June 18, 2021 • 17 mins
A memory lapse could be perfectly normal, or a sign of something more dire. Dr. Saltz reveals how to tell ordinary forgetfulness from dementia, and ways to help loved ones who are struggling with memory loss.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. One of the things
people fear most about aging is the concern about developing dementia.
That's why today I'll answer two questions I received about
the topic of forgetting. Most often, dementia is a disease
(00:47):
of aging, meaning it's relatively more rare in those under
the age of seventy. But we hear so much about
dementia and are often exposed to the ravage is of
it in older populations that it is not unusual for
me to speak to patients who express anxiety about their
(01:08):
memory and whether they may have a future with dimension.
To put it in perspective, the vast majority of dementias
are Alzheimer's dementia. That's as much as eight percent of
all dementias, and for Alzheimer's dementia, it's really only three
percent of people between the ages of sixty five and
(01:29):
seventy four years old that are affected. Once you're se
four s of the population is affected, and once you're
over the age of eighty five that's when the numbers
really go up, whereas much as thirty two of the
population is affected. Fears of forgetting are really a common fear.
(01:52):
In fact, fears of forgetting is one of the most
common fears, along with the fear of losing one's mind,
whatever that means to the individual who is afraid, and
in some cases it does mean forgetting. Our brains are
minds for most people, they would agree, is our most
(02:12):
vital organ, the organ through which all experience, both internal
and external, is perceived. The idea that this organ would
perceive incorrectly and thereby mislead us is scary. But in addition,
it's also true for many people that the idea that
(02:34):
memories of all of our experiences, which actually make up
our identity, would be lost and therefore shake the very
foundation of who we are. This thought is also scary,
and last, but not least, is the fear that we
will lose our independence. For the most part, these fears
(02:56):
are things that happen really only in the severe in
late stages of Alzheimer's dementia. Most people with Alzheimer's of
the mild and even moderate stage don't experience a loss
of identity or independence. Nonetheless, if you have witnessed a
life loss to dementia, merely witnessing it and be very
(03:18):
traumatic and leave you with fears of forgetting and what
it may mean. The tricky thing is that experiencing some
forgetting is actually a very normal part of aging. More,
forgetting can also be due to other factors going on
in your life, factors that are treatable. So let's turn
(03:42):
to the questions I got that relate to these very
concerns and see how can I help Question one, Dear
doctor sALS, how can we differentiate signs of age related
forgetfulness and dementia? As you age, it is normal to
(04:04):
experience forgetting certain things a certain amount. This is not dementia.
But beyond the occasional forgetting, there are more specific signs
that point to something beyond age related forgetfulness. I'm going
to try to delineate which points in which direction. Sometimes
(04:27):
forgetting names are appointments, but then remembering them later is
really normal aging, but memory loss that actually disrupts your
day to day life could mean something more. For example,
often forgetting recently learned information, or forgetting important dates or
(04:48):
events and then not remembering them later asking for the
same information over and over from the people around you,
and if you're very noticeably increasing the need to rely
on memory aids like sticky notes or electronic devices to
remember even basic things in your day, or if you're
(05:12):
turning to family members to handle those things for you
and remind you all the time, that would be more
concerning and more speak to the idea of a possible
something going on in your mind that is not normal. Agent.
It's normal to sometimes make an error balancing your checkbook
or even in a calculation, maybe for example, adding up
(05:34):
your tip, but cognitive changes such that you're having trouble following,
for example, a recipe, or you find you can't count
change really consistently, can't work with numbers, or keep track
of paying your bills, particularly if you have problems lanning
things and concentrating on something for any length of time
(05:57):
in a way that is different from before work. These
are the kinds of tasks that are more associated with dementia,
and of course as technology keeps advancing, it's normal to
have trouble sometimes, for example, recording a new TV show
or fixing something on the computer that seems to have
gone awry. But if something has been a familiar task,
(06:20):
like playing a favorite game or driving someplace that you
are familiar and usually know how to drive to, or
for example, managing a work budget, and now you can't
remember the rules or the directions, and for example, you
find yourself getting lost, then this is not typical or
(06:41):
normal age related forgetfulness. And to be honest, we've all,
especially this year, forgotten what day of the week is it,
or even what is the date, but then you often
remember later. That is normal. But if you can't remember
the year, the season, or frequently what day it is,
(07:04):
or for example, you can't remember where you are, then
this is more of a concern. Similarly, we've all forgotten
a word sometimes that's very normal, and actually that's the
kind of thing that I find frightens people, like the
word just didn't come to me or won't come to me.
