Memory varies from person to person, but it may also deeply impact the quality of your life. While there are various factors influencing the change and decline in memory, age is among the leading ones. How can we determine whether our loved ones are experiencing common memory lapses, or the potential early signs of a more serious condition?
It is important to note that early signs often go beyond memory loss, manifesting as subtle changes in mood, personality, and decision-making. These issues often manifest subtly, sometimes mistaken as mere absent-mindedness, but they become increasingly evident as a person`s functional independence diminishes.
Neurologists outline the subtle differences between typical age-related forgetfulness and the potential early indicators of cognitive decline, reversible causes of memory loss, diagnosis and management strategies, lifestyle practices for brain health, and more.
Beyond normal forgetfulness: When to be concerned
Normal aging might involve minor lapses, like temporarily forgetting someone`s name or misplacing keys. However, these occasional episodes do not significantly affect daily life, decision-making, or independence. Early cognitive decline, on the other hand, is characterised by more persistent and progressive difficulties.
According to Dr Pradyumna Oak, director, neurology, Nanavati Max Super Speciality Hospital, Mumbai, “Early cognitive decline is characterized by persistent, progressive difficulties. Individuals might repeatedly forget recent conversations, struggle significantly to recall new information, or frequently misplace items. They may also find themselves confused about time and place, have trouble navigating familiar routes or recognizing familiar surroundings, and show noticeable impairments in judgment or problem-solving abilities.”
He further highlights specific instances, “Repeated questions, difficulty remembering details of recent events, or regularly getting lost in familiar places typically suggest something more than just age-related forgetfulness. While minor forgetfulness is normal, persistent issues like repeatedly forgetting familiar recipes, difficulty handling money, or sudden challenges performing daily activities like dressing or grooming are not.”
These symptoms can be particularly concerning in Indian communities. As Oak notes, joint family systems may “sometimes mask early signs due to constant
support from family members.”
Warning signs beyond memory loss
It’s not just about memory. Early cognitive decline often manifests in other subtle, easily overlooked ways. Dr Tushar Raut, consultant, neurology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, emphasises, “Forgetfulness alone isn’t always the first red flag. Early cognitive decline often manifests in more subtle, easily overlooked ways.” He advises watching for:
1. Mood fluctuations: Increased irritability, anxiety, apathy, or sudden withdrawal from social activities may point to underlying changes in brain function.
2. Poor judgment or decision-making: Mismanaging finances, falling for scams, or dressing inappropriately for the weather can all signal a decline in executive function.
3. Personality shifts: A calm person becoming unusually suspicious or a social individual withdrawing could be an early indicator of cognitive impairment.
4. Disorientation or confusion: Getting lost in familiar places or struggling to follow conversations may signal spatial and attention-related decline.
Diagnosis and support
If these signs are present, the next step is a proper medical evaluation. As per Dr Sheetal Goyal, consultant neurologist at Wockhardt Hospitals, Mumbai Central, “This typically includes a memory test, a basic health check-up, and perhaps a scan of the brain. Blood work is also carried out to exclude the possibility of vitamin deficiency or thyroid issues. Early detection actually aids in controlling the condition better.”
For older adults, initial screenings often include cognitive assessments. Oak explains, “The Mini-Mental State Examination (MMSE) is commonly employed, involving a series of short questions to evaluate attention, memory, orientation to time and place, language, and basic problem-solving skills. Similarly, the Clinical Dementia Rating (CDR) scale provides a detailed rating of cognitive and functional performance based on information provided by both the patient and family members.”
Advanced assessments like MRI may also be recommended. Oak notes that studies in older Indian adults have shown, “Reduced hippocampal size can serve as a crucial marker for early detection of Alzheimer`s Disease and mild cognitive impairment, even before severe symptoms emerge.”
Families can play a vital role in preparing for these assessments. Oak advises, “Families should closely observe and document patterns of memory lapses or behavioural changes, and prepare a comprehensive history of the individual’s overall health, current medications, lifestyle habits, education, and family history of dementia.” He also stresses the importance of creating a comfortable, stress-free environment for testing to reduce anxiety and ensure reliable results.
Reversible causes of memory loss
It is important to remember that not all memory problems are due to degenerative diseases. Raut highlights common treatable medical issues that can mimic memory loss:
1. Vitamin B12 deficiency: Often underdiagnosed in vegetarians and older adults, this deficiency can cause memory issues, confusion, and even hallucinations.
2. Thyroid imbalances: Both hypothyroidism and hyperthyroidism can lead to sluggish thinking or forgetfulness.
3. Side effects of medications: Sedatives, certain antihistamines, and some antidepressants can interfere with memory and cognition.
4. Depression: Often mistaken for dementia, especially in older adults, depression can cause “pseudodementia” a condition where attention, memory, and focus deteriorate.
Lifestyle practices for brain health
Lifestyle factors are crucial in reducing the risk of cognitive decline. According to Goyal, “Exercise increases blood flow to the brain and supports overall wellness. Eating a nutrient-rich diet full of omega-3 fatty acids (like fish, flaxseeds or walnuts) and antioxidants (like fruits and vegetables), and fibre is important for the protection of brain cells.”
She also points to the benefits of traditional Indian practices, “Meditation, yoga, and pranayama in traditional Indian culture can improve concentration, stress reduction, and mental clarity. Turmeric, which contains curcumin, possesses anti-inflammatory and antioxidant properties that can support brain health.”
Raut also links the high burden of lifestyle diseases in India to accelerated brain aging:
1. Diabetes: Poorly controlled blood sugar levels can damage blood vessels in the brain and are associated with a higher risk of both vascular dementia and Alzheimer’s disease.
2. Hypertension: Long-term high blood pressure can reduce blood flow to the brain, leading to microvascular damage and cognitive decline.
3. Cardiovascular disease: Reduced heart function can impair the brain’s oxygen and nutrient supply, increasing the risk of memory problems and dementia.
Treatment and management strategies
While there is no cure, management strategies can significantly improve quality of life. Goyal mentions available treatment options, “There are medications that can retard the speed at which the condition progresses or reduce symptoms like memory loss, anxiety, or insomnia. They may not work in all cases. They will have some side effects. But used alongside regular, brain-stimulating activities, and emotional support, they will typically improve quality of life as a whole.”
Oak further elaborates, “Though existing drugs cannot halt cognitive deterioration, they can slow down its pace or mask symptoms such as confusion, anxiety, or sleep disturbances. They work best in combination with mental-stimulating activities, physical and emotional care, and proper routines.”
The Importance of follow-up
Monitoring symptoms is a continuous process. Oak advises, “Although early tests may not indicate significant deterioration, it is worthwhile to continue monitoring symptoms at intervals of 3–6 months, particularly in older patients or those with risk factors. Subtle cognitive changes in memory, mood, or behaviour can develop gradually and require early intervention. Follow-up visits allow for monitoring of progression and modification of treatment protocols if required.”
In conclusion, being proactive and informed about subtle differences, symptoms, and screening methods is essential. Goyal concludes, “The goal is to create a system that assists with maintaining independence, routine, and emotional health, and regular consultations with a physician can “greatly enhance the quality of the person`s life. Early identification and intervention can significantly improve the quality of life and independence for individuals facing cognitive decline, particularly in culturally diverse populations such as India, where awareness and acceptance of cognitive disorders still require considerable improvement.”