A Doctor Explains What Family Gatherings Can Reveal About Memory Loss
When months pass between visits, subtle changes in memory and thinking can become easier to recognize. Here’s what to watch for and why early detection matters.
Dr. Catherine Madison is the Medical Director of Seniors At Home and Rhoda Goldman Plaza. She was also founding director of the CPMC Ray Dolby Brain Health Center in San Francisco. Lessons painfully learned caring for her mother with Alzheimer’s give Dr Madison a deeper insight and perspective in her care practices and with writing the book; “Navigating Memory Loss: Essential Questions and Answers on Alzheimer’s and Dementia.”
When someone brings in a parent to see me with concerns about memory loss, they frequently tell me that the changes first became apparent at a family or social gathering. “It all seemed to start at that dinner party,” is a common way for their story to begin.
As we gather with family and friends to celebrate this Fourth of July, keep in mind that going several months between seeing family and friends can offer a new perspective on a loved one’s cognitive health. Be sure to look for subtle changes as you soak in the merriment. Look for repeated questions or comments, and don’t dismiss lingering confusion as yet another “senior moment.”
I remember the summer many years ago when I came back to California for our annual visit with my husband and our three young daughters. That year my parents drove to the family home in Sonoma using separate cars. My father arrived first, sure that my mother was right behind him. She pulled into the driveway 20 minutes later, explaining there was a detour and she had to drive around the town square several times before turning onto our street. I accepted this absurd explanation at the time, too afraid to consider the reality that she was becoming cognitively impaired.
Living on opposite coasts from my parents meant we needed to be creative about keeping in touch. I was never enthused about phone calls with the three of us on the line, but it served as a lifeline between us. Gradually it seemed that my mother was adding less to the conversations, yet this could be overlooked in the chaos that had become my own life on the other side of the country. This new incident of becoming disoriented while driving escalated my concerns to a higher level.
I thought of this a few weeks ago when I met with a daughter and her mother who came to see me. The daughter explained she was concerned because her mother had become disoriented several times on a recent family cruise. They had taken this trip every summer for years, but this time something felt different.
Cognitive screening showed difficulty with delayed recall from a word list and a few other minor challenges. Because the family sought help promptly, the mother is now undergoing further evaluation for possible Alzheimer’s disease. Rather than being paralyzed by fear, this family can move into action and start treatments if appropriate.
Research has shown that neurodegenerative disease can begin damaging the brain 10 to 20 years before changes become evident. Now that medications to slow these destructive processes are becoming more available, we can encourage someone who we see is starting to get confused (more than they normally do!) to get an evaluation.
There are quite a few screening options available online that can help determine whether someone has had cognitive decline. One I prefer is called the AD8 Dementia Screening Interview, developed by Dr. James Galvin when he was at Washington University in St. Louis. The form asks if you have observed a person to have significant changes (related to memory loss or thinking problems) over the last few years around 8 different activities:
- Solving problems or exercising good judgement
- Reduced interest in hobbies or activities
- Repeating questions, stories or statements over and over
- Increased difficulty learning to use a new tool or gadget
- Forgetting the month or year
- Trouble with financial affairs such as paying bills or balancing checkbook
- Trouble keeping appointments
- Daily problems with thinking and/or memory
If the answer is “yes” to two or more of these, that person should have a more thorough evaluation to determine if there’s a medical condition that can cause cognitive slowing or an underlying neurodegenerative disease.
In the setting of a family gathering, you can ask gently your loved one if they are having any difficulty keeping up with bills, appointment dates, hobbies, and other activities by expressing a genuine interest in how they are doing and normalizing some changes in all of us.
See how they respond to a question such as, “Do you have trouble keeping track of appointments? I know I do sometimes.”
So whether it is gathering for the Fourth of July or meeting for a summer vacation, keep your senses attuned to cognitive changes in loved ones. We should speak openly about the advances being made in neurology and emerging treatments for neurodegenerative illnesses.
We can normalize cognitive screening around ages 65 to 70 as something we all participate in proactively, just like screening for diabetes and breast cancer. We are finally getting closer to a cure. That is worth celebrating!
