You walk into a room and forget why. Someone introduces themselves at a party and within seconds you’ve forgotten their name. You can’t remember where you parked the car. You’ve put your phone in the fridge. You can’t recall your granddaughter’s name. Your best friend dies and you keep forgetting they’re gone.
Is it tiredness, distraction, or is it dementia? Most of us over a certain age will, at least once in our lives, do one of the above and worry we are losing our marbles.
Four dementia and ageing experts give their advice about what’s normal, what’s concerning and when to seek medical advice.
We all get a little slower and many of us become a little more forgetful as we age, says scientia professorKaarin Anstey, a psychologist and director of the University of New South Wales Ageing Futures Institute in Sydney. It also happens even when we’re young and overtired.
One common complaint is something being “on the tip of the tongue” but you just can’t remember it, she says, such as a person’s name or the name of a movie. Another is temporarily losing something such as a mobile phone or car keys. “That’s what we call normal experience in ageing; having the occasional experience of misplacing something,” she says.
It’s also normal to find it harder to do things or that they take longer than they used to.Prof Amy Brodtmann, a neurologist and head of the Cognitive Health Initiative at Monash University in Melbourne, says our processing speed can slow with age, which can be particularly frustrating and alarming for people who are used to functioning at a high level. “I do see a lot of quite high-performing people in clinic who come in and say, ‘I can’t do what I used to do, I start doing six tasks at the same time and then I don’t get to the sixth one,’” Brodtmann says. “That is completely normal.”
I am always misplacing things?
“If you have occasionally forgotten where you put your keys, or you wake up in the morning and you find that you’ve left the keys in the front door, that’s not necessarily a concern,” says geriatrician andassociate professor Michael Woodward, honorary medical adviser at Dementia Australia and head of dementia research at Heidelberg Repatriation hospital in Melbourne. “If it’s happening repeatedly, more frequently, or severe lapses like … leaving the stove on all night, leaving the kitchen tap running, things like that, they might be a bit more severe.”
I forget a word, accidentally say the wrong one or call someone by someone else’s name?
Problems with language can be an early warning sign of dementia, particularly if your speech starts to sound like “word salad”, saysDr Desmond Graham, a geriatrician and chief medical officer at Geriatric Care Australia in Sydney. “If you’re stumbling over your words or you get word-block or word-finding difficulties, that’s what makes me concerned,” Graham says.
Woodward says mixing up the names of your children and grandchildren is OK, “But if you’re constantly forgetting the names of three of your four grandchildren, that’s a worry.”
I keep getting lost?
“One of the classical features of typical Alzheimer’s disease is people starting to actually get lost,” Brodtmann says. It’s normal to get lost driving somewhere new, but when people repeatedly have trouble navigating to familiar places, that can be a warning sign.
“We call that topographic or geographic disorientation, and that is something that’s new because you should have those representations in your head,” she says.
I forget important information I was recently told?
If something has both valence – it is subjectively, emotionally important – and salience, meaning that we pay it a lot of attention, then forgetting about it can be a warning sign of dementia, Brodtmann says. “If someone’s best friend died two days ago and they knew about that, and you were having a conversation with them and you said to them, ‘That person’s died, when’s the funeral’, and they have no recollection of that actually occurring, that’s really concerning.”
I repeat the same story to the same person?
Repeating the same story within a single conversation can be an early warning sign, Woodward says. “So even in a single telephone conversation saying, ‘Oh, by the way did I tell you that John across the road has planted a … ’ and then, a few minutes later, ‘By the way, did I tell you that John across the road has planted a … ’ – that’s of concern,” he says.
I walk into a room to do something and forget what it was?
“That happens to everyone, and that can be more of a lapse of attention,” Anstey says. “People who have ADHD have that experience right across the life course.” It happens when you’re “not focusing on what you’re doing and starting on something, and then your mind switches to the next thing before you finish the first thing”.
There are many reasons why otherwise cognitively healthy people might experience memory lapse, Anstey says. “Mothers with young children who’ve been up all night forget where they park their car … or can’t find their car keys, so those lapses of everyday cognition happen.”
Some people experience “brain fog” after Covid-19 infection, and forgetfulness or memory issues can also be a side effect of chemotherapy or drugs to help sleep or relieve pain. Chronic stress can also have a negative effect particularly on short-term memory.
Being a forgetful or absent-minded person doesn’t necessarily put you more at risk of dementia, but it can make it harder to pick up in the early stages. “The challenge with mild cognitive impairment as well is that people classically always put mild cognitive impairment down to normal ageing,” Graham says.
At the same time, people who are really high functioning, but are in the early stages of more significant cognitive decline, can also be more challenging to diagnose, Anstey says. “They know they’ve declined and sense something is wrong, but because they’re still performing relatively well on cognitive testing they may not show any objective impairment early on, which means they may not meet clinical criteria and may not be diagnosed as early as someone else,” she says.
Only around one in 10 people with early warning signs – what’s called mild cognitive impairment – will progress to dementia, Graham says. There are many interventions that can reduce the risk of that progression, such as improved diet and exercise, particularly if it’s picked up early.
That’s why all the experts we spoke to recommended seeing a GP or preferably a geriatrician sooner rather than later, especially if friends, family or colleagues also start to notice changes.
“Even if people don’t think it’s anything, or they think that they’re worrying about something that is just normal ageing … I strongly encourage them to go see a GP,” Graham says. “Ideally, if they can, get referred to a geriatrician.”