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The four horsemen of forgetfulness

FEB 2013

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Consider the most likely causes of memory slips before assuming the worst. You may just need more sleep.

Worried that you're getting more forgetful lately? Ironically, worry itself can trigger memory slips. Stress, anxiety, depression, and sleep deprivation are the four horsemen of forgetfulness in aging brains. It might take a conversation with your doctor to pinpoint the cause of your memory slips—especially if the change is sudden or uncharacteristic. "If it's worse than it was a few months ago, or somebody is asking you about it, that would definitely be something to see a doctor about," says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.

Many causes

If you consult a medical reference on possible causes of memory loss, you'll find an assortment of possibilities—from brain tumors and infections to syphilis and migraine headaches. But hiding among them are a few ordinary causes that are worth serious consideration.

Alcohol: Having more than the recommended number of daily drinks can contribute to memory loss. For men, the recommended limit is no more than two standard drinks per day, defined as 1.5 ounces (1 shot glass) of 80-proof spirits, a 5-ounce serving of table wine, or a 12-ounce serving of beer.

Medications: Tranquilizers, certain antidepressants, and some blood pressure drugs can affect memory by causing sedation or confusion, which interfere with your ability to pay close attention to new things. Talk to your doctor or pharmacist if you suspect that a new medication is taking the edge off your memory.

Thyroid disorder: Faltering thyroid hormone levels could affect memory as well as cause sleep disturbance and depression, which both contribute to memory slips. Although thyroid function is usually not the cause, your doctor may want to rule it out.

Stress and anxiety

For older adults, disturbances in mood are among the most common causes of memory problems. The cause of the problem could be an illness in the family—or something with more positive overtones, like moving to a new home. In either case, the new life stressor can make it harder for you to keep on top of things.

Stress and anxiety affect memory because they make it harder for you to concentrate and lock new information and skills into memory. You may end up forgetting something simply because you were not really paying attention or had too much on your mind.

Depression

The symptoms of depression often include forgetfulness. Most people think of depression as a stifling sadness, lack of drive, and lessening of pleasure in things that you ordinarily enjoyed. But the signs can change with aging.

"Depression in older people often presents with physical symptoms," Dr. Fabiny explains. "People don't come in and say they are really depressed. They say my shoulder hurts, I have a headache, I have stomach pains, I don't sleep very well."

Sleep deprivation

Lack of restful, high-quality sleep is perhaps the greatest unappreciated cause of memory slips. Sleeplessness can become more of an issue with aging. "Older adults spend less time in the deep stages of sleep, which are the most restful," Dr. Fabiny says. "As a result, they may not feel as rested upon awakening in the morning because they haven't slept well."

Lack of restful sleep can also trigger mood changes. Anxiety is one possibility. "It's not uncommon for people to become anxious because they can't sleep, or to not sleep well because they are anxious," Dr. Fabiny says. "Both can leave you in the same place."

When to seek help

If you think you are sleep deprived, see a doctor about it. Don't succumb to the myth that older people need fewer hours of slumber, Dr. Fabiny says. "If you were a nine-hour-a-night sleeper when you were 29, you will still be when you are 79. But sleep quality may change with aging." You may wake more often, for example, and find it more difficult to get back to sleep.

It can also help your memory to give your brain a break. "As you get older, it may become more difficult to maintain a high level of attention for several things at once," Dr. Fabiny says. "Dividing your attention can definitely cause you to think you are having memory problems."

Finally, remember that fatigue which interferes with memory—and life in general—is not normal. Inadequately treated pain, sleep disorders, or
low thyroid hormone levels in your blood could be at the root of a pooped-out and forgetful demeanor. "If you are feeling fatigued or lacking in energy, it's important to have a conversation with your doctor," Dr. Fabiny says. "It's possible that an existing medical problem needs more attention or that an evaluation�for a new condition is warranted."