Dear Dr. Ron:
Most people seem to think that forgetfulness is just part of normal aging. That is what I used to think. However, after the last four very difficult years with my mother who turned out to have Alzheimer's Disease, I think quit differently. I feel my father and I waited too long to get help for my mom. By doing that, we may have denied her the benefit of getting the right medications early, among other things. I am still puzzled. How do you decide when "normal" forgetfulness crosses the line to something that needs serious attention? Signed -- Distressed by Dementia in Des Moines.

Dear Distressed:
Thank you for writing! This is one of the most challenging subjects to write about mostly because it is so complex. Degeneration of mental functioning, in its early stages, may not appear to be very serious because the changes are so mild that they are often interpreted as "normal aging" for years.

Our culture tends to play down memory loss and personality changes in seniors. I personally dislike the phrase "senior moment." It implies that memory problems are a natural result of aging and, therefore, we should not be so concerned about it.

The truth is that noticeable changes in memory, organization, and personality are warning signs at any age. The key word is "changes." Very, very slow changes occur in the normal aging brain -- so slow, that for there to be a significant loss of brain cells, you need to be over the age of 85. In people between 55 and 85, any noticeable mental function changes should always be approached as potentially serious.

Some disorders that are characterized by abnormal brain cell loss are Alzheimer's Disease (AD); miniature to massive strokes that kill cells due to blocked brain vessels or brain bleeding; Parkinson's Disease; and tumors. Many disorders can mimic brain cell loss, such as depression, certain metabolic disorders, vision and hearing impairments, infections, and drugs.

Which brings me to the point of this article: I recommend standardized testing for mental functioning at age 55 to establish a baseline score to which future tests done as often as every two years can be compared. Similar to what happened with your mother, AD is such a slowly progressive disease that it can go mostly unnoticed for years and, then, suddenly, the person affected by it is significantly disabled.

We encourage yearly mammograms for women over 40, yearly prostate exams for men over 50, and colonoscopies for both men and women every five years after age 50. Yet, for probably the most expensive and debilitating diseases of our time (AD and other brain cell loss disorders), no screening is currently recommended nor routinely done.

When an initial or repeat test reveals a significant change in mental functioning, the search should begin for the cause. There are many treatments and strategies for delaying and/or preventing further brain cell loss that can prolong quality of life and reduce the overall burden for communities and families.

Four million people currently have AD and it is projected that 250,000 new cases will emerge each year with 14 million by 2040. It may be time for the Surgeon General to recommend a comprehensive study about the possible benefits of routine mental function testing for those over age 55. To read more about the aging brain, please go to AgingBrain.org. -- Best wishes, Dr. Ron.

Author Bio:

Ron Sterling, M.D. is a 61 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. Read our Disclaimer.

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