How to tell the difference between normal brain aging and dementia

You forget where you left your car keys. You walk into a room and then don’t remember why you went into the room to begin with. You see a familiar actor on TV and can’t recall their name.  

When people experience these types of episodes of forgetfulness, they often worry they may be signs of dementia or Alzheimer’s disease. But neurologist Sean Horrigan, DO, at Neurologists of Cape Cod assures us we should not worry about common memory issues. 

"These examples illustrate what we consider largely normal memory lapses,” he explained. “It's often more about our attention span than forgetfulness itself." 

As individuals age, their ability to multitask and quickly recall information may decline, which is a natural part of aging. Dr. Horrigan emphasized that significant concern arises when memory issues begin to impact daily living. 

"I focus on activities that people have managed well for years but now struggle with," he noted. "Three concrete examples that many can relate to are managing finances, taking medications and driving a car." 

If someone who has always paid the family finances starts forgetting to pay the electric bill or struggles to use online banking, that is a more worrisome symptom. Likewise, if someone has taken the same five medications for several years and starts forgetting to take them or double dosing, that is another troubling sign, he said. When it comes to driving, forgetting how to get home from the grocery store, the transfer station or some other familiar place is also a red flag. 

"When someone struggles to think, focus or concentrate, and it negatively affects their daily life, that’s what I find more alarming," Dr. Horrigan added. 

That can include changes in behavior that may occur slowly over time, he said. Alzheimer’s and other forms of dementia are neurological conditions that slowly get worse over time until all of a sudden it becomes apparent something is wrong. Oftentimes, partners compensate without even noticing they are picking up the extra slack until one day they realize that they are doing much more of the household chores than they used to. 

Who Will Notice? 

A partner or child is usually the first to notice when symptoms become worrisome, but doctors are also paying attention for possible memory issues. 

"On the Cape, we maintain a robust communication plan among primary care doctors, emergency departments and urgent care centers," Dr. Horrigan explained. "This is where medicine meets the front line, so I often receive referrals. Many doctors initiate tests like blood work, MRIs and formal memory assessments to understand what might be going on.” 

At Dr. Horrigan’s office, they do a very focused five-minute memory screen and cognitive assessment. Assessments like this can also be done at many local Councils on Aging. He also recommends a formalized neuropsychological evaluation, especially if the person who is experiencing memory difficulties is under the age of 65.  

"These assessments can help determine if cognitive difficulties align with Alzheimer’s or indicate an undiagnosed learning disability or underlying mental health issues such as depression, PTSD or anxiety," he explained. 

Dr. Horrigan advises all of his patients—regardless of their current memory capabilities—to maintain a healthy concern about the risk of developing dementia, as this risk increases with age. Approximately 40% of people who reach age 85 will develop Alzheimer’s or another form of dementia. 

Preventing Cognitive Decline 

Even if you have a perfectly working brain, there are things you can do to prevent cognitive decline. Dr. Horrigan recommends the following lifestyle habits that help slow the progression: 

• Exercise regularly. Dr. Horrigan encourages his patients to exercise for 30 minutes a day for at least three days a week, and preferably five to seven days a week. 
• Eat a plant-based whole-food diet or at least stick to the Mediterranean diet. 
• Do not smoke tobacco or drink alcohol. 
• Do mind teasers, crossword puzzles and play games to keep your brain stimulated. 
• Stay social and engage with family, friends and your wider community. 

The benefits of staying social came into sharp focus during the COVID-19 epidemic because so many people stayed home and didn’t socialize. Dr. Horrigan was struck by how many people declined more quickly than he expected. 

“We witnessed countless examples of individuals with mild cognitive challenges that progressed to serious dementia due to prolonged isolation during the first year of COVID-19. It was devastating,” he reflected.