I was about to board my flight back to Los Angeles and turn off my cell phone -- I was being thrifty with the battery since I had forgotten where I left my travel charger -- when a journalist called urgently asking for a comment on Paul McCartney's recent admission that he was having trouble remembering the lyrics to some of his old songs. I envisioned him singing "She loves you -- hey, hey, hey..."
"So you're trying to get me to go on record that Paul McCartney is getting Alzheimer's? I won't do that," I said in anticipation of where the interview was going.
I flashed back to 1993 when Ronald Reagan announced that he was suffering from this devastating illness, which robs the mental life from millions of Americans. Back then, reporters kept asking me to speculate about whether Reagan might have been slipping mentally while serving as our commander in chief. For our former president, his senior moments may have been early warning signs of further cognitive decline. In fact, an analysis of his progressive extemporaneous speech errors during debates over the years pointed to such subtle progressive deficits.
But for the average aging Baby Boomer like Sir Paul, middle-aged pauses and senior moments do not necessarily mean that rapid mental decline is inevitable. The risk for Alzheimer's disease is only about 10 percent for people age 65 or older. Misplacing keys or struggling to find a word is what we all joke about as we age. Sure, our memory abilities are not quite what they were when we were in our 20s, but age-associated memory impairment is an expected and quite common experience of aging. Approximately 85 percent of people 65 years or older complain that they often recognize a face but can't recall the name that goes with it.
How can we tell if this normal memory loss will progress? It's not easy, even for doctors. We often look for risk factors: age, family history or other illnesses like diabetes or Parkinson's that predispose someone to neurodegeneration. If your memory challenges symptoms begin to interfere with your everyday life, if others start commenting on them, or if you find yourself worrying about them, it may be time to discuss it with your doctor. Because of the general fear and denial about Alzheimer's disease, many people ignore early symptoms. That's not always a great idea, since the earlier you get help, the better your chances of staving off future symptoms. Clearly, it's easier to protect a healthy brain than to try to repair one once damage has set in. We don't yet have a miracle cure for Alzheimer's disease, but there are treatments that improve symptoms and keep people functioning better for longer. In general, earlier intervention translates to better outcomes.
The emotional impact of the illness is huge. We may joke about our memory lapses, but behind the humor is anxiety and fear. I have spent a good part of my career studying and caring for patients and families who have had to cope with this tragic mental struggle. And although I'm an expert, I initially refused to accept the fact that the illness was causing subtle personality changes in a close friend and mentor. I looked for almost anything else that could explain his symptoms -- a possible medical condition, a depression or maybe a drug side effect -- but I eventually had to face the fact that his mind was drifting away and I couldn't stop it.
When Sir Paul McCartney was 16, he wrote "When I'm Sixty-Four." Now that he's 67, I'm not too worried that he may not remember a few of his old lyrics -- chances are that his senior moments won't progress too quickly over the years. I, on the other hand, wish I could remember where I left my cell phone charger.
Gary Small, M.D., is Director of the UCLA Center on Aging, and author of the forthcoming book, "The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases." (Morrow, September, 2010)
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