Normal Aging? Or Disease...

When I speak with someone older about my experience with cognitive decline, they often express concern about their own condition or about that of someone they love.  Like me, they will have anecdotes about the time they forgot this, that, or the other thing.  Not surprisingly, they are very concerned about it. 

We all know that, as we get older, our memory declines.  It's common for us to have a "senior moment" when we go into room and can't remember why we went there.  It's natural and normal for the human brain to atrophy with age, and memory with it.  But disease introduces an entirely new phenomenon, and the atrophy of the brain accelerates.  So how do we know when memory issues are just a matter of normal aging and when are they a consequence of disease?

The best explanation that I've found is that when you have trouble recalling a word you want to use, or you can't remember a name that you've known before, this is likely normal aging.  But if you have trouble learning something new, this is likely disease. 

I have a friend who is 94 and is still as sharp as a tack.  But five years ago I saw him struggling in conversation when he couldn't recall words he wanted to use.  At the time I thought he had Alzheimer's disease, and he was in a waterfall decline.  But to be as sharp as he is now strongly suggests that his difficulty in recalling words was really just normal aging.  He didn't get better, but he has not experienced the accelerating decline into dementia typical of Alzheimer's disease.

I began learning Spanish in 2008 and worked hard at it for several years.  My sense was that I was initially building my vocabulary at a reasonable rate.  I have continued to work at it until today, but it has been an up and down experience.

I first began to believe that something might be seriously wrong with my memory in late 2014, and I was diagnosed with MCI in March of 2015.  This is about the time that I felt compelled to stop driving, and my ability to add to my Spanish vocabulary failed.  I continued to practice, but my ability to learn new words was nonexistent.  While this is a subjective judgement, I believe that my ability to learn new words returned in early to mid-2017.

When I go for cognitive testing, two important exercises are to learn a list of words and to learn a story.  I will be given a list of 10 or 12 words to recall, and I will be told a story with many details.  I will be asked to recall the words, perhaps after a distraction, and I will be asked to recall details of the story some time later.  I believe that this kind of testing is the best measure of the progress of mild cognitive impairment.  There are other tests (e.g., copying a drawing), but at the stage I'm at, these two tests best challenge my ability to learn something new.  Loss of the ability to learn new things is the hallmark of disease.