Alzheimer's and dementia care at BayCare Health is designed to attempt to stimulate the senses, trigger memory, slow disease progression, and keep patients functioning at their highest level possible.
Dr. Shannon Foster Barsema discusses age-related memory loss, what's normal, and what warning signs or symptoms should send you or a loved one to see a physician to assess the level of dementia. Learn more about BayCare's memory disorders centers and services.
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Age-Related Memory Loss
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Learn more about Dr. Shannon Foster Barsema
Shannon M. Foster Barsema, PhD
Shannon Foster Barsema, PhD is a licensed clinical psychologist who specializes in neuropsychology and geropsychology. She is passionate about early detection of dementia and helping individuals with dementia and their caregivers optimize their quality of life. Dr. Foster Barsema values the opportunity to provide patients, their families and medical teams, the information they need to make informed decisions regarding clinical care and future planning. In addition to working with individuals who are experiencing memory loss related to aging, she has experience evaluating and providing treatment to individuals with a diverse range of neurological and psychiatric symptoms, including but not limited to traumatic brain injury, epilepsy, depression and anxiety. Dr. Foster Barsema has also worked on interdisciplinary teams with neurologists and neurosurgeons to complete presurgical evaluations for epilepsy and Parkinson’s disease treatments. She is a member of the American Psychological Association, the Gerontological Society of America and the International Neuropsychological Society.Learn more about Dr. Shannon Foster Barsema
Transcription:
Age-Related Memory Loss
Melanie Cole (Host): We’ve all misplaced keys, blanked on someone’s name or forgotten a phone number. When we are young, we don’t pay so much attention to those kinds of lapses, but as we grow older; sometimes we start to worry about what they mean. My guest today, is Dr. Shannon Foster. She’s a licensed clinical psychologist who specializes in neuropsychology and geropsychology at BayCare Health System. Dr. Foster, is memory loss a normal part of aging? Is it something that’s inevitable or not?
Shannon M. Foster, PhD (Guest): Well, there is some normal memory loss that comes along with aging for all of us, really beginning around the age of 30, we start to experience a decline in terms of memory as well as some other thinking skills like even how quickly we think. And that for that type of memory loss, that’s the kind where you generally remember it later, it doesn’t really affect your everyday, you can help out by doing things like repeating what’s been said or relating it to something you already know. That’s normal memory loss. But then there’s also other types of memory loss that’s not normal. So, when a person comes to see me, the other two categories they might fall into would be what we’d classify as either mild cognitive impairment or dementia and both of those really it’s memory loss greater than we expect for age and in the case of mild cognitive impairment; that’s not something that’s impacting everyday activities like driving or managing finances and in dementia, it is something that then begins to affect those everyday skills.
Melanie: People worry about Alzheimer’s. Tell us a little bit about the difference between Alzheimer’s disease and how it’s different from some of this dementia that you are discussing.
Dr. Foster: Okay so, basically, dementia is an umbrella type of a term. It means you have got memory loss greater than we expect for age as well as difficulty in at least one other type of thinking skill like language functions, visual functions, and that’s been causing these problems in everyday activities. But something has to cause dementia. So, Alzheimer’s disease is the most common cause of dementia, but there are other things that can cause it as well. In the case of Alzheimer’s disease; that’s really characterized by a problem with memory in terms of storing new memories. So, a person really has difficulty actually laying down new memories. They may be able to remember things from the past, but they have trouble learning new things. So, that’s what we call rapid forgetting where you just said something and maybe five minutes later, they might repeat themselves or ask the same question. That’s the kind of memory loss we see in Alzheimer’s disease.
Melanie: Okay, thank you for clearing that up. Because that can be a little confusing. So, tell us a little bit about how a diagnosis is made. If somebody is starting to fear that they are forgetting things or becoming more forgetful; what is their first step?
Dr. Foster: So, usually often that begins with their medical doctor, so they might complain to their doctor that they feel like they are having more memory difficulties, or a family member might mention that to a medical doctor. And then in that case, hopefully usually the first step is a really thorough medical evaluation to rule out anything that might be causing memory loss, but that could be reversable. So, for instance, for some people, if they have a vitamin deficiency especially vitamin B12; that could cause memory problems. Or perhaps they have a sleep disorder like sleep apnea. That could cause memory problems. Or even low thyroid functioning. So, the first thing is really a good thorough medical evaluation to rule out anything that could be reversable. After that, then a primary care may either just directly order neuropsychological testing or they might refer a person to a neurologist and the neurologist often will do things like order a brain scan, so either a head CT or a brain MRI to look at the structure, maybe the function of the brain to see if there is any abnormalities and then often then they would refer to neuropsych.
