Panicked patients are convinced they have Alzheimer’s. More often, the diagnosis is much less dire.
Memory loss, a possible symptom of dementia such as Alzheimer’s disease, is usually associated with old age. But as a geriatric psychiatrist and head of a memory center, I am seeing more patients age 50 to 65 who complain of increasing memory lapses and other cognitive issues.
These people are in the prime of their lives, and the very thought of having dementia is causing them to panic. They are particularly fearful of Alzheimer’s, the most common form of dementia, knowing it is incurable and difficult to detect early on.
Everyone needs to take a deep breath.
While possible signs of cognitive decline or dementia certainly warrant careful assessment, in patients of this age, such symptoms are more likely the result of a relatively benign and eminently more treatable 21st-century ailment that one might simply refer to as brain fog.
More often than not, what these patients actually are suffering from is normal age-associated declines in cognitive skills, along with some combination of other factors such as depression, drug side effects, substance abuse, sleep disorders or adult attention deficit disorder.
Here are a few examples, using experiences from my own practice:
The overtaxed brain
A patient I’ll call Marion is a successful business owner who arrived at the memory center with an anxious look. She reported having memory problems and said that because she was only 55 years old, she worried she was going “senile” like her grandfather, or possibly had a dementia such as Alzheimer’s.
Marion told me that she was under severe stress to keep her small business afloat. This was compounded by sleepless nights, crying jags and regular doses of a sedative prescribed by a doctor. Over the past 12 months, Marion had noticed increased memory lapses such as forgetting to pay vendors, missing appointments, and on one occasion being so preoccupied that she got lost driving to a regular customer. Increasingly, she felt as if she couldn’t concentrate while reading.
It was clear to me that Marion was panicking over something she didn’t understand. I explained that processing speed and other skills of the typical brain begin to slow down in middle age, and that she was taxing them even more with several common cognitive lodestones: overwhelming stress and depressed moods that distracted her and lessened her interest in daily tasks; lack of sleep; and a medication that can disrupt memory formation. These reversible factors, I told her, were likely behind her memory lapses.
I also explained that “senile” is an antiquated term that simply means old. In a previous era, where “old” was equated with losing one’s memory or some other degenerative process, “senile” became synonymous with dementia. It’s a term doctors no longer use.
Marion still warranted a comprehensive work-up to clarify the diagnosis and find a solution. Neuropsychological tests revealed an interesting finding: Her memory, along with most other cognitive skills, tested nearly perfect for her age, but her attention skills were poor.
A likely diagnosis of adult ADD was confirmed when she responded beautifully to a trial of the stimulant methylphenidate—a drug identical to one prescribed for children with ADD. This medication, along with psychotherapy, improved her thinking and mood and shooed away remaining concerns about her memory.
A combination of things
A patient I’ll call Jonathan came to me in a panic, worried he had Alzheimer’s and that his livelihood was in jeopardy. This 62-year-old attorney had been called in by his firm’s lead partner, who noticed his forgetfulness and disorganized work and urged him to see a doctor.
The first stop was his primary-care physician, who listened to his story, reassured him and prescribed a sleeping pill for the insomnia. Jonathan felt his memory only worsened after that and, convinced his brain was deteriorating, he began making plans to take a leave from work.
His only vision of Alzheimer’s disease had been an agitated grandmother, and he fretted about who would care for his family if he was truly descending into a similar state of “madness.”
We ran the appropriate battery of medical tests. As is the case for many middle-age and older individuals, the tests often won’t point to a specific dementia diagnosis but will rule in or out transient but important causes. In Jonathan’s case, a combination of factors were at work.
Jonathan’s sleep was poor and he snored excessively. A previous sleep study had confirmed severe obstructive sleep apnea, which meant his brain was spending much of the night deprived of adequate oxygen. This caused frequent exhaustion and poor concentration during the day.
He refused, however, to wear the continuous positive airway pressure, or CPAP, device as a remedy. He thought a routine evening cocktail would help him sleep, and when it didn’t he added a second and sometimes a third. Jonathan was also apt to add a few hits from a joint before bed, thinking this would help him relax and sleep better.
Put together, the sleep apnea, alcohol and cannabis were dragging down his cognition. The sleeping pill tipped the balance even further. What’s more, Jonathan had moderate depression and anxiety, which long predated any memory changes and was driving his insomnia.
The first step for Jonathan was to commit to using the CPAP machine for his sleep apnea. He also eliminated the bedtime use of alcohol, cannabis, the sleeping pill and an occasional over-the-counter antihistamine. These changes helped considerably to improve his concentration, energy and overall memory, but it was the later addition of an antidepressant that really turned the tide. Jonathan jumped back into work with renewed vigor and confidence.
If you find yourself worried about your memory or other cognitive skills, seek out an expert such as a geriatric psychiatrist or a neurologist who can review your symptoms and history and run some tests. These should include a neurologic and psychiatric exam, basic labs, a brain scan and some form of neuropsychological testing.
I urge a calm and cautious investigation of any problems, since seldom will the outcome turn out to be the worst-case scenario.