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Forget About It
Are you simply forgetful or at risk for Alzheimer’s?
By Cynthia Marone

You forget names. You spend 20 minutes looking for keys. And you know you should remember how to get to that restaurant, but you don’t. Eventually, these memory glitches come with the nagging feeling that something sinister, like Alzheimer’s disease, is lurking in your brain.

“The beginning of forgetfulness is going to happen in your 50s. There’s a problem recalling information but, if reminded, it’s there,” says psychologist Andrea Casher of Cooper University Health Care. “If you have an appointment next week and you didn’t write it down, but something happens on Tuesday, it may trigger a reminder of that appointment. With Alzheimer’s, it’s an Etch-A-Sketch. If you shake it, it’s gone and not retrievable.”

Casher, who specializes in neuropsychology, sees patients worried their lost moments are a precursor to something much scarier. She says the fact they are in her office is a tipoff that their lapses are just that and nothing more.

“There is a lack of insight with Alzheimer’s, so it’s family members who bring people in,” she says. “The common mistake I see is attributing attention difficulties to memory. You have to attend to it to remember it.”

It is easy to hit the panic button when it comes to navigating the line between what is normal for the aging brain and what could be the onset of Alzheimer’s. Though tricky, there are ways to differentiate between the two and, like the heart, a person can work to make his brain stronger.

Fear that a momentary glitch is something more is an easy jump when looking at the data. More than 5 million Americans have Alzheimer’s, according to a 2013 Alzheimer’s Association report. The group predicts that by 2025, 170,000 New Jerseyans age 65 and older will have Alzheimer’s, up 13 percent from 2010.

Alzheimer’s is a fatal form of dementia, where neurons in the brain die and causes memory, thinking and behavioral problems, according to the Alzheimer’s Association. It is, unlike memory loss, not a normal part of getting older.

Though they do not take the place of a doctor’s opinion, there are ways to tell the difference between what is normal brain behavior and what is not. Memory loss may be frustrating, but will remain just that; Alzheimer’s, on the other hand, has a host of other symptoms.

With normal aging, you are aware of the change. “The way you recall is, you give your memory information then you get it back. It may take longer to retrieve, but what should not change is your vocabulary, language abilities, reading comprehension and fund of knowledge,” says Christian White, DO, a geriatric psychiatrist at the UMDNJ-SOM’s Institute for Successful Aging.

Alzheimer’s, unlike memory loss, can come with mood or personality changes, impaired reasoning or judgment, and a decrease in visual and spatial ability.

With Alzheimer’s “there are abnormal cells that are only seen on an autopsy. The problem is, it’s relevant to behavioral manifestation. You see patients becoming more apathetic and lacking in affective expression or motivation,” says Casher.

Occasional memory loss may be a result of not paying attention. When a person is younger, no warning bells go off because the retrieval rate is quicker. The aging brain, Casher says, “is not working as fast.”

Casher says there is a normal loss of connectivity, some atrophy and fatigue in the brain as years pass. “There is a lot that comes with aging – sleep issues, stress, anxiety, depression. The information is not registering well so it can be retrieved later on,” she says. The brain “is not as good on rapid transmission. The neurons don’t transmit as efficiently. It’s normal wear and tear.”

People who sometimes forget where they parked the car can live independently, but Alzheimer’s patients are prone to lapses in judgment that put their safety at risk. White likes to ask patients and their families “what if?” questions to get the severity of the situation across.

“What if there is a fire? Someone with Alzheimer’s might say, ‘Close the window,’ not ‘Call 911,’” he says. “The difference [with memory loss] is there is no functional impairment. While troublesome, memory loss is not incapacitating.”

If the episodes become upsetting, a full medical workup will rule out other factors, such as too many medications or a stroke. Neuropsychological testing will spot any deviations from the normal range for the patient’s age.

Just like with the heart, there is much that can be done to slow changes to the head. The dreaded words diet and exercise appear as they always do when it comes to good health. But when dealing with the brain, the words “socialization” and “stimulation” come up, too.

“We don’t thrive in isolation,” says White, who suggests volunteering as a way to mingle. “There is cognitive enhancement with things like crossword puzzles or driving a new way to go home. Challenge the brain. If you stay mentally energized and active, it can help.”

Though watching what you eat and hitting the gym can make a difference, some factors are out of a person’s immediate control. Those with depression, hearing loss and fewer years of education may be at risk.

“Depression and dementia has been much studied. The thought is that depression is a precursor. That’s the question: does it put the person at risk of dementia? Treating depression becomes all the more important,” says Casher.

Later-in-life depression can cause inflammation that may restrict blood flow to the brain and may raise cortisol levels, which can affect the part of the brain responsible for learning and short-term memory, according to a British Journal of Psychiatry report. “There’s also the suggestion there may be more than a casual relationship around hearing,” says Casher. “Hearing-impaired people – not using aids or getting treatment – are at a higher risk.”

Seniors with hearing loss were found to be more likely to develop dementia, according to a Johns Hopkins study. Though the reason was not clear, the strain to hear could be neurologically overwhelming to the person, while the social isolation that comes with hearing loss could be damaging in the long term.

Schooling, or rather the number of years spent pursuing an education, also has been linked to the development of Alzheimer’s. Some researchers believe a deep well of knowledge helps people compensate in the early stages of the disease, according to the Alzheimer Association’s 2013 report, while others see the increased risk coming from factors such as access to medical care.

“If a person is a genius, they decline at the same rate, but they may have more to lose before getting to that [impaired] stage,” says White. “There might – might – be more connections between the brain cells. It’s a hypothesis.”

Memory loss is a part of Alzheimer’s, but Alzheimer’s is not a part of memory loss. The two may never become one. What sounds like a riddle truly is when it comes to determining the “whys” of the disease.

“We still do not know what causes most Alzheimer’s. Part of the problem is it’s arguably one of the most complex diseases known,” says Karl Herrup, a professor in the Cell Biology and Neurosciences Department at Rutgers University. Herrup also heads the Division of Life Science at The Hong Kong University of Science and Technology.

“It has also been held back by factors more related to human research. Our older, conceptual models are proving inadequate, and their champions are resistant to alternative viewpoints. Making matters worse, we really don’t have any good animal models of the disease to study our ideas and possible therapies. The models we have are partial models and, while helpful, they are incomplete replications of the disease.

“Things are changing,” says Herrup, “but slowly.”

July 2013
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