Forgetfulness, what is normal?

I once had a patient that would ask constantly if her varied bouts with forgetfulness or confusion meant she was “losing it” she greatly feared the beginning of the end. Unfortunately in her case (and I don’t believe she is alone) her obsession with memory loss increased her anxiety to the point that her forgetfulness did increase.

We all at one point or another struggle with mild confusion or forgetfulness. This is often related to stress, lack of sleep, or other physiological or environmental changes. In the example of losing our keys, most of us have a routine, we leave our keys subconsciously in the same place MOST of the time, except for when we don’t, usually when we are distracted by something we toss them somewhere else and they aren’t where we expect them the next time we need them. Eventually we are able to retrace our steps and find them.

As we age our cognitive functioning begins to slow leading to some delay in thought process and increased forgetfulness. As with the rest of our body we slow down and need a bit more help. To answer more extensively my clients consistent question. Here are a few examples of normal vs not normal:

• Normal: Occasionally forgetting plans especially when they are not routine.
• Not Normal: Consistently forgetting appointments or important dates such as birthdays or anniversaries.  
• Normal: Not keeping track of a conversation when you are distracted.
• Not Normal: Consistently forgetting recent conversations.
• Normal: Misplacing items you don't use often.
• Not Normal:Forgetting locations of familiar objects such as where the forks are kept.
• Normal: Occasionally forgetting someones name or finding the right word
• Not Normal: Difficulty finding the right word to use several times a day or speaking incoherently.
• Normal: Getting turned around or having difficulty following directions in unfamiliar situation. Not Normal: Getting lost in familiar places, for example on the way to the grocery store.
• Normal: Some difficulty in learning new things.
• Not Normal: Inability to cook a favorite recipe.
• Normal: Getting overwhelmed and having trouble coordinating when there is a lot to do, for example when moving or during a holiday.
• Not Normal: Inability to appropriately routine self care, meals, hygiene and finances.
• Normal: Trying new things.
• Not Normal: Being dangerously less inhibited or drastically different with language, actions or clothing choices.

Notice the key is recognizing when occasional becomes often. We all go off the tracks a bit occasionally but if we are unable to get ourselves back on track there may be a problem. Also if issues begin to threaten safety and well being it is time to seek help. Presence of these symptoms does not always mean dementia, it is not uncommon for some thought disturbance to be related to other physiological issues that can be treated. It is also important if there are signs of dementia that you or your loved one begin treatment as soon as possible for the best possible outcome.

The good news is that there is a lot that we can do even after a diagnosis to care for our brain. See my brain building blog 1,2,3,4. Living a life with healthy social connection, exercise, healthy eating, curiosity about the world around and hope makes our brain more strong and resilient even in the face of disease. If I could be of assistance in helping you and your family navigate challenges arising from memory loss please contact me. Here are also just a few fantastic resources in our area:

Senior Serv

Alzheimers Orange County

Alzheimers Association

Keep caring from your brain and brains of those you love.

Brain Building Challenge Week Three

By now you should definitely be feeling like you have a brain. You are more than half way through integrating new healthy ways to invigorate and grow your brain in order to face all the year has in store.

Brain Challenge #16: Read or watch the famous speech by martin luther king and write out (hand write) your own dream or feelings related to the speech. Thinking through others visions or experiences then applying it to your own opens up new neural pathways and increases empathy and social understanding. Handwriting also challenges and strengthens our brain muscles in all new ways.

Brain Challenge #17: Drink water. Staying hydrated will improve your mood, your concentration, your memory and improves blood flow and oxygen to the brain.

Brain Challenge #18: Acknowledge one accomplishment. Find one thing to pat yourself on the back about today. You showed up today and that counts. Acknowledging accomplishments and taking pride in who we are can actually rewire our brain to increase our self esteem, and confidence. You are an amazing, unique individual - own it.  Comment on what you are proud of.

Brain Challenge #19: Take a walk. It is no secret that walking has many health benefits but it has also been found in many studies to decrease risks of dementia, depression and of course can also reduce weight and increase strength.

Brain Challenge #20: Brain Challenge #20: hug someone (with permission) we all need human connection and our brain needs the oxitocin that comes with it. More on this topic here , here and here.         
 
Brain Challenge #21: Sniff some lavender. Lavender can alleviate anxiety and depression by balancing neurotransmitters. Breath in the good and out the bad.

Awesome work my brain building friends. Keep up the good work, keep checking facebook, we only have a week more to go.

Brain Building Challenge Week Two

You made it through week two - yay you!!

Brain Challenge #9: Its Monday - we all deserve a bit of a break for showing up today. Treat yourself to a bit of dark chocolate. I know your diet was supposed to start today but dark chocolate, among other health benefits, improves blood circulation to the brain, improves cognitive functioning, increases memory retention and improves mood so indulge yourself, your brain deserves it. *remember moderation is key, while pure dark chocolate has all of these benefits most consumable dark chocolate also contains fat and sugar which are not fantastic for us. Here and Here are two articles that explore it further.

