Memory Problems: Forgetfulness, Stress or Alzheimer’s Dementia?

What causes memory problems as we age? Are we experiencing mild cognitive impairment? Or is it the early stages of Alzheimer’s?

What Causes Memory Problems?

There are many different reasons why you can have memory problems.

Depression is one of them. Right now, we see people who are being affected by negative emotions and they are depressed.

Social isolation translates into memory problems for many people. And whenever you increase stress or those negative emotions, you can face problems with memory.

Infections. If someone went through COVID and their body’s had a really hard time getting over that virus, you might see memory and thinking problems.

Many of those situations will turn themselves around when you fix the problem or when people have enough time to get back on track.

During the pandemic, some people have reported having more difficulty sleeping due to emotional stress or anxiety. If your sleep gets disrupted on a regular basis, your memory is not going to be very good. If you can fix the sleep problems and you feel healthier and more rested, it’s likely that those memory problems will go away.

Alcohol abuse and medication side effects can impair mental abilities. They may even look like dementia symptoms.

Age-related brain disorders like mild cognitive impairment (MCI) or Alzheimer’s can cause memory problems.

How Does Stress Affect Memory?

Stress can activate an inflammatory response in your body and, in turn, in your brain.

Inflammation is one of the key drivers of memory problems and changes in the brain because of various kinds of stressors that occur in the body due to increased levels of cortisol.

You can release higher levels of the stress hormone cortisol for many reasons. Increased cortisol could be due to:

• a virus
• not getting proper sleep
• going through trauma
• being a caregiver and having to care for a loved one day in and day out

There’s many different kinds of stress, but it all ends up as inflammation. And inflammation is a common factor to stress-related diseases like high blood pressure, cognitive problems and higher risk of Alzheimer’s and other dementias.

Read Dr. Huentelman’s article on how to de-stress your brain during trying times.

Memory Problems: Is it Forgetfulness or Selective Memory?

We all have selective memory. That’s true for all of us. We are all forgetting lots of things that happen to us.

If I asked you what you had for breakfast yesterday, you’d be able to tell me. Most people can. But if I asked you what you had for breakfast on Tuesday a month ago, it’s unlikely that you would remember. Because you don’t have to remember that.

So, we’re forgetting all kinds of things that we don’t consider to be important. That’s selective memory and not forgetfulness.

But here’s another very important occurrence that happens in Alzheimer’s that doesn’t happen in aging.

In normal aging, you may think that you’re forgetting things. They happened in your past, but you don’t remember. But when you are given the right reminders, you remember those events.

Whereas once a brain is damaged with the kind of damage that we see in Alzheimer’s, those individuals have truly lost those previous events.

Mild Cognitive Impairment or MCI vs Normal Aging: How are They Different?

Normal aging is when you might forget someone’s name, but you haven’t forgotten who that person is. Or you might forget where you put your keys, but you don’t forget how to drive a car. You might not quite remember the details of some previous event, but you don’t forget that the event happened.

MCI is more difficult to define.

We may see someone who seems to be having more of these memory slips than we would expect for someone of that age, with that background and level of education. This makes us suspicious that it might be something more than normal memory problems with age. So, we call it mild cognitive impairment.

This individual is having little bits of memory problems, but they are not yet interfering with his or her life. But their cognitive health might be impaired. And it’s a red flag.

This person may end up having more difficulty with memory down the road. Or not. A significant number of people who get a diagnosis of MCI end up reversing it and being perfectly fine. 

Do Alzheimer’s Patients Lose Short-Term Memory?

No one can tell me what the difference between short-term versus long-term memory is. So, I don’t endorse this type of memory differentiation.

Those are terms that neurologists generally use. What do they mean when they talk about short term memory? Is it the last couple of hours? Or the last couple of days?

I see it as a continuum. It’s either what happened in the last three minutes or everything else is long-term memory.

What you see in individuals with Alzheimer’s is that they tend to retain information and knowledge about their lives, not so much based on how long it’s been, but on how close they’ve been to them.

Imagine someone who’s been married for 60 years to the same person. They’ve been with that spouse every single day for 60 years. Their children may have moved away and they may not see them on a regular basis. So, they’re more likely to remember their spouse, but not their children in a consistent manner.

