Eventually, you start to notice that you are forgetting things, and when you start forgetting enough that you worry about it, it’s time to investigate if something more serious is going on. If someone else mentions they are concerned because you seem to be forgetting things a lot, that is also a reason to seek help.

How do you know when to chalk up losing something to absent-mindedness vs. a more serious memory issue? For example, what do you do when you lose your keys? If it’s absent-mindedness, you usually go about the house looking for the likely spots where you have found your keys in the past, including tabletops, coat pockets, and hooks by the door. You might go out to the car and check to see if the keys are still in the ignition! When that doesn’t work, then you try to remember the last time you used your keys and mentally retrace what you did after that. Sometimes you find the keys quickly, and sometimes it takes longer.

Frequency is a factor here. If you find yourself losing your keys more and more often, that might be a sign that your brain is having difficulty with short-term memory. If you find your keys in strange places such as a garbage can or a kitchen cupboard or the tool box, that might also be a sign that your short-term memory is not capturing what you are doing. If you start accusing others of stealing the keys, that is a big warning sign to get help.

Sometimes you might forget the word for key and describe it instead as “that pointy metal thing you put in the hole in the door and turn it so the door opens.” The more time you spend searching for words in your memory, the more you need to investigate what is happening.

Memory loss is often the main symptom in Alzheimer’s disease (the most diagnosed form of dementia) and the first sign to appear.

The biggest indicator that something might be changing in your brain is when your Basic Activities of Daily Living are affected. You learned the Basic Activities of Daily Living (BADLs) when you were a child. You were considered independent when you didn’t need help to perform them anymore. Here is a list from StatPearls, part of the internet library from the National Institute of Health:

• Walking/Ambulating: the ability to walk independently and to change position.
• Feeding: The ability to feed oneself.
• Dressing: The ability to choose appropriate clothes and to put the clothes on.
• Personal hygiene: The ability to bathe and groom oneself and maintain dental hygiene, nail, and hair care.
• Continence: The ability to control bladder and bowel function.
• Toileting: The ability to get to and from the toilet, use it appropriately, and clean oneself.

When we are teenagers and young adults, we learn another set of functions called Instrumental Activities of Daily Living (IADLs). These are tasks that are more complex and require organizing and sequencing.

• Handling finances – paying bills on time, maintaining a bank account, managing assets
• Transportation – getting from one place to another by driving or using public transportation or a ride service
• Housecleaning and home maintenance – this includes cleaning up after meals, keeping the house clean and safe and taking care of items that need repair
• Managing communication – this includes letter writing, phone calls, emails, texting and use of apps
• Shopping and meal preparation – think of everything required to get a meal on the table at a certain time. This also includes shopping for clothing, for gifts, for gas and other needs for everyday life.
• Managing medications – this means taking all the pills as prescribed by a physician and reordering medication as needed

If you notice that you are forgetting to take your medications, or if you start to get late notices in the mail due to unpaid bills, or you can no longer remember easily how to write a check or reply to an email, you might seek the help of your primary physician to see if you have a memory problem developing that is more serious than usual aging.

WHAT TO DO IF YOU THINK YOU MIGHT HAVE THE START OF DEMENTIA

If you think you might be developing dementia, it’s best to make an appointment with your primary care physician to discuss your concerns. If possible, take your spouse or a trusted friend with you so you have someone to help you absorb all the information.
Doctors use four steps in forming a diagnosis, so you may not know the full picture when you leave your first appointment. The four steps are:

• A detailed medical history
• Memory and thinking tests (MMSE, Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog), Neuropsychological testing lasting several hours)
• Laboratory tests (CBC (complete blood count), CMP (comprehensive metabolic panel), TSH (thyroid stimulating hormone), vitamin B12, RPR (rapid plasma reagin), HIV (human immunodeficiency virus).
• Brain scans (CT, MRI, PET, SPECT)

Your doctor can perform a Mini-Mental test in the office at the first appointment. The formal name is the Mini-Mental State Examination (MMSE). This is a quick test (5 to 10 minutes) with 11 questions focused on five categories of cognitive function: recall, orientation, attention and calculation, and language. The maximum score is 30. A score of 23 or lower is a sign of cognitive impairment.

Your doctor may refer you to a neurologist or gerontologist. Additional assessment might include radiological tests and brain imaging techniques including a CT, MRI, and a PET scan. A CT or MRI scan shows if there is evidence of a stroke, bleeding in the brain, a tumor, or fluid buildup. A PET scan shows activity in different parts of the brain and if there are plaques or tangles that indicate Alzheimer’s disease.

Try to get a more specific diagnosis than “dementia” because pinpointing the type of dementia opens the door to specific treatment opportunities for you.

The earlier you get a diagnosis, the better because you have a chance to take care of financial and legal responsibilities while you are still able to make these important decisions. It is a must to create your Power of Attorney and name who should take over making decisions for your assets and well-being if/when you can no longer do it yourself. A document known as a Living Will or an Advanced Medical Directive allows you to make your end-of-life wishes known.

WHAT A DIAGNOSIS of MCI MEANS

Mild Cognitive Impairment (MCI) is a condition characterized by cognitive changes that are noticeable to the person experiencing them and may be observed by others, but these changes do not significantly interfere with daily functioning. MCI represents a stage between the normal cognitive decline of aging and the more serious cognitive decline associated with dementia.

Some common features of MCI include:

• Memory problems: Individuals with MCI may have difficulty remembering recent events or information, such as appointments, conversations, or where they placed items.
• Language difficulties: They may struggle to find the right words in conversation or have trouble following the flow of a conversation.
• Impaired judgment or decision-making: People with MCI might find it challenging to make complex decisions or might exhibit poor judgment in certain situations.
• Difficulty with complex tasks: They may experience difficulty with tasks that require multiple steps or problem-solving skills.
• Changes in mood or behavior: Some individuals with MCI may exhibit increased irritability, anxiety, or depression. However, it’s essential to note that these changes can also be due to other factors unrelated to MCI.

MCI is important to remember when looking at assisted living homes. Someone with a diagnosis of MCI will be allowed to live in an assisted living facility or care home. However, once there is a diagnosis of dementia, the person will have to live in a memory care facility or small residential home that provides memory care.

You need to understand that not everyone with MCI will progress to dementia. Some individuals may remain stable or even improve over time, while others may eventually develop more severe cognitive decline.

If you receive a diagnosis of MCI, it’s crucial for you to undergo regular monitoring and assessment by healthcare professionals to track any changes in cognitive function and provide appropriate support and intervention when necessary.

Keep a journal and write down the date and time of any changes you notice. This will help your doctors get a better picture of what is happening daily. The more you participate in your healthcare decisions and inform yourself along the way, the better equipped you will be to handle the changes in your life.

SOURCES

What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)?

Better ways of diagnosing dementia

What Is Mild Cognitive Impairment? | National Institute on Aging

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