Brain Challenge #10: Find something to laugh at. You know what makes you laugh, seek it out. You will relieve tension, improve relationships, increase endorphines and clear up the fog in your brain. Here and Here  and Here are articles that explore it further.

Brain Challenge #11: Stretch your muscles for at least 15 minutes. Regular stretching several times a week can improve your focus and attention span.

Brain Challenge #12: Take a different route today.  Breaking familiar patterns in our daily routine builds and strengthens new connections in your brain cells.

Brain Challenge #13: Add Rosemary to your dinner tonight. Whether you cook your chicken in it, dip your bread in it or steep it in a tea, it slows the degradation of acetylchholine which is involved in developing new memories, and regulating muscle activity.

Brain Challenge #14: Remember these? Play a card game today, with real cards not your app. Along with strengthening long and short term memory you are building problem solving and using parts of your brain that zone out with tech engagement. Information on how this benefits seniors here, how it benefits children and families here, game rules here and finally just for fun your brain on candy crush here.

Great work!!! Take today to think through what worked for you and what you can integrate more regularly into your schedule. Any brain use is beneficial, keep using it so you don’t lose it.

If you haven’t already be sure to sign up for my facebook account to get regular challenges or contact me here if you would prefer to get them through email.

Home for the Holidays, Facing Dementia

Coming home for the holidays carries with it many relational and emotional challenges. While there is hopefully some wonderfulness and childlike magic there are also expected and unexpected stressors. While I wish I could fully address all the many facets of emotional stress over the holidays all I will say is be gentle with yourself and others, its okay to find a closet or a parking lot to hide in for a while and ask for help when you need it.

Today I’m going to address a specific ‘home for the holidays’ stressor I rarely hear discussed at parties but I know to be a real and painful holiday experience.

When I worked in Geropsychiatry we often had a rise in admissions just after the Holidays when families would get together and realize “Dad’s not right”.  Dementia in all forms comes on gradually and it is often those closest to the individual who miss the early signs. After spending more time with them during family gathering it feels like all of a sudden Mom is not okay. I wanted to briefly go over some things to watch for if you are at all concerned. Its important to note that the primary difference between a normal age related forgetfulness and advancing dementia is consistency and impact on daily living. Here are a few things to look for.

•   Forgets significant dates (birthdays, anniversaries).
•   Forgets routes to familiar locations.
•   Unable to follow a familiar recipe or balance a check book.
•   Demonstrates difficulty finding the right word in conversation.
•   Unable to remember the name of a family member or close friend.
•   Unable to keep appointments straight or remember what day it is.
•   Poor judgement in dressing (short sleeve shirt to the snow).
•   Poor judgement in spending.
•   Increased clumsiness or small vehicle accidents.
•   Losing items and unable to retrace steps to find them or finding them in odd places.
•   Mood swings.
•   Repetitive speech, talking in circles.
•   Loss of initiative, seeming to give up.
•   Paranoia or suspiciousness.
•   Constant crying or tearfulness with no obvious prompt.
•   Change in personality or behavior.
•   Unable to make simple meals.
•   Decrease in self care (bathing, grooming, changing clothes)
•   Not maintaining household duties (cleaning ect.) that are within physical abilities.
•   Gets lost in familiar areas.

If you checked more than 4 items or if the items you did check are to the point of impacting daily life and safety it would be a good idea to check in with your loved one’s doctor. Again look at the consistency or extremity. We all can forget a word occasionally but if its several times a day that's a concern. While all of the above are indicators of dementia they could also be caused by other things such as poor diet, not taking medication correctly, grief, stress, depression, infection, other physical issues.

We always want our loved ones to be okay and it is very common for us consciously or subconsciously to attempt to will them to be better, to rationalize or ignore signs. Currently there is no cure for Alzheimers disease but there are medications that slow the progression when caught early, there are also simple lifestyle changes that can improve quality of life when attended to early. The more proactive you can be before it becomes a crisis the better.

Any transition or shift in family situations can be difficult, recognizing your loved ones need for increased care impacts the entire family. It is very common to experience feelings of fear, anger, anxiety, depression and guilt. Such shifts can also revive, intensify or initiate family tensions or unresolved relational issues. It is important to seek help for yourself as you seek help for your loved one. I would love to accompany you on this journey or help you find someone who can, contact me here.

A few resources to get you started are the alzheimers association with local chapters in orange county  and LA county if you are in the orange county area, Senior Care 101  is a monthly informational seminar on senior resources, for more information on alzheimers, the alzheimers family center  is offering a mind boosters series in January.  I won't overwhelm you with reading options but I will recommend The 36-hour day  and I have to confess I’m a fan of the dummies books there's no shame in it, they are clear, thorough and comprehensive.

This is a lot of information and I'm really just scratching the surface. I plan to do more entries on Dementia and aging. If you have questions or specific topics you would like to hear more of contact me or comment below.  I truly hope that your holiday season is one of grace and joy and that despite it all you are able to rest, enjoy a cookie, laugh with a friend, breathe in the smells and embrace what is good about right now.