Memory loss is a common concern. What to do if you notice changes.

March 3, 2022
caregiver showing concerns about memory loss in aging man.
Caregivers provide crucial support for people showing signs of memory problems and dementia. It’s important to know your options if you have concerns about memory loss. Photo by Getty Images.

Comedians casting about for joke fodder often remember what worked before. Ironically, a reliable subject is memory loss. Among the numerous gags about forgetfulness: a guy walks into a seminar on short-term memory loss, whereupon the host says, “Good evening, you’re probably wondering why you walked in this room.”

The inevitable chuckles mask the fact that memory loss is often far more than a mild annoyance. It can make performing everyday activities harder and decrease the quality of life. It is also often a symptom of broader, more serious cognitive problems, such as Alzheimer’s disease and other types of dementia. The fallout can be devastating, both emotionally and financially, particularly in an aging population. A 2021 report from the Department of Health and Human Services summed it up: “The possibility of developing cognitive impairment is among the most consequential risks older adults and their families face.”

The links between memory loss, cognitive decline and psychiatric problems like depression can be difficult to untangle. For help, we spoke with Dr. Samantha Holden, who practices at the UCHealth Neurology Clinic – Central Park and is assistant professor of Neurology at the University of Colorado School of Medicine and medical director of the University of Colorado Memory Disorders Clinic.

How do we define ‘normal’ memory and when should we be concerned about memory loss?

The short answer is it depends on the individual. Misplacing keys or fumbling for a name or word are not automatically reasons for panic. “It’s important for me when I’m trying to understand the person I’m seeing in the clinic to find out where they are coming from,” Holden said. “What is their baseline? Has there been a change or decline in their thinking and memory? Not that there has always been a deficit – like a learning disability – but that a person was previously doing well and now they’re not.”

Dr. Samantha Holden is medical director of the University of Colorado Memory Disorders Clinic. Photo by UCHealth.
Dr. Samantha Holden is the medical director of the University of Colorado Memory Disorders Clinic. Photo by UCHealth.

What is a good example of a change that might raise concerns about memory loss?

Holden said a person who gets lost but has never been strong with directions would be far less worrying than one who had been very good at reading maps and getting places but begins to have trouble navigating familiar neighborhood streets. That’s why it’s so important to learn as much as possible about the individual before making a diagnosis.

“It’s always vital to place that person’s current cognitive status in the context of their previous baseline,” Holden said.

You mentioned both memory and thinking. Should we think about them separately?

Yes, and no. Thinking, or cognition, “broadly includes all those neurological processes that include not only memory, but also language, planning, multitasking, attention, decision making, and visual and spatial functioning,” Holden said. “Memory is a very defined subset of cognition.”

So memory loss is just one kind of cognition problem?

Yes. What might be loosely labeled a memory issue – say a person more than occasionally failing to recall what another person just said or forgetting to show up an important appointment – might actually be a deterioration of the brain’s attention or planning functions, Holden said. That kind of problem can be hard to tease out because the brain doesn’t function like a collection of individual computer workstations doing discrete jobs. Its parts interrelate.

“For a long time, brain anatomy has been simplified to say, this part of your brain does this and that part of your brain does that, but it’s really much more integrated,” Holden said. “It’s a network. It takes a lot of detective work to sort out where problems are coming from.”

I feel that I am having trouble thinking. Is that dementia?

It is important to define terms, Holden said. “Dementia is a decline in cognition that progresses and over time affects a person’s daily functioning, like paying bills, taking medications and driving,” she said. The deterioration can gradually affect “more basic things, like dressing, bathing and grooming,” she added. Memory loss doesn’t define dementia, but it is a common symptom.

Are there different categories of dementia?

Yes, and different forms have different treatments, so it’s important to make an accurate diagnosis, Holden said. There are three underlying forms:

  • Medical dementia, caused by, for example, sleep deprivation, obstructive sleep apnea, thyroid disease, vitamin deficiencies, or medication side effects. “These are external stressors on the brain that we can fix,” Holden said.
  • Neurological dementia, which occurs when “something triggers the brain cells to start dying over time,” Holden said. “Where the cells die is what triggers the outward symptoms.” The most well-known example is Alzheimer’s disease, which most often first causes cell death in the hippocampus, the brain’s memory center. Other forms are Lewy body dementia and frontotemporal dementia, which have a range of effects, including not only memory loss but also personality changes and language and movement problems.
  • Vascular dementia, which affects the blood vessels in the brain. The causes include high blood pressure, high cholesterol, diabetes, genetic vascular disease and smoking, Holden said.

In addition to these neurological problems, can psychiatric issues like depression and anxiety affect memory and overall cognition?

