WHY IT IS NOT ALZHEIMER’S
It sounds paradoxical but if you have spent the past few years worrying about your memory, the mere fact that you arc worried could be an excellent sign.
Your worries mean there is a good chance you don’t have Alzheimer’s. If you were on the slippery slope of Alzheimer’s you would be less likely to remember that you failed to remember.
In contrast, people with normal age-associated memory changes are often highly aware of their memory lapses and often worry about them. The difference between normal ageing and dementia can be illustrated with the writing of a cheque.
A person with Alzheimer’s may forget how to write a cheque while a person with an ageing memory might forget whether they wrote a cheque. The difference is crucial.
The person with Alzheimer’s has such significant brain changes that they can’t draw on their knowledge of writing out a cheque. The ageing person knows very well how to write out a cheque but may have been distracted at the time and didn’t pay proper attention.
Increasing numbers of younger men are now attending memory clinics, anxious about short-term memory loss. Although they are experiencing normal changes, they are worried, pessimistic and at risk of getting caught in a memory-anxiety spiral.
Each time they forget something it supports their theory that their memory is degrading. This anxiety interferes with concentration and affects their ability to pay proper attention. As a result, they become more forgetful. Eventually they work themselves into a position of negative expectation that undermines their ability to remember.
Self-diagnosis of memory impairment can be destructive. Those who are concerned should take a memory test. ‘These tests can also be used as a reference point for their memory in later years.
The possibility of developing dementia is one of the greatest fears people have about growing old. About 70 per cent of all dementia is related to Alzheimer’s, and the most common sign is progressive memory loss.
Fortunately, dementia is not part of normal ageing: only four in every 10 000 people under the age of 65 have Alzheimer’s. However, the incidence rises with age, and by the age of 84, about 16 per cent of people will have the condition.
Some years ago, U.S., a retired academic, noticed changes in her memory. Anxious about Alzheimer’s, she was referred for a memory assessement. The diagnosis of Alzheimer’s is a ‘diagnosis of exclusion’. This means that all other conditions that could be causing the memory loss have been ruled out. If no other reason for the memory problem can be found, then it is diagnosed as Alzheimer’s.
There were four good reasons why D.S. wasn’t diagnosed as having the condition. First, she was highly aware of changes in her memory and could relate in great detail all the things she had recently forgotten. Second, her memory abilities fluctuated: with Alzheimer’s the problem is usually there all the time. Third, she had no problems with other areas of intellect or language abilities: these abilities are generally impaired early in Alzheimer’s. Fourth, there were other factors in her life that could explain the changes in her memory: a dramatic alteration in her routine and a heavy workload.
People frequently complain that once they retire, their memories let them down. While employed, they never realised just how much the structure of the work environment supported their memory. Even without a secretary to keep the diary and organise the day, regular timetables, routines and predictable events of the work place prop up memory.
Noticeboards, emails, coffee-break chats, newsletters add extra support. Even the smells, sounds and lighting of the workplace are memory cues. D.S. says when she used to walk up the steps and through the front door of her building at university her mind would slot into the context. The physical setting, the hierarchical relationships and the daily running of the centre were so familiar she didn’t have to worry about remembering them. But when she retired and all that structure disappeared from her life, there was a risk that years of memory cues would go with it.
When people change the context in which they live or work, they must understand that there will be a change in the cues and habits that assist them in remembering well. Rather than becoming bewildered, they need to make an effort to translate these into the new environment.
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