ASK DR. BAUGHAN                                             March 26, 1999

FORGETFULNESS OR DEMENTIA?

Almost everyone becomes more forgetful with age, and some people have always had lousy memories.  With the increased awareness and increased incidence of dementia, though, forgetfulness often triggers considerable anxiety in a patient or the family - Could this be the beginning of Alzheimer’s Disease?  By reviewing the features of dementia, I hope many people may be better able to determine whether they just need to rely on memory aids or exercises, or whether they really should seek medical evaluation.

The criteria for dementia require that more mental functions than simply memory be affected.  In performing a “mental status exam,” the following areas are evaluated:

Attention - Can the person follow a conversation, or do they go off in tangents that no one else quite follows?  Do they repeat the same social chit-chat regardless of the situation?  Can they follow one or two thoughts or instructions, but then they get lost?

Orientation - We all may struggle to remember the date and even the day occasionally, but do we are unlikely to get the month or the year wrong.  We may forget how to get somewhere that we do not often go, but with dementia the person may not know what town, county, state or country they are in.  They may have no idea how they got there.  They may guess at whether they are at a doctor’s office or in a hospital.  (This feature should always be put in the context of whether there is an acute illness.  Since hospitals often share laundries, a patient may awake in Memorial Hospital in North Conway wearing a gown that says Huggins Hospital in Wolfeboro and wonder what’s going on.)

Memory - Even with dementia, distant memories are preserved long after recent memories are lost.  Loss of memory for names and tasks is common with age and fatigue.  Loss of memory for complete blocks of time is more worrisome, though.  Loss of memory moment to moment is more typical for dementia.  Forgetting to do something is common; forgetting you even intended to do it is not.  Ensure that hearing loss or some other communication problem is not part of the picture.

Language - Difficulty remembering words is not unusual unless there is a noticeable reduction in a person’s vocabulary.  Usually a person will remember a word’s meaning if they hear the word.  With dementia they may not recall the word at all or make up an off-the-wall definition.  A demented person may speak much less and have difficulty pronouncing words they used to use easily.

Executive function - This refers to what executives are supposed to do - plan, organize, make decisions.  Not all of us are executive material, but if we used to be able to plan our day, our meals, what clothes we wear, when it is time to do the laundry and go to the store, and we lose that ability, then dementia is more likely.  An important distinction is to be made that many older people do not want to continue taking care of all life’s chores.  That’s one thing.  But if they need to and they can’t pull it together for even a short while, that’s another.

Visual-spatial skills - The connection between vision and cognition can be disrupted in several ways.  In certain dementias, a person may be able to define the word “pen,” but when shown a pen, may not be able to name it or tell what it is for.  They may not be able to draw the hands on a clock face to indicate the time.  They may not be able to copy simple diagrams.

Remember that not all dementias are untreatable.  Sometimes dementias can be due to side effects of medications, depression, thyroid disease, and other conditions.  So even if a person does have more symptoms than memory loss, a careful evaluation may be productive.