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If you're new to this blog and want some context for it, read this post from the day I announced my Alzheimer's disease and this post about the day I announced I had lost it. For more info, visit my website with my autobiography and all blog entries in chronological order for easier reading to catch up. There's also a sermon on the spiritual lessons I've learned through this journey through my damaged mind.

Thursday, November 07, 2013

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.


  1. Anonymous11/07/2013

    David, you were writing this post just for me! Thanks.


  2. Good post as usual, David, thank you. One of the challenges of getting diagnosed is that one's own doctor may be in denial about the warning signs of cognitive impairment or the doctor may have insufficient training and experience to know how to diagnose or refer a person having cognitive difficulties. I've found most medical professionals (doctors, nurses, dentists, physical therapists) to be without ANY training in Alzheimer's disease; it just doesn't exist on their radar. So if a person thinks there's a problem, it's important to keep asking until you find someone who's knowledgeable AND can communicate with you - because neurologists are notorious for their poor communication skills! Cheers.

    1. It's certainly true that I received no training in recognizing or dealing with early cognitive impairment. hat's a long time ago, but I don't think it's changed a lot. In this area we have to evaluate not only our symptoms but also the medical people we chose to help us.

    2. Anonymous1/14/2014

      Medical personnel treat anxiety/ depession very poorly. I believe Alzheimer's might be treated even worse: arrogance seems the norm. Your blog is the kindest, most revealing story I could imagine. Bless you for your humble honesty. I am still terrified bit maybe not so alone. Isa

  3. Anonymous11/08/2013

    Very interesting information.As l was reading through this article, l was thinking to myself, this sounds like me.The most worrying thing now is, l am still very young in my early 40s.

  4. Anonymous11/08/2013

    I am reading MAKING LOSS MATTER by David Wolpe, and I recommend it. We are all dealing with the difficulties of memory loss and Wolpe's book shows us how we can create meaning from that which we cannot control.


  5. Anonymous11/09/2013

    I never realized the extent to which mental function may be impaired by stress and depression until 6 months after being laid off at age 56, with a family to support. 95 job applications later, I was 30 days from running out of unemployment. I had made, then lost 3 years equivalent salary in stocks while unemployed. Having been rehired as an on-call employee, each time I come with a matter of days or hours of being sent home due to lack of work anxiety levels interfere with normal mental functioning. Working long hours just to impress coworkers to try harder to find more projects for me to stay on adds the stress of mental exhaustion. Meanwhile, my running schedule slips due to long working hours, which prevents the physical and mental relaxation from periodic exercise. Add to that the periodic interviews that result in rejections. Working hard to get a new job, keep a part time job, hold the family together as the funds get scarcer, and keep on the horse and top of the investing game. One year ago, before this started, I was 200% more efficient and sharp in my normal business activities.

    1. Thank your for bringing this to our attention again. Depression is probably the most common of reversible cognitive impairment. But for too many of us depression is almost as hard to admit as cognitive impairment. From my point of view, even if we can't change the depression or the mental functioning immediately, knowing what it is that's causing the problem is much easier than having the same level of impairment but not knowing what's going on.


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