Almost all of us of a certain age -- say, anywhere north of 40 -- worry at some point about memory glitches. No wonder. Our brains begin to deteriorate by our late 20s. But some memory troubles are signs that there may be something more seriously amiss than normal aging.
"Everybody's memory is different, so you have to use your own as a baseline to notice changes that are worrisome," says University of Wisconsin geriatric psychiatrist Ken Robbins. "But certain signs are more strongly associated with a problem like Alzheimer's."
When to worry? The following five signs of Alzheimer's disease, which you yourself might notice, suggest a trip to your doctor, a neurologist, a psychiatrist specializing in geriatrics or memory disorders, or a geriatrician. A thorough evaluation can also rule out other things that can cause memory loss besides Alzheimer's -- for example, medication side effects, depression, pregnancy, and stress.
Sign #1: Your memory problems frighten you.
It's one thing to get irritated when you lose your keys. Or to search a vast parking lot for your car after a concert, growing more upset by the minute. Everybody experiences such frustrations. But when you feel downright uneasy about the oddness or frequency of memory lapses -- say, you can't remember where you parked the car and there it is, right in your driveway -- that's emotional information to pay attention to.
"For many people with early dementia, the nature of the memory problems frighten them or cause a strong emotional reaction," Robbins says. The fear tends to stem from knowing in your gut that something's "just not right."
Other examples: You're uneasy because you can't explain how your car keys wound up in the refrigerator -- and it's the second or third time you've found them in an odd spot. Or you're driving down the road and suddenly have no idea where you are or where you're heading -- and a few moments later, you realize you're on the same old road to work.
Worry sign #2: You've changed how you work or play because of memory problems.
A hallmark distinction between normal memory loss and dementia is that the symptoms interfere with your ability to conduct everyday life. Many people with early dementia are unable to do certain tasks as well as they once did, but they're still cognizant enough to be aware of some of the shortcomings.
So they compensate: They make detailed to-do lists, and then leave reminder notes to consult the to-do list. They send more e-mails, because the disembodied voices on phone calls are becoming hard to follow. They ask others for help. They buy more takeout because their cooking gets messed up. They abandon a craft because it never turns out up to their standards any more. They give up driving under certain conditions (with the radio on, at night, on highways, with others in the car).
Worry sign #3: Friends or family point out mistakes and/or express concern.
Are your loved ones making comments about your memory or urging you to get it checked? If not, and you feel like you're keeping lapses to yourself, they may well be ordinary lapses. But if others are calling you on goofs, they may be onto something.
A 2010 study at the Washington University School of Medicine in St. Louis found that family and friends tend to be able to spot the early warning signs of Alzheimer's disease even better than traditional screening tests and high-tech measures. What they're apt to notice: Symptoms that you may not even be aware of -- that you're repeating stories or questions numerous times, often word for word, in a short period, for example; or that you seem more apathetic and withdrawn than usual. Or others notice changes in your ability to independently conduct everyday life (work, cooking, money management).
What you may notice yourself: a sense that you're having to defend yourself a lot. "What happens is that relatives notice mistakes, and you -- the person with memory loss -- find yourself constantly in arguments with people about what you said or did," geriatric psychiatrist Robbins explains. "You're on the defensive a lot."
Worry sign #4: You notice friends or family starting to cover for you.
"Don't worry, Hon, I'll order for you." "Oh no, I've got it" (at the cashier). "Oh, anybody could get lost on these twisty roads, dear. Want me to drive now?"
When you increasingly hear these kinds of "smoothing over" or "taking over" statements from family or friends, they can be a sign that others are seeing problems they're not willing to address directly.
Covering up is a sign that they've lost confidence in your capacity to do things, University of Wisconsin's Ken Robbins says. Difficulty managing money, for example, is a common early sign of dementia because it involves keeping track of details and making judgments. Other areas where relatives may rush in to cover: driving, cooking, and giving directions.
Having trouble with choices
Worry sign #5: You find it hard to make choices.
People with early dementia are often oblivious to certain mistakes, like where they've mislaid something or that they've just repeated themselves -- again. But one symptom they do tend to notice, and feel uncomfortable about, is not being able to make quick decisions.
It becomes difficult, and takes longer, to choose from among several options -- off a menu or a buffet, from the closet, or from a list of movies, for example.
"If you used to be a definitive person and now you can't work your way through choices, that's a red flag," psychiatrist Ken Robbins says. "Choosing involves enough cognitive powers -- remembering what you like, thinking about how the options differ, and thinking about what you want now -- that it's a problem that shows up early on."