How does aging affect memory and cognition (thinking)?

Almost all of us become aware of changes in memory and cognition (thinking) as we get older. We begin to have difficulty recalling names of people and places, notice that our mental processing has slowed, and that learning is more difficult. We find that certain functions (for example, eye-hand coordination) are also slower.

When should memory loss become a concern?

This question is difficult because memory loss can be influenced by many factors. A temporary cognitive decline can be brought about by factors including:

  • Changes in a person's physical health, including a chronic disease that is worsening
  • Certain medications
  • Use of substances
  • Changes in electrolytes
  • Changes in kidney, liver, and thyroid function

In addition, psychosocial issues — such as stress or loss of friends or loved ones — can lead to depression, which may affect thinking and functioning. In the absence of these factors, if changes and memory and thinking are noted and are occurring more frequently than in the past, they could be a concern.

When are the effects of aging considered dementia?

The formal definition of dementia requires not only memory loss, but other signs of cognitive decline such as:

  • Inability to express or understand language (aphasia)
  • Inability to carry out specific skilled motor actions (apraxia)
  • Impairment in visual or auditory perception (agnosia)

Common definitions of dementia require that these cognitive changes interfere sufficiently with social or occupational functioning, be sustained and a change from one’s base cognitive level.

What is the role of the physician in treating dementia?

Patients or families who believe that the normal effects of aging have been exceeded should consult a physician, often a family practitioner, internist, geriatrician, or neurologist. The evaluation that can be expected should include a careful and thorough history and examination with neurological assessment, involving some screening tests of cognitive function designed to aid in diagnosing impairment in cognition.

Additional laboratory studies would usually involve blood work and a scan of the brain to look for conditions other than the most common form of dementia, Alzheimer's disease.

How common are dementia and Alzheimer's disease?

It is generally acknowledged that dementia doubles in frequency every 5 years from the age of 65. Estimates suggest that 5% of adults over age 65 have dementia and as high as 50% for those over age 85. Of those who have dementia, from 50% to 75% are thought to suffer from Alzheimer's disease.

Dementia — and particularly Alzheimer's disease — represent very significant public health problems, since the percentage of the population in this age group is rapidly increasing. It is currently estimated that some 4.5 million adults suffer from Alzheimer's disease and by the year 2030, this number may easily double or triple. Current estimates of the total cost for health care to this segment of the United States population come close to 100 billion dollars annually.

What can be done about Alzheimer's disease?

At this point Alzheimer's disease cannot be cured. However, it can be effectively managed through education on the disease and on handling behavior, as well as counseling and support for family members and caregivers. Some medications are available to treat the changes that occur with the disease.

Medications for Alzheimer’s

Current symptomatic drug treatment targets the cognitive and the behavioral changes brought about by this disease. Four drugs are currently available for cognitive impairment: donepezil (Aricept®), rivastigmine (Exelon®), galantamine (Reminyl®), and memantine (Namenda®).

The first three medications increase the neurotransmitter acetylcholine, which is deficient in patients with Alzheimer's disease. Side effects are common, including decreased appetite, weight loss, diarrhea, and even slow heart rate and increased risk of passing out. Memantine acts on a different chemical system, and is commonly used together with one of the other medications and also to help with disease symptoms, including irritability and agitation.

Non-medication approaches to Alzheimer’s

Of equal or perhaps even greater importance are efforts to control the behavioral aspects of dementia, including apathy, agitation, anxiety or irritability, wandering, depression, and lack of inhibition.

A variety of non-medication approaches are available. The most important of these include:

  • Educating the caregiver about the disease
  • Providing the patient with a stable and calm environment
  • Offering the patient outlets for energy expression
  • Promoting normal sleep patterns

Medications may be necessary for sleep and for the not uncommon symptoms of uncontrollable agitation, violence, or hallucinations.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/1/2017...#6437