicians don’t have the time or training to thoroughly evaluate MCI. Instead, look for a doctor who focuses on cognitive function, such as a behavioral neurologist, a geriatrician, a geriatric psychiatrist or a neuropsychologist. Your doctor should help direct you to an appropriate specialist.
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or judd@elderlawcalifornia.com. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