What I do then, when somebody comes to see me is we do a really thorough kind of interview that gives background information like educational history, occupational history to put things into context as well as information about just everyday functioning. Is the person doing fine in terms of managing finances and driving, etc. Then we usually do testing and that testing is usually just the person who is being evaluated with the person testing them, paper and pencil type testing where we are testing pretty much everything the brain does from attention and concentration to language skills, visual skills, memory, what we call executive functions like switching attention from one thing to another. So, the person engages in those tests. After testing, we compare their scores to other people their age, their level of education in some cases and then we can see what’s just normal for age. If we are looking at – if scores are falling below that, then we look at the pattern of difficulties which helps us understand what part of the brain is likely involved and then that helps us figure out is this – are we looking at mild cognitive impairment, are we looking at dementia. If so, if we are looking at dementia; what’s underlying that? Is it Alzheimer’s disease or is it something else, like vascular disease?
Melanie: Are there treatment options for dementia? Is there anything that can stop or reverse this kind of disease process? Give us some of the behavioral strategies as well that people or their loved ones can try at home to optimize memory function.
Dr. Foster: Okay so, there are a couple of pieces to that. So, in terms of is there anything that can be done from a treatment perspective? It really does depend on what’s underlying the disease process. So, if a person has vascular disease and that’s what’s causing the memory problems; then the most important thing is to treat the underlying vascular condition. If it’s Alzheimer’s disease; there are some medications that are available. They don’t stop or reverse the disease process, but they can maybe keep a person at a higher functional level for a longer period of time.
As far as things that are generally helpful, pretty much the best thing you can do for your brain is to take good care of your heart. That vascular system that supplies blood to both of them; it’s critical so, good cardiovascular exercise is actually pretty much the best thing you can do for your brain. But also eating a heart healthy diet, that type of thing is just overall good for the brain.
In terms of strategies, things people can do at home, that really depends on kind of what the memory problem is and what’s underlying it. So, when I say that, what I mean is in vascular disease; really the problem is not in storing the information like it is with Alzheimer’s disease, but it has more to do with how the information is getting into the brain and being able to retrieve it. So, in this case, people can benefit from cues so using a calendar, using notes. Those things are actually helpful for a person with memory loss caused by vascular disease. But in the case of Alzheimer’s disease, the problem is in actually storing that new information. So, they are not going benefit from a cue. It doesn’t help to say well don’t you remember. They don’t remember. It didn’t get stored. So, really what needs to happen then is giving a person information they need at the time that it’s useful to them. If they have a doctor’s appointment, telling them in the half hour they need beforehand to get ready for the appointment. Otherwise, you are just giving them information that’s going to become lost and it becomes frustrating for both people.
Melanie: Wow. Great advice. Really, usable advice. How would you like to wrap this up Dr. Foster, with your best advice about memory loss as maybe it relates to age or as it might not, and what you want people to know about what’s normal and when the red flags come up and say you know what, something is not right here?
Dr. Foster: I’d say basically, if you are able to adapt to the changes that come along with age in terms of memory and you can use strategies to get around those changes that you are experiencing so you can use notes, you can use a calendar, you maybe give yourself more time to do tasks; if you can adapt to the changes you are experiencing, that’s probably normal aging. But if you are having more trouble adapting and you are needing to take a lot more time or you are needing other people to help; then that is probably not normal aging. But if you are not sure; the best thing really is to seek an evaluation. At a minimum, we establish a baseline that we can use for comparison down the road.
Melanie: Great advice. Thank you so much for joining us Dr. Foster and for letting us know what’s normal, what’s not and when we should really seek care. Thank you again. You’re listening to BayCare HealthChat. For more information, please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.
Age-Related Memory Loss
Melanie Cole (Host): We’ve all misplaced keys, blanked on someone’s name or forgotten a phone number. When we are young, we don’t pay so much attention to those kinds of lapses, but as we grow older; sometimes we start to worry about what they mean. My guest today, is Dr. Shannon Foster. She’s a licensed clinical psychologist who specializes in neuropsychology and geropsychology at BayCare Health System. Dr. Foster, is memory loss a normal part of aging? Is it something that’s inevitable or not?
Shannon M. Foster, PhD (Guest): Well, there is some normal memory loss that comes along with aging for all of us, really beginning around the age of 30, we start to experience a decline in terms of memory as well as some other thinking skills like even how quickly we think. And that for that type of memory loss, that’s the kind where you generally remember it later, it doesn’t really affect your everyday, you can help out by doing things like repeating what’s been said or relating it to something you already know. That’s normal memory loss. But then there’s also other types of memory loss that’s not normal. So, when a person comes to see me, the other two categories they might fall into would be what we’d classify as either mild cognitive impairment or dementia and both of those really it’s memory loss greater than we expect for age and in the case of mild cognitive impairment; that’s not something that’s impacting everyday activities like driving or managing finances and in dementia, it is something that then begins to affect those everyday skills.
Melanie: People worry about Alzheimer’s. Tell us a little bit about the difference between Alzheimer’s disease and how it’s different from some of this dementia that you are discussing.
Dr. Foster: Okay so, basically, dementia is an umbrella type of a term. It means you have got memory loss greater than we expect for age as well as difficulty in at least one other type of thinking skill like language functions, visual functions, and that’s been causing these problems in everyday activities. But something has to cause dementia. So, Alzheimer’s disease is the most common cause of dementia, but there are other things that can cause it as well. In the case of Alzheimer’s disease; that’s really characterized by a problem with memory in terms of storing new memories. So, a person really has difficulty actually laying down new memories. They may be able to remember things from the past, but they have trouble learning new things. So, that’s what we call rapid forgetting where you just said something and maybe five minutes later, they might repeat themselves or ask the same question. That’s the kind of memory loss we see in Alzheimer’s disease.