But it's actually normal to do this, more so as
(07:27):
you age. But the person with dementia doesn't just forget
the word, the person who's forgetting the word with dementia
actually will substitute it, often with other words that make
no sense in that sentence. They're more likely to lose
track of the conversation altogether, and to maybe even just
stop talking in the middle of the conversation because they've
(07:51):
lost track of their sentence. And you might even find
that someone with dementia will start to socially withdraw because
the forgetting and the associated confusion makes them uncomfortable, and
so they won't have the social conversation to start with.
And of course we all misplace something sometimes or lose
(08:11):
something from time to time, again normal aging. But if
you're putting things in a place that they don't belong,
like you're putting your keys in the refrigerator, and even
when you stop and say I'm looking for something and
try to retrace your steps, you really can't do that
at all, then that might be more of a concern.
(08:35):
In addition to the frequent forgetting of dementia, other things
change in dementia as well, so it's not just about
am I doing a little more forgetting. Things change like
your judgment, such that you're more likely to make some
bad decisions, for example, a decision that might cause you
to lose money or find yourself in a bad situation.
(08:57):
And actually with dementia you're more were likely to have
mood and personality changes, so you might experience more fear
and particularly more suspicion and also depression. But suspicion when
you weren't a suspicious person in the first place, is
definitely a sign that it could be more of a
(09:20):
situation like dementia. For example, if you can't find your
keys and you think that's because someone put them somewhere maliciously,
especially if you're in an unfamiliar place, then you might
find these symptoms to be worse than usual. If this
is a process with dementia, but without changes in judgment
(09:42):
or mood or character, then sometimes mild forgetting is really
just the normal change that occurs in everyone's brain post midlife.
Of course, when in doubt, it's always possible to see
your doctor and do some very basic testing to see
if there's any reason to be concerned, which might just
put your mind at ease. But it's often true that
(10:04):
the more anxious one is about forgetting, and the fear
that this is dementia. Often the more exaggeratedly focused you
can become on forgetting. And in addition, it's important to
know that if you are getting very anxious, that high
anxiety can increase the difficulty of concentrating and can actually
(10:25):
by itself impair your memory, thereby causing more forgetfulness. However,
when there is a clear and discrete change in memory,
it can be important to see your doctor because it
could be a treatable cause that isn't dementia. So, for example,
(10:46):
a side effect from medication, new thyroid disease, sleep apnea
can cause memory difficulties, lime disease, drinking too much alcohol,
and even just depression. All of these things can cause
you to have an impairment with your memory, and they
(11:07):
are also all treatable. So it's important to see your
doctor if you do see a specific difficulty going on,
because then you can receive treatment. How can I help
with Dr Gail Salts will be back after this short break?
(11:35):
Question two? Dr Gail, how can we talk more empathically
with elder people that do struggle with dementia? Like when
we talk to someone that keeps repeating the same stories
all the time but forgets information as soon as they
hear it. My first thought is to calmly repeat the
information and act as if that was the first time
(11:57):
I'm hearing the story. But should I say something aiming
to let them know that they said that already or
whenever they forget about something to comment on that. Do
they improve by knowing or is it just more painful
for them to realize that they have dimension. When a
loved one has dementia, they may ask the same question
(12:20):
over and over again, or they may tell you that
they did something that you asked about, like have they
eaten breakfast? Or have they taken their medicine? Because dementia
is a disease of the memory, and the reality is
they cannot remember. It's easy to feel like they might
be lying to you to get you to stop asking,
(12:43):
or to feel they're being very annoying because they keep asking,
But the truth is they don't remember that they did
ask nor what their answer was. So to them, they
just have a question or a concern on their minds
and the question or concerned is still there, so they
(13:04):
ask again, or they say they took their medicine when
they did, not not to lie, but because they don't
remember but since they're used to taking care of themselves
and therefore assume that they probably did, they say yes.
