By: Marc Agronin, MD Geriatric Psychiatrist and Sr. Vice President of Behavioral Health at Miami Jewish Health
Everyone worries about memory changes as they age, but how can we know what’s normal and what’s not? In my practice running the Memory and Research Center at Miami Jewish Health, I see people every day with these concerns. It’s common, and expected, to notice some slowing of memory function as we age into our 60s and beyond. Typically, people feel that it takes a little longer to remember names or process mental calculations. Tip-of-the-tongue experiences — when you feel a memory hovering just under the surface but can’t recall it — are more frequent. These changes can worsen temporarily due to lack of sleep, stress, depression, anxiety, physical illness, excessive alcohol use, and overuse of certain medications, such as narcotics or sleeping pills. When memory lapses happen on a regular basis and begin to interfere with daily life, it’s time to get an evaluation.
A memory or cognitive evaluation is just as important as having your blood pressure or blood sugar checked. It allows the doctor to look for reversible causes before they do too much damage, and to prescribe a brain healthy lifestyle. Your primary care doctor can review your medications and rule out any obvious causes of memory change, but you need to see a specialist such as a geriatric psychiatrist or a neurologist for a more comprehensive evaluation, especially at a designated memory center. A typical evaluation involves getting a description of the memory changes from you and someone who knows you well, reviewing your medical and psychiatric history, and conducting a neurological and a mental status exam. The mental status exam involves asking about and observing your mood, thinking and behaviors, and then giving you a brief cognitive test. The memory specialist will also consider ordering a brain scan (usually an MRI since it provides a more detailed view of your brain than a CT scan), blood work, and more detailed memory testing called neuropsychological testing. The doctor can then look at all of the test results and try to see if there is evidence for some form of brain impairment that we call dementia or a major neurocognitive disorder. Alzheimer’s disease is the most common type of dementia, but there are many others, such as vascular dementia due to strokes, or Lewy body disease due to a specific toxic protein.
Many people turn out to have only mild memory changes that warrant close monitoring and the adoption of a brain healthy lifestyle consisting of: regular physical exercise; enjoyable mentally and socially stimulating activities; and a Mediterranean diet that prioritizes vegetables, fruits, healthy oils such as olive oil, lean meats, whole grains, and even a glass of wine over excessively processed or high-fat foods. Individuals who appear to have early stage Alzheimer’s disease or another form of dementia may be started on one of several FDA-approved medications to help improve symptoms. There is currently no cure for Alzheimer’s, but there are many promising research studies. Good care that helps both the person with dementia as well as their caregivers can make all the difference, even as we work towards finding a cure for dementia.
Ultimately, it is important to have a good connection with your memory specialist and team at a memory center. If you are interested in a memory screening, evaluation or research study, please contact Dr. Marc Agronin at (305) 514-8710.