Melanie: Okay, thank you for clearing that up. Because that can be a little confusing. So, tell us a little bit about how a diagnosis is made. If somebody is starting to fear that they are forgetting things or becoming more forgetful; what is their first step?
Dr. Foster: So, usually often that begins with their medical doctor, so they might complain to their doctor that they feel like they are having more memory difficulties, or a family member might mention that to a medical doctor. And then in that case, hopefully usually the first step is a really thorough medical evaluation to rule out anything that might be causing memory loss, but that could be reversable. So, for instance, for some people, if they have a vitamin deficiency especially vitamin B12; that could cause memory problems. Or perhaps they have a sleep disorder like sleep apnea. That could cause memory problems. Or even low thyroid functioning. So, the first thing is really a good thorough medical evaluation to rule out anything that could be reversable. After that, then a primary care may either just directly order neuropsychological testing or they might refer a person to a neurologist and the neurologist often will do things like order a brain scan, so either a head CT or a brain MRI to look at the structure, maybe the function of the brain to see if there is any abnormalities and then often then they would refer to neuropsych.
What I do then, when somebody comes to see me is we do a really thorough kind of interview that gives background information like educational history, occupational history to put things into context as well as information about just everyday functioning. Is the person doing fine in terms of managing finances and driving, etc. Then we usually do testing and that testing is usually just the person who is being evaluated with the person testing them, paper and pencil type testing where we are testing pretty much everything the brain does from attention and concentration to language skills, visual skills, memory, what we call executive functions like switching attention from one thing to another. So, the person engages in those tests. After testing, we compare their scores to other people their age, their level of education in some cases and then we can see what’s just normal for age. If we are looking at – if scores are falling below that, then we look at the pattern of difficulties which helps us understand what part of the brain is likely involved and then that helps us figure out is this – are we looking at mild cognitive impairment, are we looking at dementia. If so, if we are looking at dementia; what’s underlying that? Is it Alzheimer’s disease or is it something else, like vascular disease?
Melanie: Are there treatment options for dementia? Is there anything that can stop or reverse this kind of disease process? Give us some of the behavioral strategies as well that people or their loved ones can try at home to optimize memory function.
Dr. Foster: Okay so, there are a couple of pieces to that. So, in terms of is there anything that can be done from a treatment perspective? It really does depend on what’s underlying the disease process. So, if a person has vascular disease and that’s what’s causing the memory problems; then the most important thing is to treat the underlying vascular condition. If it’s Alzheimer’s disease; there are some medications that are available. They don’t stop or reverse the disease process, but they can maybe keep a person at a higher functional level for a longer period of time.
As far as things that are generally helpful, pretty much the best thing you can do for your brain is to take good care of your heart. That vascular system that supplies blood to both of them; it’s critical so, good cardiovascular exercise is actually pretty much the best thing you can do for your brain. But also eating a heart healthy diet, that type of thing is just overall good for the brain.
In terms of strategies, things people can do at home, that really depends on kind of what the memory problem is and what’s underlying it. So, when I say that, what I mean is in vascular disease; really the problem is not in storing the information like it is with Alzheimer’s disease, but it has more to do with how the information is getting into the brain and being able to retrieve it. So, in this case, people can benefit from cues so using a calendar, using notes. Those things are actually helpful for a person with memory loss caused by vascular disease. But in the case of Alzheimer’s disease, the problem is in actually storing that new information. So, they are not going benefit from a cue. It doesn’t help to say well don’t you remember. They don’t remember. It didn’t get stored. So, really what needs to happen then is giving a person information they need at the time that it’s useful to them. If they have a doctor’s appointment, telling them in the half hour they need beforehand to get ready for the appointment. Otherwise, you are just giving them information that’s going to become lost and it becomes frustrating for both people.
Melanie: Wow. Great advice. Really, usable advice. How would you like to wrap this up Dr. Foster, with your best advice about memory loss as maybe it relates to age or as it might not, and what you want people to know about what’s normal and when the red flags come up and say you know what, something is not right here?
Dr. Foster: I’d say basically, if you are able to adapt to the changes that come along with age in terms of memory and you can use strategies to get around those changes that you are experiencing so you can use notes, you can use a calendar, you maybe give yourself more time to do tasks; if you can adapt to the changes you are experiencing, that’s probably normal aging. But if you are having more trouble adapting and you are needing to take a lot more time or you are needing other people to help; then that is probably not normal aging. But if you are not sure; the best thing really is to seek an evaluation. At a minimum, we establish a baseline that we can use for comparison down the road.
Melanie: Great advice. Thank you so much for joining us Dr. Foster and for letting us know what’s normal, what’s not and when we should really seek care. Thank you again. You’re listening to BayCare HealthChat. For more information, please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.