Normal forgetting or a warning sign? How I learned to tell the difference

The day I put the milk in the cupboard and the cereal in the fridge, I laughed about it. The day I drove past my own turn on the way home from the hardware store, I did not laugh. I pulled over, sat there a minute, and then went home and started reading.

What I wanted to know was simple. Which of these slips are just getting older, and which ones mean something is wrong? It turns out there is a fairly clear answer, and I wish somebody had handed it to me sooner.

The normal column

The National Institute on Aging describes a list of memory changes that are common with age and are not, by themselves, a sign of dementia. In my own words:

• Taking longer to learn something new, like the remote for a new TV.
• Forgetting a name and remembering it later.
• Misplacing things now and then, like glasses, keys or the phone.
• Missing a monthly payment once in a while.
• Losing track of what day it is and figuring it out later.

The key words are "now and then" and "later." The memory is slower, but it comes back. Your brain is still filing things, it just takes longer to find the folder.

The warning column

The Alzheimer's Association's 10 warning signs are the list I would put on the refrigerator. A few of them, in plain terms:

• Memory loss that disrupts daily life, like asking the same thing again and again or relying more and more on notes for things you used to handle.
• Trouble planning or solving problems, like following a familiar recipe or keeping track of the monthly bills.
• Getting lost in a familiar place, or forgetting how you got somewhere.
• Trouble finding words in the middle of a conversation, again and again, or calling things by the wrong name.
• Putting things in odd places and being unable to retrace your steps to find them.
• Pulling away from hobbies, friends or work.
• Changes in mood or personality, like becoming confused, suspicious or anxious.

What separates these from the normal column is pattern and impact. One missed turn is a bad day. Missing turns every week is a pattern. One forgotten bill is a slip. Bills piling up that you used to pay without thinking is an impact.

The part nobody told me: a lot of it is treatable

This was the most useful thing I learned. Memory trouble has many causes besides Alzheimer's, and some of them can be fixed. MedlinePlus, the government's health library, lists some of the usual suspects:

• Side effects from medications, especially some sleep aids, allergy pills and bladder medications.
• Low vitamin B12, which is common in older people and in people taking metformin or acid reflux medication for years.
• Thyroid problems.
• Depression, which can look a lot like memory loss.
• Poor sleep, including sleep apnea.
• Drinking more than you realize.
• Hearing loss, which makes you miss things and then look forgetful.

When I finally went in, my doctor went through my pill bottles one by one. It turned out an over-the-counter sleep aid I had been taking most nights belonged to a group of drugs that can fog your thinking in older people. I stopped it. I am not going to tell you that fixed everything, but my mornings got clearer.

When to call the doctor

My rule now is this. If you notice something from the warning column, or if your wife, husband, kids or friends mention it, make the appointment. Do not wait to see if it goes away, and do not try to fix it yourself first with something from the internet. Bring your pill bottles, including vitamins and supplements, and bring someone who knows you well. The MedlinePlus page on dementia has a good overview of what tests to expect.

And what about memory supplements?

I get asked this a lot by friends. My take is that a supplement is not the first step if anything from the warning column is going on. It might be a reasonable thing to try for the ordinary, normal-column slips, once a doctor has ruled out the fixable causes.

Of the ingredients that show up in these products, saffron has the most research in people, and I found what the saffron trials found explained clearly and without the hype. The thing I would watch out for is ingredients that lower blood sugar or thin the blood, because so many of us are already on pills for both. There is a good rundown of how supplement ingredients can clash with common prescriptions using one popular product as the example.

How the doctor actually checks

I was nervous about my appointment because I did not know what they would do. It turned out to be simple and not at all scary.

First, questions. How long has this been going on, is it getting worse, what kinds of things am I forgetting, how am I sleeping, am I feeling down. My wife came along and added things I had left out, which turned out to be the most useful part.

Second, a short paper-and-pencil test, about ten minutes. Remember a few words and repeat them later. Draw a clock showing a certain time. Name some animals. Count backward. There are a few standard versions, and doctors use them to see whether memory and thinking are in the expected range for your age. Mine was fine. Not perfect, but fine.

Third, blood work, to check for the fixable causes: vitamin B12, thyroid, blood sugar, kidney function.

Fourth, a look at every pill bottle I had brought. That is where the sleep aid got caught.

If anything had looked off, the next steps would have been a referral to a specialist and possibly a brain scan. Knowing the steps in advance took a lot of the dread out of it.

A word to family members

If you are the son, daughter or spouse reading this because you are worried about someone, bring it up gently and early. My wife waited months to mention my missed turns because she did not want to hurt my feelings. I wish she had said something sooner. Pick a calm moment, talk about specific things you have noticed rather than a diagnosis, and offer to go to the appointment together. Most of us would rather hear it from family than from a stranger.

What I do now

I keep a small notebook in my shirt pocket, which my late father did too, and I used to tease him about it. I write down appointments and anything I want to remember from a conversation. I used to see it as a sign of getting old. Now I see a tool, same as a micrometer. And once a year, at my checkup, I ask the doctor directly: anything in my memory you would want to look at? Asking out loud has made it a lot less scary.