forgetfulness - Lynette M. Burrows

Think You Know What Dementia Is?

Dementia. Alzheimers. Those are two scary words. Many people think they know what dementia is. What Alzheimers is. They use the terms synonymously. Alzheimers is the most common one, but it is not the only dementia.

image of a man where the top of his head is puzzle piece that are floating away

Over the last month we’ve been talking about memory. In my post “What Do You Remember and How” you learned about the study of memory, the stages of memory, and the types of memory. “Do You Have a Terrible Memory?” discussed why you forget, the types of forgetting, and what normal forgetting is. You also learned that there were two umbrella terms that describe abnormal types of forgetting: Amnesia and Dementia. My post, Amnesia: Beyond the Tropes described what the scientific or medical reality of the forgetting called amnesia.

What Dementia Is

Many people think it is only about forgetting past events and people. It is more than that. Some believe that changes to memory, thinking skills, behavior, movement, and emotions are signs of senility or senile dementia. That represents a misbelief that serious mental decline is part of aging.

Dementia is a term for a variety of symptoms caused by damage to brain cells. This damage is not normal aging. Usually, it occurs after age 60. But in rare cases it may develop at earlier ages.

It can affect memory, thinking skills, behavior, movement, and emotions.

There is no cure for dementia. It is permanent and progressive.

While brain damage is permanent, there are conditions that cause the same symptoms but are treatable problems. Things like depression, medication side effects, excess use of alcohol, thyroid problems, vitamin deficiencies can cause thinking and memory problems. They can treat these conditions. If you or a loved one have any of these symptoms, don’t guess or assume. See a medical professional. Get a diagnosis and appropriate treatment.

What Causes Dementia?

We don’t understand what causes these diseases well enough. More research is needed. Better devices to study the brain are needed. In many cases today, only an autopsy can definitively diagnose the specific disease.

There are conditions scientists have identified as causing dementia.

A genetic mutation passed down from one generation to the next.
Alzheimer’s disease patients have plaques and nerve tangles in their brains.
Damage to the vessels that supply blood to your brain result in damaged brain cells in Vascular Dementia.
Other diseases are due damage from other kinds of proteins or damage from degeneration (breakdown) of nerve cells.

The Diseases of Dementia

Alzheimer’s Disease is the most common cause one. Ronald Reagan and Glen Campbell had Alzheimer’s.

Vascular Dementia is the second most common cause of dementia. Actor Andrew Sachs had this disease.

Atypical Parkinsonian Dementias are dementias with Parkinsonian movement disorders. This group of dementias include: Progressive Supranuclear Palsy (PSP), Multiple system atrophy (MSA), and Corticobasal Syndrome.

Lewy Body Dementia is a dementia caused by a protein in the brain. Robin Williams had LBD (discovered on autopsy).

Frontotemporal Dementia (a group of diseases) where nerve cells in the frontal lobe (behind the forehead) are damaged.

Mixed Dementia is when multiple diseases of dementia are present. People with dementia who are over 80 often have more than one.

Huntington’s Disease, Traumatic Brain Injuries, Creutzfeldt-Jakob Disease, Parkinson’s Disease, and other conditions and diseases may also cause dementia. Huntington’s disease causes certain nerve cells in the brain and spinal cord to whither away. Traumatic Brain Injury (TBJ) refers to injuries of the brain such as concussions and severe injuries to the head and brain. Creutzfeldt-Jakob Disease is a rare, fatal brain disorder. And Parkinson’s Disease is a movement disorder.

Symptoms

There are many distinct areas in the brain. Each area controls certain functions. The area and extent of damage causes compromise or loss of those functions. For example, damage to the hippocampus affects long-term memory and emotional responses.

Each disease has specific symptoms. And each type’s symptoms can overlap other diseases of dementia. For symptoms specific to each disease, see the links above.