This is why they confuse their child with their spouse. Their spouse was much closer to them for much longer than their children. It happens very often as they lose the storyline of their life. In the end, they will probably forget everyone.

When they see someone, they may think that they’re in another city and that this is their spouse. And it’s actually their daughter. But they think that it’s their spouse and that they are years younger. The continuity of their life, it sort of disintegrates for them.

In normal brain aging you don’t see things that we see in Alzheimer’s. Like seeing your daughter and thinking that it might be your wife. Never. 

Getting Lost: Spatial Memory Impairment in People with Alzheimer’s

Another behavior we see very often, because of the damage in the hippocampus very early on in Alzheimer’s, is that people get lost.

And it’s not when they’re trying to get to some strange place that they’ve never been to before. It’s when they go to the grocery store that they’ve been to hundreds and hundreds of times. All of a sudden, they can’t find their way anymore.

This is a personal story about a woman I knew. She was in her 70s and had Alzheimer’s disease. No one knew because her husband sheltered her.

For 40 or 50 years, she would go to church twice a week, and the church was right around the corner. She would walk out the door of her house, turn right and turn right again, and there was the church. She’d come out of the church, she’d turn left, turn left, and there was her house.

And one day she didn’t come home. And her husband went to the church and they said, “yes, she was here for church and everything was fine, and then she left and we don’t know where she went”. And she was lost.

It took the police many hours to find her. She was wandering in a big city miles away from her house because she had no idea where she was.

All she had to do was turn right, turn right as she did for 40 years and suddenly she didn’t know where she was. It’s as if the environment around her became totally unfamiliar without a warning.

You don’t see that in normal brain aging.

If that happens to someone and they get lost in a circumstance like that, their physician should test them to make sure of the diagnosis. But I’m quite sure that that person has a significant disease process happening in the brain.

So, that’s the differentiation. We see these behaviors in Alzheimer’s. It is not severe aging.

That’s another myth from not that long ago, that if people lived long enough, they would get Alzheimer’s disease. That’s not true. It is a completely different process.

Caregiver Stress: Impact on Memory and Brain Health

Do countries where people have a healthier diet, walk and bicycle more have less memory problems?

There are some countries where people live longer than we do here in the US. And you would think that it would result in differences in how you perform memory-wise as you get older.

Cancer rates differ greatly all over the world and it’s potentially for the same reason. Lifestyle does have an impact on cancer and on the kinds of cancer that you get. Your diet has a big impact on this.

And for a lot of people, a healthy diet is not even a choice.

If you live in a small rural town, or in many areas in the US, the only place you can buy food is at the gas station. And that’s what you buy.

You don’t have access to all of the fresh fruits and vegetables that we have. Even if you wanted it for your family, it could be that it’s either not available or it’s so expensive that you can’t afford it.

For these people, access to healthy food, exercise and a healthy lifestyle are going to make a difference in how their brain ages.

Can We Prevent Memory Loss in Older Adults?

We don’t have a pill. And we don’t have any magic combination of factors that will ultimately prevent Alzheimer’s.

We know we can decrease the risk if we look at the whole population. But for a given individual there is no way to know.

I spent time with a family whose father had been a professor at a university for many years. And his wife said exactly that to me, “we did everything right and he still got Alzheimer’s.” They were struggling with understanding because they thought that they could prevent it.

We don’t know what the secret sauce is, yet. On the flip side, we do know that things like obesity, heart disease, and stress are things that really increase the risk for a damaged brain. Not necessarily Alzheimer’s.

It’s scary for people when they have many family members who get Alzheimer’s disease. But it’s not what happens for most people. It’s much more likely that you’re going to die of something else than it is that you’re ever going to experience Alzheimer’s.

Lee Ryan, Ph.D. is a Professor and Head of the Psychology Department at the University of Arizona. Her research focuses on understanding the basic mechanisms of memory using functional magnetic resonance imaging (fMRI). She also studies how age-related changes in brain structure and function relate to memory changes in older adults, and the importance of cardiovascular health for maintaining “brain health” as we age. Dr. Ryan gives frequent presentations to the public on aging and memory, Alzheimer’s disease, and the positive impact of lifestyle choices on brain health.