This document discusses normal age-related memory changes versus signs of conditions like Alzheimer's disease. It notes that brain changes vary individually based on personality, ability to compensate, and brain strengths/weaknesses. Normal aging can cause slower processing speed, divided attention difficulties, and weaker working memory, but language, knowledge, and skills are often preserved. Mild cognitive impairment involves cognitive decline without impairment in daily life, with a risk of developing dementia. The document outlines evaluating and treating different types of dementia.

1. Memory Changes:
It’s Not Always Alzheimer’s
Beth Spencer, MA, LMSW
Hartford Center of Excellence in Geriatric Social
Work, University of Michigan

2.  Brains are very individual
 Brain changes are very individual
 What we see depends on:
 Past personality
 Ability to compensate
 What parts of the brain are strong/weak
 Examples: spatial problems, attention/absent-
mindedness, difficulty with decision-making
Individuality of brain change

3.  Language abilities, except for word retrieval
 Problem-solving abilities except where require
sophisticated working memory abilities
 Simple attention /focus
 “Crystallized intelligence” – factual information,
knowledge of the world
Less affected by age

4.  Speed of processing slows down
 Attention – multi-tasking/divided attention more
difficult (shows up in driving)
 Training helps
 Aerobic exercise helps
Normal Changes with Age

5.  Working Memory – manipulating & reorganizing
information (ability to hold information in focus and change it
around)
 Decision-making, problem-solving, planning all involve this
ability
 Several theories being investigated about the cause of decline
in working memory with age
 Practice may help strengthen this area
Normal Changes with Age

6. Other forms of memory:
 Episodic – specific events from past
 Not always coded or retrieved efficiently
 Lose detail & specificity with age
 Source knowledge is more difficult (retrieval)
 Semantic – general knowledge
 Preserved or improved with age; often better than
young
 Procedural – skills & procedures, e.g., tying shoes,
riding a bike
 Tends to be preserved with age
Normal Changes with Age

7. Everyone has some cognitive losses
 Every brain is different
 Many different brain changes on this continuum
 What does “normal aging” mean if half the people
over age 85 show some clear cognitive losses?
Cognitive change as part of the
continuum of aging

8.  Self reports of memory problems
 Mixed research on how well self-reports correlate
with actual memory decline
 Subjective memory complaints are often indicative of
depression
 Often does not show up on cognitive testing
Subjective Memory Complaints

9.  Evidence of cognitive decline on
tasks &/or cognitive tests
 Intact ADLs; impairment or difficulty with IADLs or
more complex tasks
 Limbo between “normal” & dementia
 Very heterogeneous group
 About 50% will convert to dementia within 5 years
Mild Cognitive Impairment (MCI)

10. Dementia: An umbrella term
for a group of symptoms
 Change in thinking abilities.
 Many different causes.
 Person alert and awake.

11.  Memory loss
 Disorientation to time or place
 Ability to do calculations
 Difficulty performing familiar tasks
 Problems with language
 Poor or decreased judgment
 Changes in personality or behavior
 Different diseases have different symptoms.
Symptoms of Dementia may include

12.  Medical and family history
 Physical & neurological exams
 Laboratory tests
 Cognitive screening – MMSE / Clock
 Brain imaging – CT, PET, MRI
 Depression evaluation
 Neuropsychological testing
Key Components of a
Dementia Evaluation

13. “Pseudo &/or Treatable Dementia”
 Medications
 Infections
 Anemia
 Vitamin B12 deficiency
 Malnutrition
 Kidney failure
 Electrolyte imbalance
 Hypoxia (lack of O2)
 Hypothyroidism
 Vascular disorders
 Depression
 Delirium

14.  Getting lost in familiar places
 Repetitive questioning
 Forgetfulness of recent events
 Personality changes
 Odd or out-of-character behaviors
 Decline in planning and organization abilities
 Increased apathy/less motivation
 Changes in language abilities, including
comprehension
What to watch for

15.  Repeated falls or loss of balance
 Changes in diet/eating habits
 Changes in hygiene
 Difficulty with reasoning &/or abstract thinking
 Disorientation &/or decreased spatial awareness
 Judgment lapses
 Mood changes (depression, anxiety)
What to watch for

16.  Mayo Clinic definition: Delirium is a serious disturbance in a
person's mental abilities that results in a decreased
awareness of one's environment and confused thinking.
The onset of delirium is usually sudden, often within hours
or a few days.
 Sudden onset
 Confusion, disorientation, memory loss
 Usually caused by medical condition &/or environment
 Extremely common in hospitalized older adults
What to know about delirium

17.  Often looks different in older adults than younger
 May be more somatic (physical) complaints
 May show up as anger, negative thinking, glass half
empty
 Can greatly affect memory and attention
 Can co-exist with MCI or dementia
What to know about depression

18. Concept of “Excess Disability”
 The idea that there are things other than the memory
loss or disease that can decrease functioning, such as
 Depression
 Becoming overly dependent
 Untreated illness
 Social isolation
 An unsupportive environment

