Is it Senescence, Senility, or Alzheimer's?
"My dad is only 68 but he's always forgetting where he puts things. He sometimes can't remember the right words when he talks and he can't seem to keep up to speed with a conversation. Last week I found his pen in the fridge. Is this normal for his age or is this the start of Alzheimer's?"
When I first started nursing we used to talk about the differences between senescence, senility and dementia. Senescence was considered a natural and rather genteel process involving a general slowing down of functions as the person aged. Senility was considered more commonplace but quite normal in that it pointed to loss of memory, some lapses in judgment and greater difficulty in learning new material. Dementia was considered a worsening of senility in which all mental processes were affected and became progressively worse. However, in just a few decades our understanding of mental processes has changed the way we view things.
I began this Sharepost with a question that is fairly typical of several I receive. It taps into the most fundamental question about whether changes in mental function are signs of Alzheimer's onset. Today, we tend to use the term Mild Cognitive Impairment (MCI) as a way of describing symptoms similar to those outlined in the question. Forgetfulness is something that becomes more common in older people and it's true to say the distinction between this and MCI can become blurred.
Mild Cognitive Impairment is something the affected person is aware of, as much as it is to those around them. We can all share the experience to some extent. For example, it's the frustration of not being able to find something you were using just a couple of minutes ago. It's not remembering the name of someone you were introduced to only yesterday. It's grinding to a halt in the middle of a sentence because the right word eludes you. Now ramp these experiences to a point where they happen every day, several times a day and you begin to get an idea of what it is like to have a mild cognitive impairment.
Is MCI the precursor to Alzheimer's?
Not necessarily. First it has to be remembered that MCI can be a feature anxiety, stress, depression or even physical illnesses. It could, for example, appear marked at certain key events in a person's life, such as the death of a spouse or even retirement.
The very fact of memory loss can itself become a worrying experience. Because the person is aware of the problem it makes them more anxious and symptoms become more severe. In real terms though the person with MCI is still able to shop, handle their finances, cook, and be fully capable in all aspects of daily living.
Although complaints of memory loss are extremely common it is possible that they signal the very early stages of Alzheimer's. If this is found to be the case the sooner treatment can begin the better.
If symptoms of memory loss are experienced over a period of time it is worth visiting the doctor. Memory loss and mild confusion can sometimes be due to thyroid problems, blood pressure irregularities or vitamin deficiency. Ruling out possible physical causes is often the first step. The doctor may then want to know about the person's emotional state (anxiety, depression) and may suggest treatment if this is revealed. The doctor may also run some tests to determine the extent of memory loss and whether these fall within the parameters regarded as MCI.
To date there are no simple or effective methods that can determine whether a person who has MCI will go on to develop Alzheimer's. There is no specific treatment for MCI but there are indications that symptoms may be relieved by medication used for mild to moderate Alzheimer's.
Family members and loved one's have a role in encouraging self-help. All the evidence suggests that a person's lifestyle can have a marked effect on cognitive capabilities and can help prevent Alzheimer's. For example, physical exercise, good diet, maintaining social contacts, doing crossword puzzles and learning a new language, are all associated with maintaining and even developing cognitive capabilities. Memory lapses can fairly readily be compensated for by use of calendars, diaries or other tools to help things along. This can provide a big boost to confidence, increase the person's sense of independence, and provide a continued sense of value within their family and community.