Yes. “Psychiatry and neurology are much more closely entwined than we make them out to be,” Holden said. She reiterated that changes in the brain’s structure, cells, chemistry and electrical signaling occur in a terrain composed of interrelated and interdependent parts. The effects of those changes can be varied and complicated.

“So to say that this one change causes this kind of disease and another change causes this completely separate kind of disease is false,” Holden said. “Neurological symptoms have traditionally been tied to structural changes in the brain, while psychiatric changes have been tied to chemical changes, but there is so much that we can’t visualize yet with our current testing modalities. We can’t reliably separate them out.”

How can this neurological-psychiatric connection play out in patients?

A good example is Parkinson’s disease, a progressive movement disorder that frequently leads to memory loss and other cognitive changes in patients, as well as psychiatric challenges, such as depression, anxiety and apathy. “The vast majority of neurological conditions as currently defined come with behavioral and psychiatric symptoms,” Holden said. “That’s because the changes in the brain can’t occur in isolation.”

She added that other emotional factors, including grief and adjustment after the diagnosis of a chronic disorder, as well as sleep problems and pain, can affect thinking and memory. “We need to broaden our perspective of how we think about the brain overall. We can’t just pick and choose the little pieces that we focus on. We have to think about it more holistically and consider the person and their experience and their overall well-being in terms of the changes in their brain.”

How do you help people with possible memory and other cognitive issues in the Memory Disorders Clinic?

“It starts with a lot of getting to know you,” Holden said. “By getting to know you, I know your brain and that’s how I do my job.” It’s also important for someone who knows the patient well to come to the appointment to offer a viewpoint independent of the patient’s, she said. “As a patient, you have only an inside view of your brain. It’s not built to keep track of itself.”

At the initial appointment, Holden and the patient and caregiver have a lengthy conversation, during which she observes speech patterns, manner of dress, and movements, as well as life details, such as education, work and family. She also administers screening to assess the patient’s ability to problem-solve and answer questions as well as their gait and balance.

If Holden concludes after the lengthy initial exam that the patient is at risk of cognitive decline, she may order tests, including blood work to confirm or rule out a vitamin deficiency or thyroid problem. Patients may also get a brain MRI, which reveals any shrunken or stressed areas of the brain, blood vessel damage or signs of “silent strokes.” Paper-and-pencil neuropsychiatric tests, three to four hours long, produce information about memory, cognition, language, ability to organize and plan, and more. Holden compares the results to people of the same age and education. “They show us patterns of strength and weakness,” she said.

If the tests show memory and/or cognition issues, what treatments are available?

One important point is that people should not simply chalk up the decline to a part of aging, Holden said. “A lot of us have conceptualized that as something to be expected, but there are people who live into their 90s sharp as a tack,” she said. “There is also a misconception that there is no ‘cure,’ so why bother? But we can manage the symptoms.”

Holden said treatments tailored to each patient include medications like Aricept, which “allow brain cells to communicate better.” They don’t restore memory but may modestly slow the loss.

Some patients may benefit from anti-depressants to treat mood disorders. “Sometimes depression is the only cause of the stress on their brain, but often there is a complex interplay,” Holden said. “But even if it is not the only cause, we are still treating the depression.”

Other patients may need help with sleep problems. In those cases, Holden said, sleep medicine specialists can provide help with sleep hygiene techniques without resorting to sleep medications that often have unwanted side effects on memory.

How can caregivers help their loved ones with these issues?

“The overarching tenet is you need to take care of yourself first,” Holden said. She acknowledged that there may be “guilt and anguish over that,” but she noted that airlines routinely instruct passengers to use oxygen themselves before helping others in an emergency. It would be even more beneficial to allow “early, embedded” home care for caregiver support, she added, but at this point it is not paid for.

I hear there are plenty of supplements I can take to help with my memory. True?

No. Holden said she is “asked on a daily basis” about a widely advertised over-the-counter supplement, which claims to improve brain function and memory. She said there is no evidence to support that claim or those made by many other producers of diet supplements and vitamins. The sole exception is vitamin B12, which studies show can improve memory in people whose levels are low. She warned that some supplements can have unpredictable interactions with prescription medications and urged people to consult their physicians before taking them.

So is there anything I can do to prevent memory loss and cognitive decline?

“The number-one thing you can do to protect your brain and slow any cognitive decline is to exercise,” Holden said. “It’s been proven effective by multiple studies and it’s free. If there was a pill or vitamin supplement that did what exercise does for you, people would be begging for it. Exercise is the closest thing we have to a cure-all for all conditions, and it has clear, objective benefits for brain function.”

It’s best if people start exercising and following a healthy diet in their 30s to 50s, Holden concluded. “It reduces stress on your brain,” she said. “Be proactive and take healthy steps throughout your life that will protect your brain and reduce your risk of dementia as you age.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.

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