Fears of Memory Loss by Elderly Called Overdone

SAN DIEGO —  The flood of publicity about Alzheimer’s disease in recent years has caused an unintended side effect: an increase in the number of older people who worry that brief memory lapses are the first signs of certain, traumatic senility in coming years.

In truth, only 4% to 6% of those over 65 suffer from significant brain impairments that cause dementia, said Jennifer Watson, assistant director of psychological services at Alvarado Parkway Institute. Much more common are milder problems, the “normal forgetfulness” or “benign forgetfulness” that accompanies the aging process, she said. Accurate statistics on the size of that group are unavailable.

To help people distinguish between serious and mild memory problems and cope with the latter, Watson and Ken Dellefield, a clinical nurse specialist in the department of psychiatric nursing at the Veterans Administration Hospital, presented a seminar on memory loss recently at Alvarado Parkway Institute.

With a little information, it is fairly easy to determine whether a memory lapse is the result of the normal slowing down of growing older or a more serious problem, Watson said in an interview. People with pathological memory problems forget the most important events and people in their lives rather than the small details of daily living, she said.

Many Causes Treatable

Misplacing car keys, forgetting a neighbor’s name or temporarily losing track of a parked car are not sources of concern, Watson said. Neither is taking more time to come up with an answer or a name.

But forgetting the name of a hometown, becoming lost in one’s own home, or failing to recognize old friends and relatives are signs of more serious illness, she said.

A normal person “might forget a person’s name, but he wouldn’t forget an entire event,” Watson said. “They might be going to a party and they might forget a few people’s names, but they wouldn’t forget about the party entirely. A person who is having serious memory problems would forget entirely that they were going to a party.”

It is also important to note that memory losses have numerous causes, many of which can be treated if recognized, Watson said. Sudden, severe memory changes may indicate dehydration or an undiagnosed illness. Short-term lapses may be merely the result of fatigue, anxiety, poor nutrition and, especially in elderly people, depression.

The death of a spouse can precipitate the kind of depression that produces absent-mindedness and memory problems along with other symptoms such as self-isolation from friends and relatives, lack of motivation and difficulty getting up in the morning. Though it is sometimes difficult to recognize that depression is the cause, testing will show that grief--not pathology--is at the root of the problem, Watson said.

But when they do not recognize these other causes, older people lose confidence in their memories as lapses persist and their problem often snowballs, Dellefield said in an interview. Embarrassment, frustration, anxiety, humiliation, loss of self-confidence and fear can result, he said.

At the very least, battling memory losses requires keeping a positive attitude about one’s ability to remember, Dellefield said. “If you’re being introduced to somebody and you’re saying ‘Oh, God, I’ll never remember that name’ . . . you’ll never spend the time to repeat that name three or four times, which is what you need,” he said.

Memory is made up of three components--registering, retaining and retrieving--any one of which can become faulty.

Registering information requires concentrating on it to learn it in the first place, Dellefield said.

Clues the Key

Retaining is more complicated. The short-term memory will retain information for 30 seconds or less (thereby ensuring that every trifle ever perceived does not clutter the memory) before it is transferred to the long-term memory or forgotten, Dellefield said.

Information is stored in the long-term memory through the use of clues like the sound of a first letter, a visual picture or the location where the information is picked up, he said.

Retrieving information is the reverse process, using clues associated with, say, an event, to pull up a fuller description of what happened, he said.

As memory declines with advancing age, people have two choices to cope with lapses: better preparation and organization, or the use of mnemonic devices. Dellefield strongly recommends the former. Mnemonics, which involves associating things to be remembered with mental pictures, acronyms or word sounds, requires constant practice and discipline. It is better suited to memory stunts, he said.

For everyday living, Dellefield recommends:

- Be organized. Keep lists of things to be done that are easy to read and use. Keep the lists in the same place every day. Use an appointment book or calendar, and look at it each morning when you get up. Cross items off as they are accomplished.

- Prepare. Write down questions before arriving at the doctor’s office. Think about the names of people at an upcoming gathering.

- Get in the habit of practicing a “cockpit drill” when leaving home. Like an airplane pilot just before takeoff, say aloud a checklist of items, such as: turn off the stove, turn off the lights, start the dishwasher. Do the drill in the same order every time.

- Be orderly. Establish places to keep glasses, keys, medications, incoming mail and important papers. Put them there all the time.

- Establish routines and follow them: Wash the car on Mondays. Mow the lawn on Tuesdays. Pay the bills on Wednesdays.

- Use alarms or timers. If you have to do something in 15 minutes, set an alarm to go off at that time.

Dellefield said that mnemonics can be learned and enables tremendous memory feats, but that it is useless without practice. “They don’t come naturally to people. Unless you’re very disciplined . . . you’re not going to spontaneously use it,” he said.

One technique involves setting up word patterns, acronyms (such as NATO, FBI) and rhymes (“In 1492, Columbus sailed the ocean blue”) or linking concepts to a catchy saying (“Spring forward, fall back.”)

For more mundane life events, create an outlandish visual picture that links the item to be remembered with something else. The more ridiculous, the better. Action should be involved in the image, he said.

If you want to remember to pick up spaghetti on the way home from work, imagine driving the vehicle through a mountain of spaghetti as you get into your car in the morning. When you get into your car at night, the image should come back, Dellefield said.

“Once you get it, it stays with you,” Dellefield said. “You could also do it with smell or touch. It has to capture you. It has to stay with you.”