19. Research on Quality of Life in People
with Alzheimer’s Disease
 High QOL associated with focus on abilities and
continuing interests.
 Low QOL associated with focus on losses and giving
up interests.
 Relationship to environment, “excess disability.”
-RG Logsdon, in The Person with Alzheimer’s Disease

20.  Alzheimer’s disease (AD)
 Dementia with Lewy Bodies (DLB)
 Vascular dementia
 Mixed dementias
 Frontotemporal dementias (FTD)
 Behavioral FTD
 Primary progressive aphasia (PPA)
 Motor diseases
Progressive Diseases

21. Most common cause of dementia – up to 50% of
dementias are AD.
Individual differences from person to person.
Early symptoms: Short term memory loss, increased
difficulty with thinking & orientation.
Plaques & tangles in the brain.
Alzheimer’s Disease

22.  Quality of life activities
 Aggressive treatment of medical conditions
 Medications
 Aricept, Exelon, Razadyne
 Namenda
Treatment of AD

23.  Related to Parkinson’s dementia
 Up to 20% of cases of dementia
 Characterized by visual hallucinations,
Parkinsonism, visual spatial difficulties, sleep
disturbance, executive problems, day to day
fluctuations. Memory loss variable.
 Treatment: Alzheimer’s medications. Sometimes
use Parkinson’s medications.
Dementia with Lewy Bodies

24.  Associated with vascular disease / strokes
 5-10% pure; 10-15% mixed dementia
 Usually impairment in multiple domains: attention,
executive functioning. Memory loss secondary
 Stepwise course
 Frequently can see vascular changes on CT or MRI
scan
 Treatment: Alzheimer’s medications; treat underlying
vascular issues – hypertension, high cholesterol,
diabetes
Vascular Dementia

25.  5-10% of those with dementia
 Tends to affect younger people (75% between 45-65)
 Treatment: No approved treatments; usually meds to treat
behaviors
 Different forms of FTD:
 Behavioral FTD – changes in personality, social behavior,
loss of insight, apathy
 Primary progressive aphasia (PPA) – language
impairment initially; eventually other cognitive domains
affected
 Motor neuron diseases with FTD component (e.g., ALS)
Frontotemporal Dementias

26. Problems with Attention
 Get distracted easily
 Hard to stay focused

27. Attention Strategies
 Keep information in small pieces
 Repeat instructions to yourself (or have someone else
do it) as task is being done
 Have written instructions

28. Learning & Memory Problems
 Trouble retaining new information
 Facts don’t “stick”

29. Learning & Memory Problems Strategies
 Repeat information immediately
 Train family/friends to ask for immediate repeat
 Use written cues – calendars, etc.
 Set up an orientation spot as needed

30. Language Difficulties
 Hard to think of the words you want
 Don’t comprehend as well as used to

31. Language Difficulties Strategies
 Check hearing & wear hearing aids if needed
 Allow people to help fill in the blank
 Acknowledge difficulty
 Ask people to speak more slowly
 Ask people not to say as much all at once

32. Problems with Visual Accuracy
 Not recognizing people / things as well
 Finding what you are looking for
 Judging distance accurately
 Ability to find way around

33. Strategies for Visual Accuracy
 Make sure glasses are correct
 Admit that you don’t recognize person
 Keep things in same place
 Simplify your environment

34. Problems with “Executive Function”
 Ability to make good decisions about safety, finances,
living situation
 Ability to initiate activities

35. Strategies for “Executive Function”
 Be aware that this part of your brain may not work as
well as in the past
 Have someone whom you trust who can help you
with this

36.  Aging with grace
 Acceptance
 Participate in research
Strategies

37.  Exercise
 Nutrition
 Creative/productive endeavors
 Create social outlets – don’t become isolated!
 Treat medical conditions
 Take medications carefully & accurately
Self Care

38.  Find trusted friend/ buddy/ family member to assist
with decision-making.
 Make important decisions early with help from
person above.
 Live in the moment & figure out how to enjoy life
now!!
Other important things to do

39.  Riddle, D. R. (Ed.). (2007). Brain aging: models,
methods, and mechanisms. CRC Press.
 http://alzheimers.emory.edu/healthy_aging/cognitive-
skills-normal-aging.html
 http://memory.ucsf.edu/brain/aging/dementia
 RG Logsdon, SM McCurry, L Teri Evidence-Based
Interventions to Improve Quality of Life for Individuals
with Dementia. Alzheimer’s Care Today, Oct 2007, v.
8:4.
 AE Budson & PR Solomon, Memory Loss: A Practical
Guide for Clinicians, Elsevier Saunders, 2011.
References

40.  ND Anderson, KJ Murphy, AK Troyer, Living with Mild
Cognitive Impairment, Oxford University Press, 2012.
 L Snyder, Living Your Best with Early-Stage Alzheimer’s,
Sunrise River Press, 2010.
 V Bell & D Troxel, The Best Friends Approach to
Alzheimer’s Care, Health Professions Press, 1997.
Recommended Reading