It's natural to feel a little uneasy when you forget something, knowing that Alzheimer's disease now afflicts 5.3 million Americans, many still in their 40s and 50s. It's scary, sure. But many bouts of memory loss are simply the result of much more benign situations.
How can you tell the difference? The following five situations point toward normal, age-related memory loss. The best rule of thumb: "If you're concerned, see a specialist," says psychiatrist Gary Small, director of the UCLA Center on Aging and author of several books about memory and cognition, including The Naked Lady Who Stood on Her Head. An evaluation can rule out certain potential causes and often identify reversible ones. (See also Worried About Memory Loss? 5 Signs It's Serious.)
It's probably not serious if: Lapses don't interfere with everyday life.
Everybody forgets stuff. The movie title on the tip of your tongue. The name of the dad on the soccer field. The occasional appointment or lunch date. What the heck you just came in the room to get.
Slowed recall of information from time to time is normal, caused by the naturally aging brain and other lifestyle factors (like trying to cram too many tasks into one day). What's not normal: When memory impairment interferes with your ability to get through the day. Everyday activities tend to rely on many rote steps and require you to remember basic sequences -- which the healthy brain isn't apt to forget.
So it's a reassuring sign if, despite occasional lapses, you can still work, prepare meals, dress yourself, manage your checkbook, pursue hobbies, and read 900-page novels or pursue your other usual hobbies as well as ever without needing help.
It's probably not serious if: You see an improvement after "brain training."
Dozens of "brain fitness" products now exist, promising to strengthen our synapses and buffer our brainpower. Do they work? So far, there's no evidence that brain games or cognitive training can reverse the memory loss associated with Alzheimer's-related decline, according to a National Institutes of Health panel convened in 2010. But the jury is still out on whether there's a protective effect on healthy brains.
"Our brains naturally compensate for memory loss, and we can help our brains compensate more by learning memory techniques and cognitive techniques," psychiatrist Gary Small says. "If you do some of these techniques and see an improvement, that's a good sign."
Dementia is not so much a problem of retrieving old memories as it is an inability to form new ones. If you can still learn new things, you're forming new memories.
Among the available brain-strengtheners: Software you run on your home computer, classes offered by memory centers, cognitive therapy directed by trained therapists, and do-it-yourself books offering brain teasers and other games.
It's probably not serious if: You've just started a new medication.
It's always a good idea to consider what else is going on in your life before you get too worried about a fuzzy brain. Drug side effects happen to be one of the more common, unexpected causes of memory trouble.
In fact, among older adults, who are often taking multiple prescriptions and then have an increased risk of dangerous interactions, the problem is so common that some geriatricians believe that any new symptom should be considered a medication side effect until proven otherwise.
Medications known to cause short-term memory loss include antianxiety drugs and sedatives (Xanax, Valium, Ambien), heartburn drugs (Tagamet, Pepcid), incontinence drugs (Detrol or Ditropan), cholesterol drugs (Lipitor) and some statins for high cholesterol, and antidepressants. A complete list numbers in the high dozens; always check with your doctor or pharmacist, especially if you've recently started a new prescription or have had the dosage changed.
It's probably not serious if: Nobody else seems to notice anything's amiss.
It's true that people might be noticing you're slipping but not saying anything to protect your feelings. But usually, there's a lot of family friction around memory loss that predates a diagnosis, says University of Wisconsin geriatric psychiatrist Ken Robbins. You find yourself in arguments over who neglected to do something, missed appointments, forgotten messages, or lost drivers. Family members may criticize or complain about mistakes before there's a diagnosis of something serious like dementia.
Eventually, this adds up to relatives often making a dementia diagnosis informally themselves, and being right. 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. They notice symptoms like repetitive stories or questions, social apathy, and changes in the person's ability to independently conduct everyday life (work, cooking, money management).
But if you're all still just teasing and joking over occasional slips -- think of Nora Ephron titling her new book I Remember Nothing -- odds are good nobody's alarmed yet.
It's probably not serious if: You're forgetful when stressed, sleep deprived, or multitasking.
Before you blame the worker (you), consider the workload. A stressed brain is not the same as a demented one.
Doing two or more things at once taxes the brain. No surprise there. Neuroimaging studies have shown that you're not really attending to several things at once. You're switching your attention from one to another, which means when you're attending to one thing, you're not really attending to the others in bursts lasting milliseconds. Result: short-term memory loss.
The challenge is especially hard if you're using the same part of the brain -- for example, using language centers to talk on the phone, read onscreen, and type at the same time.
Insufficient sleep is another common brain stressor, because that's when the brain processes and organizes memories for later retrieval. General stress, too, affects memory when increased cortisol production temporarily interferes with normal brain cell communication.
People with early dementia, on the other hand, tend to forget regardless of whether they're sleeping well or poorly, busy or slow at work, stressed or unstressed.