According to Mayo Clinic, symptoms can include:

Cognitive changes

Memory loss, which is usually noticed by a spouse or someone else
Difficulty communicating or finding words
Difficulty with visual and spatial abilities, such as getting lost while driving
Difficulty reasoning or problem-solving
Difficulty handling complex tasks
Difficulty with planning and organizing
Difficulty with coordination and motor functions
Confusion and disorientation

Psychological changes

Personality changes
Depression
Anxiety
Inappropriate behavior
Paranoia
Agitation
Hallucinations

Dementia can cause loss of short-term memory, long-term memory, and/or the inability to encode memories. But remember, memory loss isn’t the only symptom.

Usually symptoms develop gradually. Sometimes, especially early in the disease’s course, symptoms can be mild or seem to appear and disappear. Family members who live outside of the home or friends may notice the symptoms first.

Diagnosis

Diagnosis of dementia, particularly the specific disease, is challenging. There is no one test that will clearly diagnose these diseases.

The doctor must review the patient’s medical history and symptoms and do a physical examination. He may order several tests to rule out other medical conditions. He may also refer the patient to a neuropsychologist for cognitive testing. A neurologist’s exam assesses movement, senses, balance, reflexes, etc.

A recent discovery led to biomarkers that makes a more accurate Alzheimer’s Disease diagnosis.

Some of these diseases can only be discovered or confirmed by autopsy.

Treatment

There are a few medications that may temporarily improve the symptoms. Medications may manage symptoms such as sleep disturbances, agitation, hallucinations, Parkinson’s, or depression.

There are non-drug treatments, too. Occupational therapy, changing the patient’s environment, simplifying tasks, and simple directions are helpful.

You may read about dietary or herbal treatments. Mayo Clinic reports there is no scientific evidence that these treatments are beneficial.

Coping with Dementia

image looking at the back of a woman in a wheelchair facing some buildings that are not sharp in appearance but fuzzy

A diagnosis of dementia is devastating. Many things will and must change. Decisions, dealing with day-to-day care and concerns can be overwhelming.

Use trusted websites such as the Alzheimer’s Association or Mayo Clinic or the National Institute on Aging. Learn as much as you can about the disease.

Do advanced planning as soon as you can. Consult an elder care attorney. Establish a trust. Get a medical power of attorney and a financial power of attorney.

Learn about options for in home care and for long-term care in a facility.

If you are the caregiver, take care of you. Get counseling. Join a support group. Get help. Stay connected to your friends and family.

Caregivers frequently feel caught between guilt and anger and frustration. The dementia patient will act normal then, out of the blue, do or say something that triggers an emotional outburst. Forgive yourself. Be patient and kind with the dementia patient—and yourself.

Did You Learn What Dementia is?

You learned what dementia isn’t. It isn’t normal aging. Forgetting isn’t the only symptom.

It is a broad term for a multifaceted group of symptoms. This post only brushes across the surface of information about dementias. And the condition affects more than the sufferer. Forgetting isn’t the only symptom, but it is often the most painful one to caregiver(s) and family.

Now you know what dementia is. Did you learn anything new? Next week we’ll talk about a phenomena called Recovered Memories.

Amnesia: Beyond the Tropes

You’ve read it a million times. The heroine (or hero) has no memory of who she is. No name. No remembered family. No past. Amnesia, says the doctor. And the story takes off. She (or he) attempts to recover her name. Her family. Her past. A little frightened and a lot intrigued, you are hooked.

image of colorful but empty frames, like memory loss or amnesia

You’ve read it so many times, it’s entertaining but not surprising. However, reality might surprise you.

You may be like me. You’ve read so many stories and seen so many movies or television shows whose characters suffered amnesia that you think you understand what it is. You could be wrong.

Do You Know What It Is?

Amnesia is total or partial loss of the ability to recall experiences or events that happened in the preceding few seconds, in the preceding few days, or further back in time.
MerckManuals.com

You knew that, right? After all, that’s what the big and little screen and novels say. But did you know that people with amnesia rarely forget their name and their motor skills? Remember, I said memory is complex? So is forgetting.

What Causes Amnesia?

