What Is Normal Memory Loss and When to Get Concerned

Prompted by fear of Alzheimer’s disease or other dementias, many older adults panic the moment they start to forget names, lose things, or have trouble coming up with the right word.  And while symptoms like these can be an early indicator of a serious problem, it’s more often the case that they’re not.

It's Normal For the Brain to Change

In the same way other organs in our body change as we age, so does the brain. We can’t walk as fast at 75 as we could at 25 — our reaction time slows. Some changes in hearing and vision are to be expected.

The same is true with memory, and a certain amount of memory loss is a normal part of healthy aging. Perhaps you’re in your 40s, 50s, or 60s and beginning to notice it. When it's within normal range, doctors sometimes call it “physiologic” memory loss, which is a way of saying: to be expected. In fact, neuropsychologists, who often perform memory testing, have different “norms” for people of different ages — not only in measuring memory, but also for different cognitive abilities like concentration and focus.

Sometimes extensive testing will reveal measurable memory loss or other areas of lower cognitive performance, but it does not interfere with daily functioning. Experts call this MCI, or mild cognitive impairment. In general, people with MCI need more careful follow-up because they progress to dementia at a higher rate than those with normal cognitive functioning (adjusted for age). But some people with MCI, and even more with physiologic memory loss, never progress to dementia over their full lifetime.

When to Get Concerned

Simply put, memory loss is concerning when it begins to interfere with daily functioning. Here are some examples:

• Inability to perform ADLs (activities of daily living), like not being able to prepare a meal for oneself, wearing inappropriate or dirty clothing, or poor hygiene
• Finances suddenly in disarray, such as unpaid bills, delinquent charges, money not accounted for, or unusually speculative investments or purchases
• Appointments are repeatedly missed, especially important or regular ones
• Suddenly struggling with directions and getting lost on familiar routes
• Driving difficulties; think a sudden rise in fender benders or traffic tickets
• Language difficulty where the individual is no longer understandable or cannot understand you
• Uncharacteristic irritability in someone who typically has a mild disposition
• Unusual beliefs, like suspicion that someone is stealing from them, jealousy towards a spouse, or believing family members are imposters
• Uncharacteristic new impulsive behaviors, such as hypersexuality, foul language, poor manners, and extreme impatience
• Lack of insight into the fact that there may be a problem
• General errors in judgment in a previously judicious person

What to Do if You Have Concerns

If you have concerns about memory loss in yourself or a loved one, the first step is to involve a primary care doctor, who may refer you to a neurologist or a neuropsychologist for formal testing.

Be aware that many patients with early dementia are able to hide it from a physician; they can steer the conversation in ways that conceal what might be going on. Many studies suggest that physicians can be “fooled” (e.g. miss early dementia) even when they have had a longstanding relationship with the patient.

It’s also important to note that some cases of dementia, MCI, and even what appears to be Alzheimer's disease can have treatable and sometimes reversible causes. They range from medication side effects to infections, to hormonal diseases (think thyroid problems). These are all important potential causes to explore with your doctor.

Finally, Tempo Matters

You should be particularly mindful of the tempo or pace of decline. Memory loss that occurs suddenly is almost always something other than dementia, which has a slow progressive course (often over years). It’s important to meet with a physician as soon as you begin to notice things to explore what may be going on.