Correcting someone with dementia giving them the right word the
(13:26):
right answer does not help their memory improve. It does
not change the disease process in the brain. Telling them
they already asked that question also doesn't help. It just
makes them feel bad in the moment, but it won't
help them to not ask the question again later when
(13:46):
they again forget. Your first thought is correct. Calmly repeating
the information or answer is what's most likely to help
them to feel calm and secure. It does not help
them improve to know all the outward things they do
or say due to dementia. It may, on the other hand,
(14:09):
cause them pain in the moment. Admittedly a moment they
will probably forget the next moment, but still it can
upset them. If they ask you directly about their dementia,
then you should answer openly and honestly. Being dishonest because
they have dementia doesn't help them either, But highlighting their
(14:31):
struggle isn't helping them heal. Overall, when talking to someone
with dementia, keep in mind they are doing what they
are doing because they can't remember, not out of malice
or discourteousness, and treat them in such a way that
they can still feel some respect. If, for example, they
(14:52):
ask you to stop something, then stop it. You can
always try again later. If you know they mean past
the salt when they say sugar, just past the salt
and be done with it. Try not to ask them
questions that require them to use a memory that they
don't have. It will put them on the spot and
(15:14):
make them feel agitated or upset. Only start conversations by
saying hi, then your name, so they can be aware
that it's you. If they do become agitated, try hard
not to take it personally, because it's truly not personal.
(15:36):
But it can be a good time to leave them
alone to calm down, perhaps, or to switch environments or
tasks so they can help change their mood. So, for example,
if they're getting upset, hey, let's go for a walk.
Don't expect them to communicate effectively about present day matters.
(15:57):
It's often easier to talk about things of the past
that they do remember, because remember Dementia is often an
impairment in short term memory, and often long term memory
stays intact. Try to avoid asking questions where they would
have to remember something to answer. In that sense, questions
(16:18):
about how they are in the present, like right now
works best, So how do you feel right now? Understanding
that any answer is really a now answer. Even if
you're asking them about last week, what they're telling you
is probably about now. If they say they feel bad,
(16:39):
for example, if they say, for example, that they haven't
eaten in days, it's likely they are hungry now, but
because they can't remember when their last meal was, it
may feel like or seem like days to them. It's
hard to move from independent to dependent. So helping them
to feel that they still have respect, respect for their feelings,
(17:02):
their thoughts, their communications will really help them feel their best.
I hope that was helpful. Do you have a problem
I can help with? If so, email me at how
can I Help? At Seneca Women dot com. All senders
remain anonymous and listen every Friday to how can I
(17:26):
help with me? Dr Gails Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. One of the things
people fear most about aging is the concern about developing dementia.
That's why today I'll answer two questions I received about
the topic of forgetting. Most often, dementia is a disease
(00:47):
of aging, meaning it's relatively more rare in those under
the age of seventy. But we hear so much about
dementia and are often exposed to the ravage is of
it in older populations that it is not unusual for
me to speak to patients who express anxiety about their
(01:08):
memory and whether they may have a future with dimension.
To put it in perspective, the vast majority of dementias
are Alzheimer's dementia. That's as much as eight percent of
all dementias, and for Alzheimer's dementia, it's really only three
percent of people between the ages of sixty five and
(01:29):
seventy four years old that are affected. Once you're se
four s of the population is affected, and once you're
over the age of eighty five that's when the numbers
really go up, whereas much as thirty two of the
population is affected. Fears of forgetting are really a common fear.
(01:52):
In fact, fears of forgetting is one of the most
common fears, along with the fear of losing one's mind,
whatever that means to the individual who is afraid, and
in some cases it does mean forgetting. Our brains are
minds for most people, they would agree, is our most
(02:12):
vital organ, the organ through which all experience, both internal
and external, is perceived. The idea that this organ would
perceive incorrectly and thereby mislead us is scary. But in addition,
it's also true for many people that the idea that
(02:34):
memories of all of our experiences, which actually make up
our identity, would be lost and therefore shake the very
foundation of who we are. This thought is also scary,
and last, but not least, is the fear that we
will lose our independence. For the most part, these fears
(02:56):
are things that happen really only in the severe in
late stages of Alzheimer's dementia. Most people with Alzheimer's of
the mild and even moderate stage don't experience a loss
of identity or independence. Nonetheless, if you have witnessed a
life loss to dementia, merely witnessing it and be very
(03:18):
traumatic and leave you with fears of forgetting and what
it may mean. The tricky thing is that experiencing some
forgetting is actually a very normal part of aging. More,
forgetting can also be due to other factors going on
in your life, factors that are treatable. So let's turn
(03:42):
to the questions I got that relate to these very
concerns and see how can I help Question one, Dear
doctor sALS, how can we differentiate signs of age related
forgetfulness and dementia? As you age, it is normal to
(04:04):
experience forgetting certain things a certain amount. This is not dementia.
