Normal Aging

Washington DC

“My memory is going, David; I just can’t remember names like I used to, and sometimes I can’t find the word I’m looking for.  Am I getting Alzheimer’s?”  Before dying, clearheaded, at age 88, my father asked the same question of me, his doctor son, almost every time we visited for the last twenty or so years of his life.  He tried to cover his concern with humor, but he didn’t think his memory loss was funny.

His dilemma is common.  It’s easy to confuse normal aging with the symptoms of early Alzheimer’s.

Some of us have minds just as clear as anyone else our age, but we worry that we’re impaired.  Others of us can have significant cognitive impairment but we dismiss it as just normal aging.  It can be difficult to know.  It’s complicated by the fact that most of us who do develop cognitive impairment are also aging, so the normal changes of aging can slide imperceptibly into cognitive impairment.

While it might be tricky in those transition cases, it’s ordinarily not difficult to differentiate one from the other.  A rule of thumb: When changes begin to disrupt our daily activities, it’s past time to be evaluated. 

(Much of the following is derived from the Alzheimer’s Association website.) 

Changes in memory are the first symptoms usually noted in both aging and cognitive impairment.  It’s quite normal for older people to forget names or appointments (although we’ll usually remember the appointments later on), but if we find ourselves forgetting important dates or events, increasingly needing reminder notes to keep things straight, or needing to ask for the same information several times, then we might want to get checked out. 

It’s not just memory, though: changes in any area of mental functioning can indicate trouble.  As we age, it’s quite normal to make numerical or calculation errors when, say, balancing a checkbook or calculating a tip in our heads.  However, having difficulty concentrating and taking longer to do things; having increasing trouble following recipes or keeping track of bills, or experiencing challenges in planning or in solving problems are different matters and should be taken more seriously.  In my own case, the first sign my daughters noticed, even before I received a diagnosis, was that I was taking longer to complete the little home improvement projects I like to do when I visit them. 

As older people, we might normally lose our sense of direction for a while, but when we forget where we are or how we got there, then it’s time for an evaluation.

We all lose things and it does seem to get worse as we get older.  But when we not only lose them but also have difficulty in re-tracing our steps to find them or when we put things in unusual places (like the lukewarm coffee into the refrigerator rather than the microwave), then we’ve probably slipped over from normal aging into the area of impairment. 

As we age, our judgment can become slightly less reliable, and we can make bad decisions once in a while. But when we make repeated mistakes handling money or pay less attention to personal hygiene, then there may be problems that should be evaluated.

It’s quite normal to feel weary of work, family or social obligations and want to quit.  But when we actually withdraw from social obligations or don’t go to work, then things have changed.

As we age, we can get more set in our ways and less flexible dealing with newness; we can then become irritated when pushed out of our routines.  That’s normal.  But other changes in mood or personality—becoming confused, suspicious, depressed or fearful—are more serious.

Knowing the differences is important.  There are treatable and reversible causes of cognitive impairment (vitamin B-12 deficiency, hydrocephalus, insufficient thyroid hormone, depression, medication side effects and other).  So if we have any questions about our cognitive abilities, we should have ourselves evaluated earlier rather than later.  The first step, however, lies in knowing roughly where the borderline between normal aging and abnormal cognitive impairment lies.