That’s a huge subject. Because we store our memories in bits and pieces throughout our brains, damage to any part of the brain can cause one or another form of amnesia. The list of things that can damage your brain is a little frightening.

A nutritional disorder, particularly thiamin deficiency
A severe head injury that affects the brain, a concussion or severe trauma (mild head injuries rarely cause permanent amnesia)
Disorders that reduce the supply of blood or nutrients to the brain (including strokes and cardiac arrest)
Seizures
A brain infection (encephalitis)
Disorders that reduce the supply of blood, oxygen, or nutrients to the brain)
Alcohol abuse (both short term and chronic forms of alcohol abuse can cause amnesia)
A brain tumor
Severe mental stress, such as an emotional shock or trauma from physical or sexual abuse, or being the victim or witness of a violent crime
Use of certain drugs, such as some antidepressants, muscle relaxants, or opioids, and amphotericin B or lithium
Degenerative brain diseases, such as Alzheimer’s disease and other forms of dementia
Electroconvulsive therapy
Damage to the thalamus or hippocampus (parts of the brain and limbic system responsible for memory)

The Five Types of Amnesia

Retrograde Amnesia—In this type of forgetting, you lose existing memories. Typically, it affects your most recent memories first.

Anterograde Amnesia—with this kind of memory loss you cannot form new memories such as during an alcoholic or drug-induced blackout.

Transient Global Amnesia (TGA)—is an abrupt onset of anterograde amnesia that lasts from one to eight hours and affects people ages 40 to 80 years of age (average age is 61). Read more about TGA here.

Infantile Amnesia—the most common type of amnesia is the loss of memory of early childhood. Most people cannot remember the first three to five years of life.

Dissociative Amnesia—in this rare form of forgetting, the information lost would normally be part of conscious awareness and you might call it autobiographic memory. Read more here

How is Amnesia Diagnosed?

A key labeled memories, if you have amnesia it would be nice to find a key to your memories

When someone arrives in the emergency room with a sudden memory loss, the doctor often orders an MRI or CAT scan to check for brain damage from a stroke or tumor. The doctors will also check blood work and take a detailed history.

Often a neurologist or neuropsychologist will perform a cognitive behavior test. This usually is a series of questions, some with multiple-step instructions or a list of three or more items which you’re asked to repeat back at various times during the test.

Do people with Amnesia Forget Everything?

image of a blank pice of canvas pinned to the wall

When people suffer from sudden memory loss, the memories that they lose are generally what are known as episodic or explicit –they forget events and facts. They do not lose their implicit or procedural memory, which is what allows us to perform functions such as operating a cell phone or riding a bike.
Improve Memory

Most often people suffering from sudden memory loss remember their name, their spouse, their dog. But they have difficulty with everyday activities because they can’t remember where they are going or what they’ve already done or said. They get frightened and frustrated and confused.

How Long Does Amnesia Last?

Recovery depends upon the severity of the disease or trauma that caused the amnesia. Most people recover their memories in time. In amnesia caused by some medications, recovery can be within minutes. Other cases may require days, months, or even years to recover. Sometimes the person never recovers their memories.

How Do You Treat Amnesia

If there’s a specific and known cause of amnesia, the cause will be treated. There’s no medication specific to amnesia. As I said above, often no treatment is necessary. Occupational therapy teaches skills and methods for dealing with memory loss. Sometimes, psychotherapy helps people adjust to memory loss and move forward.

But What About Dementia?

Dementia is more than forgetting. With dementia the memory loss is progressive and accompanied by cognitive problems that lead to a decreased ability to perform activities of daily living. Remember dementia is another umbrella term. We’ll discuss that and specific diseases soon.

Want to Know More?

My sources for this post include the MayoClinic.org, the Merck Manual, healthline.com, and the NIH. If you choose other sources, verify that the information is based on medical science. You may also wish to ask your doctor for more information.