But beyond the occasional forgetting, there are more specific signs
that point to something beyond age related forgetfulness. I'm going
to try to delineate which points in which direction. Sometimes
(04:27):
forgetting names are appointments, but then remembering them later is
really normal aging, but memory loss that actually disrupts your
day to day life could mean something more. For example,
often forgetting recently learned information, or forgetting important dates or
(04:48):
events and then not remembering them later asking for the
same information over and over from the people around you,
and if you're very noticeably increasing the need to rely
on memory aids like sticky notes or electronic devices to
remember even basic things in your day, or if you're
(05:12):
turning to family members to handle those things for you
and remind you all the time, that would be more
concerning and more speak to the idea of a possible
something going on in your mind that is not normal. Agent.
It's normal to sometimes make an error balancing your checkbook
or even in a calculation, maybe for example, adding up
(05:34):
your tip, but cognitive changes such that you're having trouble following,
for example, a recipe, or you find you can't count
change really consistently, can't work with numbers, or keep track
of paying your bills, particularly if you have problems lanning
things and concentrating on something for any length of time
(05:57):
in a way that is different from before work. These
are the kinds of tasks that are more associated with dementia,
and of course as technology keeps advancing, it's normal to
have trouble sometimes, for example, recording a new TV show
or fixing something on the computer that seems to have
gone awry. But if something has been a familiar task,
(06:20):
like playing a favorite game or driving someplace that you
are familiar and usually know how to drive to, or
for example, managing a work budget, and now you can't
remember the rules or the directions, and for example, you
find yourself getting lost, then this is not typical or
(06:41):
normal age related forgetfulness. And to be honest, we've all,
especially this year, forgotten what day of the week is it,
or even what is the date, but then you often
remember later. That is normal. But if you can't remember
the year, the season, or frequently what day it is,
(07:04):
or for example, you can't remember where you are, then
this is more of a concern. Similarly, we've all forgotten
a word sometimes that's very normal, and actually that's the
kind of thing that I find frightens people, like the
word just didn't come to me or won't come to me.
But it's actually normal to do this, more so as
(07:27):
you age. But the person with dementia doesn't just forget
the word, the person who's forgetting the word with dementia
actually will substitute it, often with other words that make
no sense in that sentence. They're more likely to lose
track of the conversation altogether, and to maybe even just
stop talking in the middle of the conversation because they've
(07:51):
lost track of their sentence. And you might even find
that someone with dementia will start to socially withdraw because
the forgetting and the associated confusion makes them uncomfortable, and
so they won't have the social conversation to start with.
And of course we all misplace something sometimes or lose
(08:11):
something from time to time, again normal aging. But if
you're putting things in a place that they don't belong,
like you're putting your keys in the refrigerator, and even
when you stop and say I'm looking for something and
try to retrace your steps, you really can't do that
at all, then that might be more of a concern.
(08:35):
In addition to the frequent forgetting of dementia, other things
change in dementia as well, so it's not just about
am I doing a little more forgetting. Things change like
your judgment, such that you're more likely to make some
bad decisions, for example, a decision that might cause you
to lose money or find yourself in a bad situation.
(08:57):
And actually with dementia you're more were likely to have
mood and personality changes, so you might experience more fear
and particularly more suspicion and also depression. But suspicion when
you weren't a suspicious person in the first place, is
definitely a sign that it could be more of a
(09:20):
situation like dementia. For example, if you can't find your
keys and you think that's because someone put them somewhere maliciously,
especially if you're in an unfamiliar place, then you might
find these symptoms to be worse than usual. If this
is a process with dementia, but without changes in judgment
(09:42):
or mood or character, then sometimes mild forgetting is really
just the normal change that occurs in everyone's brain post midlife.
