Joking about loss of memory masks fears

By Rita Baum

The silver-haired guests on the cruise ship sit contentedly in the nightclub as The Princess makes its trans-Atlantic voyage under a starry sky. In their black ties and glittering gowns, the guests appear to have the world by the tail, laughing with glee as the nightclub comedian tells jokes about memory loss.

"Honey, will you get me some ice cream? Vanilla, please, and add some syrup--chocolate, and chopped nuts. Oh, you'll forget all that, won't you? I better write it down."

"Heck no, I won't forget!" replies the husband. He returns a while later with a plate of ham and eggs. "Now what?" he replies to her look of disbelief.

"You forgot the toast!" she groans.

Although the vacationers laugh merrily at the joke, the threat of memory loss and the dreaded affliction of dementia, especially Alzheimer's disease, lurks behind their chuckles. Underlying their mirth is the unspoken fear: Will this awful disease invade their own golden years?

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Alzheimer's Resources: Contact information for Alzheimer's support services.

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What are the chances of developing this disease that strikes indiscriminately and brings death to the brain's nerve cells? Most of us know the symptoms all too well: The disease progressively robs a person of the abilities acquired so readily as a toddler, including the ability to perform basic personal needs and to recognize loved ones.

In fact, age-related decline is less dramatic than many people think. The vast majority of people over 65 do not experience any significant problems in their daily lives because of cognitive decline. According to experts at the Alzheimer's Disease Education and Referral Center, only about 3 percent of men and women ages 65 to 74 have AD, although the incidence of the disease increases dramatically after age 85.

If the mind grows cloudy with age, there may be some treatable cause. The culprit could be a nutritional deficiency--vitamin B-12 or folic acid--or a health problem, such as hypothyroidism, depression, stress, dehydration or alcoholism. What appears to be mental fogginess may also reflect undiagnosed hearing or vision loss, repeated ministrokes, infection, or depression, or one of the commonly used medicines that can cause confusion.

Although dementia is by no means inevitable, we cannot disregard the statistics on Alzheimer's disease (AD), which currently affects 3 to 4 million older adults in the United States. That number will become even larger as the baby boom generation reaches advanced old age.

There is no cause for alarm if you merely forget to return a phone call or to make a stop at the grocery store. Occasional memory lapses are annoying but should not be mistaken for the early signs of serious cognitive impairment. Forgetting the name of a person you just met or where you left the car keys is not the same as forgetting that you own a car.

In the early stages of AD, people have difficulty learning and retaining new information. They forget important information on a regular basis, ask the same questions repeatedly, and are often confused, disoriented, or have difficulty performing familiar tasks.

As with most diseases, early diagnosis is important. An 11-year study at Mayo Clinic shows that certain mild cognitive changes have been identified that appear to mark a transitional stage between minor normal age-related memory loss and AD.

If memory declines are frequent and exaggerated, it is wise to seek a cognitive evaluation, starting with your primary care physician. Dementia specialists have developed assessment techniques that are 90 percent accurate in diagnosing AD. The assessment process usually includes a complete exam, medical history, basic medical tests, cognitive tests, brain scans, diagnosis and family consultation.

The major risk factors for AD are age and family history. Many people who have a parent or grandparent with AD want to know if they are at greater risk of developing the disease than the population at large. This question remains unanswered, although credible genetic tests to predict risk for AD are becoming more promising and may become available in the near future.

Seventy percent of AD patients are cared for at home. The caretaker's job can be exhausting. Caregivers need support and respite from what has been called the "36-hour day." Common AD changes in behavior include agitation, disrupted sleep, delusions, aggression, depression and wandering. Caregivers are advised to reduce household clutter, create a calming environment, encourage a regular schedule, and to use very specific, brief repetitive directions when making requests. Adult daycare centers provide needed respite for the caregiver and appropriate care and management for AD patients.

For families who cannot care for the AD patient at home, special residential-care homes provide the proper environment for and management of AD-afflicted residents. Later stage AD typically requires 24-hour care either at home or in an assisted living facility or nursing home, since affected individuals can no longer bathe, dress or feed themselves.

There is no firm evidence that AD can be prevented by lifestyle measures, yet prevention advice proliferates for seniors. Exercising the mind is important: never stop learning, reading, calculating, planning menus, playing word games, accepting small or large challenges, and developing your own memory tricks and cues. Participate in mind-calming, stress-reducing activities such as yoga, meditation and deep breathing. Physical exercise is also important, to keep oxygen flowing to the brain. Other suggestions include taking vitamin E and B supplements and eating a diet rich in antioxidants (vegetables, grains, and beans).

With so many alarming reports and statistics on AD, are we to believe there is no hope for prevention or cure? Researchers are optimistic. A month rarely goes by now without the discovery of a new gene, protein or chemical process that contributes to the understanding of the disease. More than half of the recent budget of the National Institute on Aging (NIA) is allocated for research on AD.

Two drugs have been approved in the last five years that might slow the progress and the rate of decline of AD. Scientists are testing other new drugs for AD at many large teaching hospitals and universities. The possible benefits of vitamin E and ginkgo biloba are also under investigation.

Early diagnosis techniques have become much more accurate and make it possible to begin interventions earlier, and doctors today are better informed about aging. AD is finally getting the attention if deserves from state policy makers. With the help and encouragement from the Alzheimer's Association, 32 states have guidelines to develop care and treatment options

Perhaps the best news of all is something that many of us know instinctively: The majority of older persons continues to absorb new material and information and adds it to the knowledge, experience and insights gained over a lifetime. The sum and substance of these include life's ups and downs, failures and successes, and the joys and disappointments of a rich and full life. These experiences comprise the essence of that little talked about but much sought-after endowment called wisdom.

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