Forgetfulness doesn’t always mean Alzheimer’s

It happens to most of us: you walk into a room only to forget why you’re there. As universal as the phenomenon is, just as prevalent is the alarm it can provoke: Am I developing Alzheimer’s disease?

But the scenario almost never signals Alzheimer’s, which affects an estimated 7.2 million Americans ages 65 and older and is marked by progressive memory loss and difficulties with language, problem solving, and decision-making.

“It happens to people of all ages,” says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School. “We do it because we get distracted or we’re thinking of something else, and then we forget why we went into the room until we go back to the place we started. Don’t worry about it.”

Many memory lapses are just part of aging and usually don’t signal anything serious. The dilemma is how to distinguish everyday forgetfulness from early signs of Alzheimer’s or other forms of dementia — a distinction many people have trouble with. “Most people who come to me have a mistaken understanding as to what’s normal and what’s Alzheimer’s,” Dr. Budson says.

When forgetfulness is a normal part of aging

Dr. Budson explains how memory works using a filing system analogy. The brain’s frontal lobes act as a “file clerk,” gathering information from daily activities and allowing us to retrieve that information when we need it.

Normal aging can affect the frontal lobes, causing everyday memory slips. But so can factors such as stress, fatigue, lack of sleep, mood disorders, and a wide variety of medications (including antidepressants, benzodiazepines, incontinence drugs, and sleeping pills, among many others).

Frontal lobe glitches can also lead to many types of forgetfulness that usually don’t signal Alzheimer’s. They include

• forgetting names or details temporarily
• misplacing objects but retracing steps to recover them
• occasional “tip-of-the-tongue” problems with word retrieval.

“In normal aging, the frontal lobes don’t work as efficiently as they used to, so information may need to be repeated a couple of times, or it may take a bit longer to recall it,” he says. “But as long as the information got into memory in the first place, it should be able to be retrieved, even if it takes a little time or a hint or cue.”

When memory loss may signal something more serious

In contrast, the brain’s hippocampus, which Dr. Budson calls the “filing cabinet,” is not generally affected by normal aging. But the structure does get damaged from amyloid plaques and tau tangles — abnormal protein deposits in the brain that characterize Alzheimer’s — leading people affected to suffer “rapid forgetting.”

“In Alzheimer’s, even when information is repeated, or you’re given a hint or cue, information cannot be retrieved,” Dr. Budson says.

These types of memory lapses may be signs of dementia:

• repeating questions and stories, especially within the same conversation
• getting lost on familiar routes
• a new or worsening tendency to misplace familiar items
• new challenges with planning or solving problems
• difficulty completing familiar tasks
• new problems with words in speaking or writing, including trouble naming familiar objects
• withdrawing from work or social activities
• changes in mood or personality such as becoming confused, suspicious, fearful, anxious, or easily upset when outside your comfort zone
• impaired judgment.

“Sometimes the first sign that leads a family to realize their loved one is impaired might be that they’ve lost $30,000 to a scam — especially if it’s someone who’s normally good at managing their finances,” Dr. Budson says.

When to act

When is it time to seek a professional evaluation? See a doctor if you’re experiencing persistent or worsening memory issues or having difficulty doing things you once did effortlessly.

“If a friend or family member is concerned about your memory, I would definitely follow up on that,” Dr. Budson says. Start with a visit to your primary care doctor, but “if you don’t feel they’re addressing your concerns, ask for a second opinion or go to someone who specializes in memory,” he says.

Getting evaluated early on is important. If your memory loss does turn out to be Alzheimer’s, treatment options may include newer disease-modifying therapies such as lecanemab (Leqembi) and donanemab (Kisunla), which are designed to remove amyloid plaques in the brain. “The earlier you start, the more effective they will be, because they can slow the decline,” Dr. Budson says.

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