As we all get older, things like hesitating with names, missing turns while driving, misplacing keys, or losing your car in a parking lot become increasingly common, and are a very normal part of the healthy cognitive aging process as we get into our 50s, 60s, and 70s. However, sometimes more serious things begin to happen to cause alarm bells to go off - leaving the stove on overnight, forgetting to turn the car off after getting out, forgetting to pay bills, or even forgetting to eat. These latter types of events are serious and scary; especially so when we have a family history of dementia. If a person has had any of these things happen to them, it is important to discuss the events with a trusted member of your healthcare team. Sometimes these events can be due to acute medical issues that need immediate attention.
If urgent medical issues are ruled out as a cause of the concerning forgetfulness, typically a treating physician will recommend a neuropsychological evaluation to determine what other contributing factors there might be to these symptoms. In cases of pseudodementia, neuropsychological evaluation results typically reveal normal and healthy cognitive functioning, leaving patients wondering: Why is all of this happening to me then? When I discuss pseudodementia with my patients, I typically cover the five major causes of memory loss that have nothing to do directly with brain health:
If you have lived with pain, you know that it affects every part of daily life. Pain is distracting, and makes it hurt to sit, stand, lay down, sleep, walk, and to do the things we enjoy. For all of these reasons, it is not surprising that pain causes us to not think as clearly and sharply as with otherwise could. It is hard to focus and remember, for example, what your granddaughter told her about her school project when your pain levels are consistently 7/10 or above. While chronic pain can be a very challenging thing to treat and gain control over, doing so can ultimately be expected to improve a person's daily cognitive functioning. In fact, there is a sub-discipline withing clinical psychology, known as "Health Psychology," that specializes in helping people cope and life fuller lives while dealing with difficult medical issues, including pain. Pain medicine physicians are also equipped to work with patients dealing with chronic pain.
Fatigue can come from a variety of sources. Overwork, poor self-care, chronic illness, sleep apnea, or depression can all result in fatigue. Much like with pain, when a person is in a state of chronic fatigue their mind is likely not functioning as clearly and sharply as it could be. If you have ever tried to take a test, drive, work, or do something detail-oriented while fatigued, you have probably noticed that it does not go as well as if you were fully rested. In my practice, the most common issue that I see leading to fatigue is uncorrected sleep apnea. Sleep apnea occurs when a person stops breathing momentarily while sleeping, and when this occurs dozens of times per hour for years or even decades, it becomes very difficult for the brain to attend to and remember everything that it needs to do. If left uncorrected, sleep apnea also happens to be a major risk factor for dementia in later life.
When someone has too much on their plate, it makes it very difficult to pay attention and remember the things that they need to or want to. Stress usually comes from the outside world, and common sources of stress include work, caregiving responsibilities (whether for young children or elderly parents), financial hardship, health problems, or relationship strain. When our focus is being pulled in many different directions, it is no wonder that important things sometimes slip through the cracks. While we often cannot directly control things that happen to us (at least in an immediate way), we can do some things that make is easier for us to absorb the stress that does come our way. Things like getting three healthy meals per day, getting enough rest, and making time in our days for things that we find to be healthy, pleasurable, and restorative. Keeping our own emotional "tank" from running out makes it much easier to deal with new stresses that come our way.
4. Psychiatric symptoms
Many people know the hallmark symptoms of depression as low or depressed mood along with diminished interest in previously enjoyed activities. In reality, depression is a complex syndrome that encompasses a wide range of symptoms. Indeed, it is possible for a person to meet diagnostic criteria for a major depressive episode without actually feeling a "depressed" mood. This is because other symptoms of depression include increased or decreased appetite, increased or decreased activity levels, increased or decreased sleep, and also **problems with memory and concentration.** Many times, when symptoms of depression and anxiety are treated effectively, most often with a combination of antidepressant medications such as sertraline, escitalopram, or fluoxetine along with evidence-based psychotherapy such as cognitive behavioral therapy (CBT), patients find that their memory correspondingly improves.
5. Side effects of medications
All medications come with side effects that you should be aware of prior to starting them. It is important to talk with your prescribing providers before taking any medications so you can know what to expect should side effects occur. In particular, medications for pain, sleep, muscle relaxants, and anticonvulsants tend to be accompanied by strong cognitive side effects that include things like brain fog, slowed thinking, and forgetfulness. Talk with your prescribing provider if you are concerned about side effects, and do not stop or start any medication until directed to do so a a prescribing provider.
Our neuropsychologists at STLCCH are skilled in differentiating between dementia, and pseudodementia. In fact, this is one of the most common referral questions we receive. Call us today for answers.