Remembering and Forgetting

Remembering and forgetting are complex issues. And story books and movies aside, amnesia is frightening to everyone involved. This post skims over this information in an effort to answer questions and point you to more answers. If you have concerns about yourself, a friend, or family member, please consult your physician. Otherwise, I’m happy to answer your questions and would love to know if you knew about amnesia.

Do You Have a Terrible Memory?

Forgetfulness gets a bad rap. There are jokes about forgetfulness. You curse yourselves when you forget things. When you forget an appointment, you explain that you have a terrible memory. But do you really? Is forgetfulness always a problem?

This is part two of my exploration of memory and memory loss. If you missed the first post, read, What Do You Remember and How. Today’s post is about forgetting or forgetfulness. It’s something we all do. It’s something many of us fear. But forgetting is to memory what yin is to yang.

Why You Forget

According to Psychology Today https://www.psychologytoday.com, we focus on understanding the world, not remembering it. In real life, there are relatively few situations where we focus on remembering—in school, preparing for a speech, and when meeting new people.

You don’t have a terrible memory. “Memory is designed to be selective.” It’s probably better that we don’t remember every—parking spot we’ve used, password and pin code we’ve ever had, every meal we’ve ever eaten. “People who are better able to prune away irrelevant events are also better able to remember pertinent events, a phenomenon known as adaptive forgetting.”

We do not remember days; we remember moments.
Cesare Pavese

Types of Forgetting

Storage Failure happens when you cannot anchor the memory properly (perhaps because of a lack of focus) or the storage system (your brain) is damaged.

Interference happens when a bit of new information overwrites older information. The article in Psychology today uses the analogy of writing something in sand, then writing something else over the top of that.

Retrieval Failure happens when you can’t access a certain piece of information even though we know it’s there. Most of you have had the experience of attempting to tell someone a name (of a person, place, book, movie, etc.) but couldn’t think of it. Then hours later, the name pops into your head.

Protective forgetting is a psychologically motivated type of forgetting. It shields you from discomfort. If you remember how your friend hurt you, forgiveness and moving on may be impossible.

Finally, Decay may play a part in forgetting. This theory suggests that our memories fade with time.

Normal Forgetfulness

You have heard of dementia and Alzheimer’s disease. Likely you associate both with forgetfulness or memory problems.

You might worry that forgetting an appointment might be a sign of memory loss. But we all occasionally forget a name, the right word, or an appointment, then remember them later. We all forget how to get to an address we don’t visit often. And we all get confused about the day of the week or the date, but figure it out later.

Normal forgetfulness and normal age-related memory loss are , according to Mayo Clinic, generally manageable and don’t disrupt your ability to work, live independently or maintain a social life.”

A question mark next to a silhouette of a head with gears inside--do you have a terrible memory?

Memory Problems

There are two general terms that describe memory problems: Amnesia and Dementia. Both are “umbrella” terms (terms that cover several conditions).

“Amnesia refers to the loss of memories, such as facts, information and experiences. Though forgetting your identity is a common plot device in movies and television, that’s not generally the case in real-life amnesia.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600033/

Merriam-Webster Dictionary defines dementia as “a usually progressive condition (such as Alzheimer’s disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior) … dementia is diagnosed only when both memory and another cognitive function are each affected severely enough to interfere with a person’s ability to carry out routine daily activities. — The Journal of the American Medical Association”

Between 60% to 80% of people with dementia have Alzheimer’s according to WebMD. But there are as many as 50 other causes of dementia.

If you are concerned about memory problems in yourself or a loved one, online quizzes and information are not enough. Please consult your physician. Or consult a neuropsychologist for cognitive-behavioral testing and evaluation.

In Conclusion

Forgetting things gets a bad rap. I know I have a terrible memory. And I’m certain I frequently use all five types of forgetting. But there’s a difference between normal forgetfulness and memory problems such as amnesia and dementia. Memory and memory loss are huge, complex subjects. My posts are a simple introduction to the concepts and diseases that affect our memory. Did you learn something? If you have concerns about yourself or a loved one, please contact your health care provider. Stay tuned. We’ll discuss amnesia and dementia in more detail soon.