Of course, when in doubt, it's always possible to see
your doctor and do some very basic testing to see
if there's any reason to be concerned, which might just
put your mind at ease. But it's often true that
(10:04):
the more anxious one is about forgetting, and the fear
that this is dementia. Often the more exaggeratedly focused you
can become on forgetting. And in addition, it's important to
know that if you are getting very anxious, that high
anxiety can increase the difficulty of concentrating and can actually
(10:25):
by itself impair your memory, thereby causing more forgetfulness. However,
when there is a clear and discrete change in memory,
it can be important to see your doctor because it
could be a treatable cause that isn't dementia. So, for example,
(10:46):
a side effect from medication, new thyroid disease, sleep apnea
can cause memory difficulties, lime disease, drinking too much alcohol,
and even just depression. All of these things can cause
you to have an impairment with your memory, and they
(11:07):
are also all treatable. So it's important to see your
doctor if you do see a specific difficulty going on,
because then you can receive treatment. How can I help
with Dr Gail Salts will be back after this short break?
(11:35):
Question two? Dr Gail, how can we talk more empathically
with elder people that do struggle with dementia? Like when
we talk to someone that keeps repeating the same stories
all the time but forgets information as soon as they
hear it. My first thought is to calmly repeat the
information and act as if that was the first time
(11:57):
I'm hearing the story. But should I say something aiming
to let them know that they said that already or
whenever they forget about something to comment on that. Do
they improve by knowing or is it just more painful
for them to realize that they have dimension. When a
loved one has dementia, they may ask the same question
(12:20):
over and over again, or they may tell you that
they did something that you asked about, like have they
eaten breakfast? Or have they taken their medicine? Because dementia
is a disease of the memory, and the reality is
they cannot remember. It's easy to feel like they might
be lying to you to get you to stop asking,
(12:43):
or to feel they're being very annoying because they keep asking,
But the truth is they don't remember that they did
ask nor what their answer was. So to them, they
just have a question or a concern on their minds
and the question or concerned is still there, so they
(13:04):
ask again, or they say they took their medicine when
they did, not not to lie, but because they don't
remember but since they're used to taking care of themselves
and therefore assume that they probably did, they say yes.
Correcting someone with dementia giving them the right word the
(13:26):
right answer does not help their memory improve. It does
not change the disease process in the brain. Telling them
they already asked that question also doesn't help. It just
makes them feel bad in the moment, but it won't
help them to not ask the question again later when
(13:46):
they again forget. Your first thought is correct. Calmly repeating
the information or answer is what's most likely to help
them to feel calm and secure. It does not help
them improve to know all the outward things they do
or say due to dementia. It may, on the other hand,
(14:09):
cause them pain in the moment. Admittedly a moment they
will probably forget the next moment, but still it can
upset them. If they ask you directly about their dementia,
then you should answer openly and honestly. Being dishonest because
they have dementia doesn't help them either, But highlighting their
(14:31):
struggle isn't helping them heal. Overall, when talking to someone
with dementia, keep in mind they are doing what they
are doing because they can't remember, not out of malice
or discourteousness, and treat them in such a way that
they can still feel some respect. If, for example, they
(14:52):
ask you to stop something, then stop it. You can
always try again later. If you know they mean past
the salt when they say sugar, just past the salt
and be done with it. Try not to ask them
questions that require them to use a memory that they
don't have. It will put them on the spot and
(15:14):
make them feel agitated or upset. Only start conversations by
saying hi, then your name, so they can be aware
that it's you. If they do become agitated, try hard
not to take it personally, because it's truly not personal.
(15:36):
But it can be a good time to leave them
alone to calm down, perhaps, or to switch environments or
tasks so they can help change their mood. So, for example,
if they're getting upset, hey, let's go for a walk.
Don't expect them to communicate effectively about present day matters.
(15:57):
It's often easier to talk about things of the past
that they do remember, because remember Dementia is often an
impairment in short term memory, and often long term memory
stays intact. Try to avoid asking questions where they would
have to remember something to answer. In that sense, questions
(16:18):
about how they are in the present, like right now
works best, So how do you feel right now? Understanding
that any answer is really a now answer. Even if
you're asking them about last week, what they're telling you
is probably about now. If they say they feel bad,
(16:39):
for example, if they say, for example, that they haven't
eaten in days, it's likely they are hungry now, but
because they can't remember when their last meal was, it
may feel like or seem like days to them. It's
hard to move from independent to dependent. So helping them
to feel that they still have respect, respect for their feelings,
(17:02):
their thoughts, their communications will really help them feel their best.
I hope that was helpful. Do you have a problem
I can help with? If so, email me at how
can I Help? At Seneca Women dot com. All senders
remain anonymous and listen every Friday to how can I
(17:26):
help with me? Dr Gails Salts
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